Uric Acid Tag

The Source Of Uric Acid

I’m often asked, “what causes uric acid?”

The simple answer is: “the natural breakdown of purines in the body.”

But this answer is too simple to be of any real value. In fact, because most people, including many professional medics, do not understand purines, there is an enormous amount of bad advice given to gout sufferers. The result of that bad advice is often a miserable low purine diet that is impossible to stick to.

Even worse, it does nothing (or in some cases very little) to help your gout.

This is a great opportunity to see how a simple question about causes of uric acid can lead to an immediate improvement in your understanding of gout. This is the starting point for you to learn how to control uric acid – the first step on your road to Gout Freedom.

As I’ve mentioned, purines cause uric acid. These are present in food, and released when cells breakdown during digestion. But they are also much more available in our own flesh. Every day, our body cells renew and regenerate our body tissues. We release many more purines as part of our natural metabolism than we eat in food. All these purines are a potential source of uric acid.

Do You Have Simple Or Complex Gout?

Read the rest of What Causes Uric Acid?

The American Society for Clinical Investigation has recently reviewed the purpose of uric acid and it’s relationship with gout and other diseases.

“Uric acid transport and disease”[1] introduces its review with reference to the role of uric acid in evolution[2]. Humans have much higher levels of uric acid than many other animals because we no longer produce uricase naturally, which reduces uric acid to allantoin.

In other articles, I look at allantoin; how bacteria in our guts retain the ability to reduce uric acid; and how new drugs like rasburicase (sold under the Elitek brand) and peglioticase (sold under the Krystexxa brand) can reintroduce uricase to our bodies.

Here, I focus on what uric acid is. The report continues with some of the known benefits of uric acid.

Uric Acid: Vital Friend

The uric acid review highlights benefits of uric acid[3] including:

• Powerful antioxidant properties
• Fights heart disease
• Fights cancer
• Extends lifespan

Of course, these benefits are not always without consequences. We are aware that uric acid probably plays a part in raising blood pressure in order to walk upright, but this relies on several processes in our bodies to produce uric acid from dead body cells. These can be our own cells, or animal cells that we eat.

Our kidneys try to regulate the uric acid concentration in our blood. They filter out uric acid, then release back enough to maintain our vital functions. When systems go out-of-balance, complex factors can interact to cause problems in other areas. Often, we can see statistical associations with other diseases and conditions even though the causal links are not yet clear.

Uric Acid: Deadly Foe

The uric acid review continues to describe problems with high uric acid levels. This condition, known as hyperuricemia, is associated with several problems including:

• High blood pressure
• Heart disease
• Metabolic syndrome (a combination of diabetes or high blood pressure or obesity with heart disease or stroke or other blood circulation problems)

This of course is in addition to the problems directly associated with gout, discussed at length throughout this site, including:

• Kidney inflammation and stones.
• Bone, cartilage, and tendon destruction.

The report continues with a summary of emerging genetic investigation. I will review this area of gout research separately, as it addresses the “Why” rather than “What” of uric acid.

Next Steps To Answer “What Is Uric Acid?”

You’ve learned that uric acid is a component of our blood that is vital to human health, but destructive when we have too much. This is why you must control it to avoid serious longterm health problems, and not simply relieve gout pain.

You can learn more about the properties of uric acid and how it affects gouty arthritis in the “Understanding Uric Acid & Gout” section.

References For “What Is Uric Acid?”

1. Author: So A, Thorens B. Title: Uric acid transport and disease. Published: J Clin Invest. 2010 Jun 1;120(6):1791-9.
2. Author: Oda M, Satta Y, Takenaka O, Takahata N. Title: Loss of urate oxidase activity in hominoids and its evolutionary implications. Published: Mol Biol Evol. 2002 May;19(5):640-53.
3. Author: Ames BN, Cathcart R, Schwiers E, Hochstein P. Title: Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Published: Proc Natl Acad Sci U S A. 1981 Nov;78(11):6858-62.

Though this new report[1] adds nothing to the Austrian study[2] in terms of understanding why elevated uric acid leads to kidney impairment, it does confirm that the two are linked. It certainly adds weight to my position that asymptomatic hyperuricemia should be taken much more seriously.
Learn more about High Uric Acid And Kidney Disease

Uric Acid Diagnosis Vs Uric Acid Management

There is a significant difference in interpreting uric acid blood test results between confirmed and suspected gout cases. For a confirmed gout patient, any number above 7mg/dL (0.4 mmol/L) is a clear risk of a gout attack. Blood tests for confirmed gouties should be used as an aid to managing gout. They indicate whether urate lowering therapy is set at the right dosage. This is a fairly simple process, though it does rely on the doctor understanding the need to set the right target uric acid level, and it relies on the patient taking the medication daily as directed.

The problems arise when a gout diagnosis is doubtful, and uric acid blood test results are being used to help form a definite diagnosis. There are two fundamental problems with this approach, which I explain below. Gout diagnosis from blood tests is possible, but needs a clear understanding of the gout process, preferably bolstered by more tests on a weekly basis.

We know that uric acid crystals can form in joints at normal temperatures with a uric acid concentration of slightly under 7mg/dL ^[1]. For confirmed gout patients, it is almost certain that uric acid will form crystals at that level. For unconfirmed gout patients, there is a strong probability that it will cause a gout attack, but this is not certain.

Uric Acid Blood Test Reporting Problem

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There are two common scales used to measure uric acid concentration. In the US, the most common scale is mg/dL (milligrams per deciliter). In Europe, the most common scale is mmol/L (millimoles per liter), and this SI unit is now the world standard in science, though mg/dL will continue in common use for some time. Occasionally, the standard scale is modified to µmol/L (micromoles per liter), which is one thousand times smaller.

To suit the common practice of most visitors, the GoutPal standard is to display mg/dL, with mmol/L in brackets.

I have included a uric acid calculator below to convert between the two main scales, but first, a few words about typical values.
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