Uric Acid: A Key Health Indicator & 10 Natural Ways to Lower Levels
"Be temperate in wine, in eating, girls, and sloth, or the gout will seize you and plague you both."
--Benjamin Franklin
Not too long ago, two of my good friends were diagnosed with gout. While I work with plenty of patients with this condition, they are typically older and have a laundry list of comorbidities (as is the nature of outpatient rehab). Gout, often called the "rich man’s disease," usually affects older males and presents with symptoms such as intense joint pain, redness, and swelling, particularly in the big toe. Historically, gout affected a smaller percentage of the population, but its prevalence has been increasing, rising to 3.9% in 2015-2016.
Out of curiosity, I delved deeper into the intricacies of gout and its partner in crime, uric acid. While I knew that uric acid plays a crucial role in gout, I was unaware of its extensive impact on other health conditions. High uric acid levels, or hyperuricemia, are not only a warning sign for gout but are also linked to non-alcoholic fatty liver disease (NAFLD), kidney stones, psoriasis, cardiovascular disease, diabetes, and overall longevity. Alarmingly, the prevalence of hyperuricemia increased from 19.1% before 1994 to 21.5% in 2008, and it is likely even higher today.
But be not alarmed. We have control over our uric acid levels and there are effective ways to manage and lower uric acid levels naturally. Let’s dive in.
What is Uric Acid?
Uric acid is a substance that forms when the body breaks down purines, which are found in many foods and are part of our DNA and RNA. The enzyme xanthine oxidase helps convert purines into uric acid. Normally, uric acid dissolves in the blood, passes through the kidneys, and is eliminated in the urine. When there is too much uric acid in the blood, a condition called hyperuricemia occurs. This can lead to the development of many health conditions that go beyond gout.
Health Issues & High Uric Acid
Gout: Gout is the most well-known condition linked to high uric acid levels. It occurs when urate crystals accumulate in the joints, causing intense pain, swelling, and inflammation, often starting in the big toe.
Kidney Stones: High uric acid can lead to the formation of uric acid kidney stones. These stones can cause severe pain, blood in the urine, and urinary tract infections as they pass through the urinary system.
Chronic Kidney Disease (CKD): Elevated uric acid levels can contribute to the progression of chronic kidney disease by causing kidney damage and reducing the kidneys' ability to filter waste from the blood.
Cardiovascular Disease: Hyperuricemia is linked to an increased risk of cardiovascular diseases, including hypertension (high blood pressure), coronary artery disease, and stroke. Uric acid can contribute to vascular inflammation and endothelial dysfunction, which are key factors in the development of these conditions.
Metabolic Syndrome: Metabolic syndrome is a cluster of conditions, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. High uric acid levels are often associated with metabolic syndrome, which raises the risk of heart disease, diabetes, and stroke.
Diabetes: There is a correlation between high uric acid levels and the development of type 2 diabetes. Hyperuricemia may contribute to insulin resistance, a key factor in type 2 diabetes.
Hypertension: High uric acid levels are frequently found in individuals with hypertension (high blood pressure), and hyperuricemia may contribute to its development and progression.
Obesity: Obesity is a risk factor for hyperuricemia, as excess body weight can lead to increased production and decreased excretion of uric acid.
Psoriasis: Psoriasis, a chronic inflammatory skin condition, has been linked to higher uric acid levels, which can contribute to the severity of the disease.
Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD, characterized by excessive fat accumulation in the liver unrelated to alcohol consumption, has been associated with hyperuricemia. Elevated uric acid levels can contribute to insulin resistance, a key factor in the development of NAFLD. Additionally, both NAFLD and hyperuricemia are often linked to metabolic syndrome, which includes obesity, hypertension, and dyslipidemia. Studies have shown that individuals with NAFLD tend to have higher serum uric acid levels. This association suggests that managing uric acid levels through dietary changes, weight management, and medications may help mitigate the risk or severity of NAFLD.
Neurological Conditions: High purine levels and elevated uric acid levels have also been linked to certain neurological conditions:
Multiple Sclerosis (MS): Some research suggests that uric acid may have neuroprotective properties due to its antioxidant effects. Lower uric acid levels have been observed in patients with MS, and it has been hypothesized that higher uric acid levels might be protective against the disease.
Parkinson’s Disease: Similar to MS, lower levels of uric acid have been associated with an increased risk of Parkinson’s disease. Uric acid's antioxidant properties may offer some protection against neurodegeneration.
Cognitive Decline and Dementia: Hyperuricemia has been linked to an increased risk of cognitive decline and dementia. Elevated uric acid levels can contribute to vascular damage and inflammation, which are risk factors for cognitive impairment and neurodegenerative diseases.
While hyperuricemia can potentially offer some neuroprotective benefits due to its antioxidant properties, it is also associated with negative effects such as increased cardiovascular risk, which can indirectly affect neurological health. Balancing uric acid levels is therefore crucial for overall health.
10 Natural Ways to Lower Uric Acid Levels
1. Avoid High-Purine Foods
Avoiding high-purine foods is crucial because they can significantly increase uric acid levels in the blood, leading to hyperuricemia. This is one of the most important and most effective ways to lower uric acid levels. Here are foods with high purine content.
Red Meat: Veal, goat, bison, beef, lamb, pork, and game meats like venison and elk.
Processed Meats: Bacon, sausages, pepperoni, corned beef, pâté, ham, hot dogs, salami, bologna, jerky, and deli meats.
Organ Meats: Liver, brain, heart, spleen, pancreas, sweetbreads, and kidneys.
Wild Game: Pheasant, rabbit, boar, duck, quail, and grouse.
Seafood: Mussels, shrimp, scallops, clams, crab, anchovies, trout, haddock, herring, sardines, tuna, mackerel, and oysters.
Refined Carbohydrates: Doughnuts, muffins, pancakes, waffles, bagels, cookies, crackers, white bread, pasta, pastries, and cakes.
Sugar-Sweetened Beverages: Lemonade, iced coffee, flavored water, energy drinks, soda, fruit juice, sports drinks, sweet tea, and other sweetened beverages.
2. Lower Fructose Intake
It’s not well known that high-fructose foods and drinks increase uric acid levels in the blood, contributing to the risk of gout, NAFLD, and many other conditions. A study published in the Journal of the American Medical Association found that consuming two or more glasses of fruit juice daily increases gout risk by 81%
Fructose, a simple sugar or monosaccharide, stimulates the production of uric acid by increasing the breakdown of ATP (adenosine triphosphate) in the liver. Fructose is found in the obvious places like fruit juices, honey, and processed food with high fructose corn syrup (HFCS) as well as the less obvious like cereal, energy bars, bread, salad dressing, and yogurts.
3. Eat Cherries
This one surprised me too. Cherries, particularly tart cherries, have been extensively studied for their ability to reduce uric acid levels and alleviate gout symptoms. A study found that cherry consumption over two days reduced the risk of gout attacks by 35%. When combined with the gout medication allopurinol, the risk reduction increased to 75%. Cherries contain anthocyanins, powerful antioxidants with anti-inflammatory properties that help decrease uric acid levels. Consuming fresh cherries or drinking unsweetened cherry juice can check these boxes.
4. Drink Coffee
Coffee lovers rejoice! Multiple studies suggest that regular coffee consumption, both caffeinated and decaffeinated, is associated with lower uric acid levels and a reduced risk of developing gout.
A long-term study involving 89,433 women over 26 years found that drinking coffee is linked to a reduced risk of gout. Specifically, women who consumed 1 to 4 cups of coffee per day had a 22% lower risk of gout compared to those who drank no coffee, while those who drank 4 or more cups daily had a 57% lower risk. The benefits extended to decaffeinated coffee as well; women who drank more than 8 ounces of decaffeinated coffee daily had a 23% lower risk of gout compared to non-drinkers. Overall caffeine intake from all sources also showed a protective effect, with those in the highest caffeine consumption category experiencing a 48% lower risk of gout compared to those in the lowest category.
If you do drink coffee, I recommend using a clean and organic brands such as Lifeboost, Four Sigmatic, or Wellsley.
5. Limit Alcohol Consumption
Alcohol consumption, particularly beer and spirits, has been linked to increased uric acid levels and a higher risk of gout attacks. The JAMA study mentioned above found that 15-29.9 g/day of alcohol (1-2 standard drinks) increases the risk of gout by 49% due to its high purine content and its ability to increase uric acid production while reducing its excretion.
If you do choose to drink, here is what to consider when it comes to alcohol and purines.
Worst:
Beer: High purine content, significantly increases uric acid levels and risk of gout attacks.
Hard Seltzers: Despite being marketed as a lighter option, many hard seltzers contain added sugars and alcohol that can contribute to increased uric acid levels and exacerbate gout symptoms.
Better:
Low-Alcohol Beers: Lower in purines compared to regular beers, but still contain some purines. Less impactful than regular beer but should still be consumed with caution.
Regular Spirits (e.g., whiskey, vodka): They’re low in purines but they still contribute to increased uric acid levels and can lead to gout attacks due to their high alcohol content.
Red Wine: Generally lower in purines compared to beer and spirits. It has a moderate impact on uric acid levels.
Best:
White Wine: Similar to red wine in purine content but may have a slightly lower impact on uric acid levels. Generally considered safer than beer and spirits.
Distilled Spirits (e.g., vodka, gin): No purines but still require moderation due to their impact on overall metabolism and potential to increase uric acid indirectly.
6. Get Enough Magnesium
Magnesium is an essential mineral that plays a crucial role in many bodily functions, including regulating uric acid levels. One study, Dietary Magnesium Intake and Hyperuricemia among US Adults, found that for men, those consuming between 200–265 mg of magnesium daily had a 17% lower risk of hyperuricemia compared to those consuming less than 200 mg. The risk further decreased with higher magnesium intake: 26% lower for 266–334 mg, 22% lower for 335–432 mg, and 30% lower for more than 433 mg. Women showed a 25% lower risk for those consuming 261–336 mg of magnesium daily compared to those consuming less than 158 mg. In sum, increasing magnesium intake is linked to a lower risk of hyperuricemia.
Foods rich in magnesium include leafy green vegetables like spinach and Swiss chard, nuts such as almonds and cashews, seeds like pumpkin, chia, and flaxseeds, legumes such as black beans and lentils, and also avocados and bananas.
Since about 75% of people don’t meet the minimum recommended dietary allowance (RDA), it may also be worth considering supplementing with magnesium. There are many forms of magnesium, however, magnesium glycinate and L-threonate are two of the most bioavailable. Two brands I recommend are Solaray Magnesium Glycinate and Life Extension Neuro-Mag Magnesium L-Threonate.
7. Fiber-Rich Foods
Dietary fiber is known to have various health benefits, including the ability to lower uric acid levels. Foods high in fiber can improve digestion and promote the excretion of uric acid through the digestive tract.
In a study of 15,278 people, it was found that higher dietary fiber intake was linked to a lower risk of hyperuricemia. For men, eating more than 27.9 grams of fiber daily reduced the risk by about 30%, while for women, consuming more than 20.7 grams had a similar effect.
Foods rich in fiber include legumes like lentils, black beans, and chickpeas; fruits such as apples, berries, pears, and bananas; vegetables including broccoli, carrots, sweet potatoes, and Brussels sprouts; as well as nuts and seeds like chia seeds, flaxseeds, almonds, and walnuts.
8. Vitamin C-Rich Foods
Vitamin C is a powerful antioxidant that can help reduce uric acid levels. Research shows that higher vitamin C intake is associated with a lower risk of gout. Men consuming 500 to 999 mg of vitamin C daily had a 17% lower risk of gout, those consuming 1,000 to 1,499 mg/day had a 34% lower risk, and those consuming 1,500 mg/day or more had a 45% lower risk compared to those taking less than 250 mg/day. Each additional 500 mg of daily vitamin C intake reduced the risk by 17%. Supplemental vitamin C also lowered gout risk significantly, with 1,000 to 1,499 mg/day reducing the risk by 34% and 1,500 mg/day or more reducing it by 45%. This protective effect was consistent regardless of BMI, alcohol use, and dairy intake.
Foods high in vitamin C include citrus fruits like oranges and grapefruits, berries such as strawberries and kiwi, vegetables like bell peppers, broccoli, and Brussels sprouts, as well as leafy greens like spinach and kale, tomatoes, and tropical fruits like mangoes and papayas. You can also supplement with high-quality vitamin C.
9. Maintain a Healthy Weight
One thing you can do for your uric acid levels that is going to benefit you in many other ways is to maintain a healthy weight. Excess body weight, particularly abdominal obesity, is associated with increased production of uric acid and decreased renal clearance. This is due to the fact that adipose tissue can enhance the production of uric acid and interfere with its elimination by the kidneys. The JAMA study mentioned above found that having a BMI of 25.0-29.9 increased the risk of gout by 95%.
Want to know how to start? Check this out: The 12 Best Tips To Lower Body Fat.
10. Medication
Medications can cause elevated uric acid levels by impairing renal clearance, increasing urate reabsorption in the kidneys, or elevating uric acid production. For example, diuretics, such as hydrochlorothiazide, reduce the excretion of uric acid by promoting its reabsorption in the renal tubules. Immunosuppressants and chemotherapy agents can also increase cellular turnover and uric acid production, leading to hyperuricemia.
Here are some medications that can increase uric acid levels:
Diuretics: Hydrochlorothiazide, Furosemide (Lasix), Chlorthalidone
Anti-Tuberculosis Medications: Pyrazinamide, Ethambutol
Immunosuppressants: Cyclosporine, Tacrolimus
Chemotherapy Agents: Cisplatin, Methotrexate
Beta-Blockers: Atenolol, Metoprolol, Propranolol
ACE Inhibitors: Lisinopril, Enalapril, Ramipril
Angiotensin II Receptor Blockers (ARBs): Losartan (exceptions apply as it can lower uric acid in some cases), Valsartan
Aspirin (Low-Dose): 81 mg (commonly used for cardiovascular protection)
Niacin (Vitamin B3): Extended-release formulations, Immediate-release formulations
FAQ
How can you find out your purine levels?
To know your purine levels, start by tracking your consumption of high-purine foods like red meat, organ meats, and certain seafood, as dietary intake directly influences purine levels. A blood test measuring uric acid levels provides the most accurate indication of how your body is handling purines. Regular visits to your healthcare provider are essential for monitoring changes in your uric acid levels and adjusting your diet or medication as needed. Additionally, at-home uric acid test kits offer a convenient way to keep track of your purine levels between doctor visits, ensuring better management and control over your health.
Can diet alone effectively manage gout and hyperuricemia?
While diet plays a significant role in managing gout and hyperuricemia, it is often part of a comprehensive approach that includes medication and lifestyle changes. Avoiding high-purine foods, reducing fructose intake, and maintaining a healthy weight are key dietary strategies. Consulting with a healthcare provider for personalized advice and treatment is recommended.
Can dehydration affect uric acid levels?
Yes, dehydration can lead to increased uric acid levels. When you're dehydrated, your kidneys have a harder time eliminating uric acid from your body, which can cause it to accumulate in the blood and potentially lead to gout attacks.
Is there a link between gout and sleep apnea?
Yes, there is a link between gout and sleep apnea. Sleep apnea can lead to intermittent hypoxia (low oxygen levels), which can increase uric acid production. Additionally, individuals with sleep apnea often have higher rates of obesity and other comorbid conditions that are associated with gout.
Are there any medications that can help lower uric acid levels?
Yes, there are medications specifically designed to lower uric acid levels. These include:
Allopurinol: Reduces the production of uric acid.
Febuxostat: Another medication that decreases uric acid production.
Probenecid: Increases the excretion of uric acid by the kidneys.
Is there a cure for gout?
There is no cure for gout, but it can be effectively managed with lifestyle changes, diet, and medication. By controlling uric acid levels, individuals with gout can reduce the frequency and severity of attacks and improve their overall quality of life.
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