An underappreciated lab test that even doctors ignore
And why you should not!
Recently, while visiting my parents, I decided to check out the new gym that had just opened. The trainer showed me around. He appeared to be in his late 30s and seemed to be in reasonable health. Once he knew I was a physician, he wanted to run something by me. His recent blood test showed high uric acid. His number was 7.5 mg/dl (standard upper limit is 7 mg per deciliter in many labs). The doctor told him not to worry, as it was only slightly high and to avoid certain foods.
What if instead, he was told that this “slightly” high number could put him at risk for developing many diseases in the next 5–15 years?
The disease of Kings
Uric acid is most popularly known for being connected with gout, where the patient suffers from painful, swollen joints. Gout was referred in olden times as “disease of Kings” as it happened because of the lifestyles that included rich foods and excessive alcohol that only kings could afford.
We don’t ingest uric acid. But we consume things that contain purine compounds that are then broken in the liver to produce uric acid.
The gout-like disease only appears in about a third of patients who have high uric acid. Even patients who show symptoms of the actual illness have had high levels for approximately two decades before they show signs.
The majority of times, in the US, uric acid is not part of the regular blood test panels that people obtain at their physical examination.
Understanding the consequences of this long period of a higher uric acid level that goes undiagnosed can make it crucial to take action at the right time.
Why do we need to know our number?
Elevated level of uric acid is associated with:
1) Increased risk of high blood pressure:
a. Uric acid causes inflammatory pathways to activate in vascular smooth muscle cells suggesting its role in high blood pressure and vascular disease.
b. The effect is particularly pronounced among the younger population. Trials done in overweight adolescents with prehypertension or stage 1 hypertension showed that reducing their uric acid below 5mg/dl normalized the blood pressure in 86% of the participants.
2) Increased risk of diabetes:
a. Elevated serum uric acid levels are strongly associated with the development of metabolic syndrome that includes insulin resistance and diabetes.
b. People with metabolic syndrome who are not overweight or obese also reveal high uric acid.
3) Increased risk of kidney disease:
a. Studies in animals showed that high uric acid levels caused kidney disease or worsened existing kidney disease. And treatment of high uric acid improved renal function.
b. In other studies, stopping the treatment of raised uric acid worsened the high blood pressure and kidney disease in those patients.
4) Increased risk of heart disease:
a. Patients with gout have more incidence of heart disease.
b. High uric acid causes systemic inflammation, has harmful effects on platelet function, and causes endothelial damage.
Normal limit is not good enough
The standard upper limit of uric acid is 7 mg/dl in most labs. Women tend to have lower levels (by 0.5 to 1.0 mg per deciliter) than men until menopause because of the positive effect of estrogen. In women after age 50, the levels increase.
Many experts recommend keeping the levels lower than 5 mg/dl in both men and women. So, next time you have a blood test, ask your physician about checking uric acid.
a. For levels above 7 mg/dl:
Consider taking aggressive measures:
- Avoid all alcohol. Beer is the worst culprit, but others can also contribute.
- Avoid eating meats or seafood. In studies, proteins from meat, seafood increased the uric acid level. In contrast, protein from vegetable sources such as soy, legumes, and low-fat dairy reduced the level of uric acid.
- Check your prescription medications as specific agents like diuretics and other BP meds can cause increased levels.
- Consider drugs that reduce the uric acid level.
- Obtain follow up levels in 6–12 months.
b. For levels between 5–7 mg/dl:
Aim to bring it to at least the lower end or below 5.
- Adopt aggressive lifestyle measures as above and follow levels in 6–12 months.
- There is no consensus about whether uric acid lowering medications should be used if levels are between 5–7 mg/dl. The risk profile should help guide the treatment decision.
Interesting tidbit:
Benjamin Franklin had high uric acid and was a severe gout sufferer. In one of his writings, he created a dialogue between himself and gout.
Franklin: “Eh! Oh! What have I done to merit these cruel sufferings?
Gout: “Many things; you have ate and drank too freely, and too much indulged those legs of yours in indolence.”
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This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
