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Uric Acid – Part I
I am in my 34th year of being a pharmacist, and I recall rather distinctly the lectures on arthritis from one of my pharmacy school instructors. Gout is a form of inflammatory arthritis characterized by excessive uric acid in the synovial fluid, the fluid that fills the space between our joints. When the concentration of uric acid gets too high, crystals start to form in the joint, and if you can imagine, having a crystal grinding into the bones of your joint is going to be very painful. The joint most often affected is the big toe.
Another medical condition that occurs from elevated uric acid levels is renal stones. Uric Acid renal stones form from the build-up of uric acid in the kidneys, and if the condition is chronic, small stones can develop from the excess. Uric acid is one of four different types of kidney stones.
Our bodies get rid of uric acid via our kidneys, so small stones start to form if we have an excess amount. These stones, if small, are readily excreted in our urine, but if they grow to a large size, they can pose quite a problem for removal. Research shows that about 1 in 10 people may develop a kidney stone, with males more likely than females.
Hyperuricemia is the medical term for high uric acid levels, and about 21% of the US population suffers from this condition. The incidence of patients with gout from the 1960s to the 1990s doubled in our country during that time. The increase in gout coincides with the increased consumption of high fructose corn syrup over that same period, which I will discuss later in this article.
There are two ways to treat an elevated uric acid level. The first is to decrease the consumption of foods rich in purines. Purines are amino acids or building blocks that convert into uric acid; therefore, reducing exposure to foods containing purine can solve the problem in many instances.
The most common purine-rich foods include animal proteins, such as beef, poultry, pork, eggs, shellfish, and organ meat. Some vegetables contain purines but eating too many of them is impossible to cause a problem.
The second way to treat high uric acid levels is to take a medication that blocks the formation of uric acid. These medications are referred to as xanthine oxidase inhibitors. The most common one that has been around for over 50 years is called allopurinol. A newer one is febuxostat, also known as Uloric. Both of these medications successfully lower high uric acid levels.
Gout is referred to as "the king of diseases and the disease of kings." I like to tease my patients with this reference when I talk to them about their medication. The history of gout dates back to ancient Egypt, with Hippocrates commenting on gout around 400BC. It has been known through time to afflict people with status or money because they were the ones that we're able to afford foods rich in purines, mainly animal proteins, and alcohol.
If you happen to get gout, you will need to take an anti-inflammatory medication to reduce the swelling and address the pain. The two most common medications for this inflammation are colchicine and indomethacin. Both drugs have been around for many years and have been the standard of care in treating pain. They are, however, very potent and can be hard on the stomach, limiting their duration of use. Once the pain and swelling are under control, patients are transitioned to the xanthine oxidase inhibitors for prevention, as discussed above.
When it comes to kidney stones, the treatment for decreasing uric acid would be the same. The best way to prevent uric acid stones is to stay hydrated. Drinking plenty of water will help reduce the concentration of uric acid in your urine, preventing stone formation.
A common question in the pharmacy is, how can I treat my gout naturally? If you were going to treat gout from a natural angle, the most common way is to take a product containing tart cherry extract or drink unsweetened tart cherry juice. Studies show that eating ½ cup of cherries per day can reduce the risk of a gout flare by 35%. Cherries contain anthocyanins and quercetin, which are anti-inflammatory and fight oxidative stress. Eating cherries or taking a product with cherry extract are preferred due to the potential added sugar in the tart cherry juice. Follow this link to our full scripts store to see product for this.
https://us.fullscript.com/protocols/irsfeldpharmacy-gout-uric-acid-reduction
Uric acid is being looked at differently these days with its potential to be an alarm for concerns around metabolic health. Author and neurologist Dr. David Perlmutter, responsible for several best-selling health books, including "Grain Brain," recently wrote a book called "Drop Acid," which examines the health problem that accompanies a person having an elevated uric acid level.
Uric acid has been downplayed as a little know metabolic waste product that has little to do with our overall health unless it becomes so high that gout and renal stones occur, as discussed above. That is the concept I learned in pharmacy school and most others in health care.
Next week's article will continue to unfold the metabolic effects of elevated uric acid levels, how to monitor uric acid, and some additional natural ways to address the excess levels before high levels further degrade your health. I encourage you to read my next article to receive the rest of the story.
My staff and I would like to help you with questions regarding uric acid and finding suitable treatment options to lower the burden, so call or stop to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to see this and other archived articles in the blog section. Until next time, be vigilant about your health!!
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