Morning everyone! 

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week we are going to talk about URIC ACID and the health conditions that may develop from having high levels.  

Most people associate uric acid with gout and kidney stones, which is true. There is a marker on the Cleveland Heart Panel called URIC ACID that we use to determine how high or low your levels are. When this marker is high you are more predisposed to having a painful type of arthritis called GOUT. If you’ve ever had gout you know what it is. It’s a painful, red, swollen joint, usually in the big toe (sometimes ankle and knee) and the smaller joints. 

You can be genetically predisposed to gout which means you have mutant genes that may cause a problem metabolizing purines. Purines are organic molecules found in the body as well as in foods, such as: red meats, shellfish, and alcohol (especially beer). All of these can precipitate a gout attack. 

But this Doctors Note isn’t about gout. It’s about URIC ACID being a biomarker for inflammation. 


Uric Acid and Inflammation


One of my PA’s, Fran Wilson, recently brought to my attention a book by Dr. Perlmutter titled “Drop Acid”.  Dr. Perlmutter is a famous neurologist who also wrote “Grain Brain”.  He comes to a lot of our functional medicine conferences where I have heard him speak many times. His message is always centered around staying lean and fit, and avoiding inflammatory conditions that lead to heart disease, cancer, and dementia. 

Dr. Perlmutter encourages keeping uric acid levels down. A normal uric acid level in the body is between 3.5 and 7.2. The optimal level that Dr. Perlmutter recommends is under 5.5. Uric acid is a marker for several unhealthy conditions when high.

Consumer fructose (not in the form of fruits, but in the form of high fructose corn syrup) leads to increased levels of uric acid in the body. As I mentioned earlier, alcohol (especially beer), red meat, and shellfish are all contributors in raising uric acid levels. 

If you have gout there are several medications that can help. I like Allopurinol and colchicine (for acute inflammation). Colchicine is an interesting drug. We used it a lot for Covid and it may be a protector against arterial inflammation as well. Look for more uses of Colchicine in the future as we find out more about it. Note: it can give you bad diarrhea if you take too much.  

Increased uric acid levels usually come with increased BMI (weight per height) and metabolic syndrome. An increased uric acid level decreases your nitric oxide, the important gas that decreases insulin resistance and blood pressure. You have reduced blood flow to your organs if your nitric oxide is low. Note: This is why I love the many uses of Tadalafil (Cialis). It increases your nitric oxide. 

So in general, you want your nitric oxide to be high, and your uric acid to be low. There are, of course, exceptions to the rule. 


If You Have High Uric Acid Levels… 


There are natural things you can do to lower your uric acid level.

A. Take supplements

  • Quercetin 
  • Vitamin C
  • DHA (one of the Omega 3 fatty acids)
  • Chlorella (plant pigment flavonoid that I love)

B. Stay away from high fructose corn syrup, processed foods, and sugar in general.

Note: High uric acid levels may be related to insulin resistance. Dr. Perlmutter recommends that you get a Continuous Glucose Monitor to see what foods and drinks raise your blood sugar levels (I’ve done this myself and even did a podcast on it!).  Dr. Perlmutter likes a fasting blood sugar level to be below 95. For most people that is hard to do. 

C. Be aware of certain drugs that can increase uric acid: 

  • Aspirin 
  • Testosterone (rarely)
  • Topamax 
  • Brilinta  
  • Omeprazole (I don’t like chronic use of this)
  • Niacin
  • L-Dopa 
  • Certain diuretics (if someone has gout, you don’t want to treat their high blood pressure with diuretics because it can precipitate gout)

Note: With many of these, you have to weigh out the cost versus benefit of taking them. Low Dose Aspirin can slightly raise your uric acid, but it’s mostly in higher doses. I don’t find that testosterone raises uric acid levels, but it could. Again, if you’re a lean fit person, you probably don’t have to worry about your uric acid levels being high. Insulin resistance and waist circumference both have a lot to do with your uric acid being higher. You’re talking about metabolism of purines, which are found in certain foods. So, think about the function of your gut which is the most important thing in your health.

D. Cut down on red meat consumption, organ meats like liver, alcohol, sugar, and processed foods (the older I get the less red meat I eat.

Note: Another marker that will tell you if you should be consuming red meat is a TMAO marker (which relates to your gut bacteria). This is also on the Cleveland Heart Panel

E. Other things you can do: 

  • Eat tart or sour cherries to keep arthritis inflammation down
  • Red wine – Good for keeping uric acid down (mostly in women), not more than one glass per day
  • Coffee – Good for keeping uric acid down (mostly in men)
  • Think about naked carbs, basically consuming high glycemic carbs by themselves. 

Note: You need protein and fat to blunt the bad effects of carbs. You can survive without any carbs, but you have to have fat and protein. This is why I like a low carb, high good fat, and moderate protein diet. A lot of people over consume foods that have purines in them. Some may be able to tolerate them and others don’t. 


In Closing


Uric acid does have its functions. When food was scarce, you needed it to survive because it keeps weight on you. Nowadays with food being everywhere, when it gets too high the risks outweigh the benefits.  Check the uric levels on the Cleveland Heart Panel. Use this marker to help keep inflammation out of your body. Look at your gut and at your biomarkers. Lower your carbs and waist size. Lower your BMI. Increase your muscle and decrease belly fat. 

Bottom line…….Stay lean and stay healthy.