- Clifford Stermer, M.D.
Doctors try to optimize cholesterol for heart health, we check other measures including liver and kidney function, blood counts, and screen for conditions such as diabetes and thyroid disease. But, do you know your uric acid level?
Having a high Uric Acid level could be contributing to high blood pressure, heart disease, and weight gain. Uric acid level is usually only checked when doctors suspect Gout. Gout occurs when Uric acid is too high in the blood and deposits in the joints causing pain and swelling of a foot, ankle, knee, hand or wrist. Doctors may also check the uric acid level when a patient develops kidney stones as high uric acid level is a frequent cause of developing these painful little guys. Only when someone develops gout or kidney stones will most doctors consider treating for high uric acid level. But there is growing evidence that a high Uric acid level is associated with myriad health problems - contributing to heart disease, blood pressure and weight gain.
A 2020 article published in the European Journal of Internal Medicine states: “Uric acid … has been recently incriminated in a number of chronic disease states, including hypertension, metabolic syndrome, diabetes, non-alcoholic fatty liver disease, and chronic kidney disease. Several experimental and clinical studies support a role for uric acid as a contributory causal factor in these conditions.”
Another article from 2018 showed a correlation of uric acid and heart disease. The highlights show that uric acid is associated with the risk of incident coronary heart disease, congestive heart failure, hypertension, stroke or atrial fibrillation. Most importantly, elevated UA is associated with the risk of all-cause and cardiovascular mortality. Although the causality in the relationship between uric acid and heart disease remains unproven, we see from the studies that people with high levels of uric acid are at an increased risk of dying.
So why do we have uric acid if it’s so bad for us? Scientists have discovered that about 15-20 million years ago, during a period of weather cooling and food scarcity, we developed a mutation that made us hold onto our uric acid. This allowed us to better store energy from fructose and meat in the form of fat! Other animals like dogs don’t have this trait and eliminate their uric acid in the urine in the form of allantoin and nitrogenous waste burning holes in your nice lawn. So, a trait that helped our hunter gatherer ancestors survive is now causing health problems in a time of food abundance, i.e. we’re all living like kings.
Knowing this, should doctors be paying closer attention to uric acid level and treating it when high? Quite possibly. There are medications that can be used to lower uric acid levels. These are generally well tolerated but risks and benefits need to be discussed with the prescribing doctor.
Modification of diet will also help. Food high in fructose or purines seem to be the worst offenders. I advise my patients to eliminate any food or drink that lists ‘high fructose corn syrup’ on the label. Eating fruits in moderation is generally fine but drinking sugary drinks or a lot of fruit juice is not advised. Purines are a component of DNA. Anything high in purines can contribute to high levels of uric acid. Beer has yeast that contain their own DNA making it a high purine alcohol choice and is best avoided or enjoyed in moderation. Shellfish, shrimp, liver and some meat products can also contribute. Foods that are good for uric acid? Low fat milk products and tart cherries are a few examples.
If you have gout or kidney stones related to uric acid, this needs to be optimized by a Rheumatologist or your Primary Care. If your uric acid level is high, called hyperuricemia, it may be a good idea to discuss ways of optimizing it for your overall health and longevity.
Dr. Stermer is the Medical Director and founder of One Rheumatology in Palm Beach Gardens, there he specializes in treating autoimmune diseases. Dr. Stermer is dual board certified in Rheumatology and Internal Medicine. His passion for gout and all things related to uric acid started during fellowship at Rutger’s University where he studied under Naomi Schlesinger, a world renowned gout expert who is known for uncovering the benefit of tart cherry juice on her gout patients.
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