The Newfound Danger of Uric Acid

October 03, 2022

The Dangers of Uric Acid

Do you know your uric acid level? Have you ever had it checked? Do you know why it is important, or what it causes? Well, I'm going to argue that it is as important a test for you to know as your HgbA1c, your cholesterol, your blood name it. It should be in your premier list of known numbers. Why, because uric acid is not the mild little leftover of purine metabolism that causes gout. Indeed, it causes gout, but it turns out to be a central player in the core disease of our time, metabolic syndrome. The confluence of diabetes, insulin resistance, overweight, high blood pressure, high CRP, kidney failure and big waistline is metabolic syndrome, and uric acid drives that bus. It is intrinsically causative and implicated in its genesis. Here is how. 

It actually all starts with fructose. Fructose, the sugar made by many fruits and is about 4-6% of that fruit, is pretty benign in that context because you eat the fiber with it. What is not benign is high fructose corn syrup in sugared sodas and hundreds of other products whereby you get 50-80% fructose in a sudden rush. We have never had fructose in such concentrations before until the 1970s when we learned how to manufacture it from corn by the enzymatic wizardry that turns corn glucose into high fructose corn syrup. That fructose is now 10% of our calories, every day.

Here is the biological conundrum. We don't have any biological means of slowing down its entry into our liver cells. In the liver cell, humans add a phosphate atom to it from an ATP molecule. (ATP is Adenosine TRI-phosphate). On reacting with fructose, it becomes Adenosine-DI- phosphate (ADP), two phosphates. In a normal cell working in normal times, an ADP would go into the local mitochondria and get turned back into ATP. But in a liver cell flooded with fructose, there is no time for that. We need ATP, now! Two ADPs get together to make an ATP and then there is an Adenosine MONO-phosphate left over. Adenosine monophosphate, AMP. And that, AMP, gets rapidly degraded to URIC acid. There you have it. Drink a Big Gulp of fully sweetened soda and your uric acid will go up 2 points. And your adenine supply gets cut in half. Your liver is starving for energy.

And now we know that uric acid is emphatically not just an end product of metabolism. It acts as a hormone, a messenger. It shifts our metabolism from burning energy to storing energy. It turns off leptin (your "I'm full" hormone) and turns on ghrelin (I'm hungry hormone). Its actions show up in every aspect of energy storage. So you get fat. And fatter, and fatter. Obesity then sets off insulin resistance, high blood pressure, kidney damage, inflammation and all the other markers of metabolic syndrome.

The first step to controlling uric acid is to stop consuming fructose in all its hidden forms. It's in sugared sodas, that we know. But just about every fruit juice is also a concentrated form of fructose. Salad dressings, peanut can spend a weary day looking at food labels and finding hidden fructose. It's everywhere. A full 10% of our calories.  (As an aside, beer has a lot of purines in it so drinking beer raises uric acid too.)

www.What will Work for me. The calories you drink are the calories you store. That adage has been around for a long time. Now we know why. It's a bit complex but the story runs rights through fructose in a concentrated form, what it does to your liver, and then, the ultimate demon, uric acid. I can now measure that. The question remains, what level is safe and good? We used to say up to ranges like 3.5-7.2 because that is the range in which you don't see gout. With the connection to metabolic syndrome, we have to revise that. Now, there are those advocating for 5.0 for men and 2-4 for women. I'm going with that.

References: Perlmutter, Eur Jr Clin Nutr. Int Jr of Cardiology, J Clin Med, Medicine, Arthritis Rheum.,

Pop Quiz

1. What is uric acid?                            Answer: A metabolic hormonal switch that turns on energy storage, and an end product of purine metabolism that causes gout.

2. What is the main cause of uric acid elevation in America today?                        Answer: (If you don't get this one, I'll shoot myself.). Drinking high fructose corn syrup in fully sugared sodas.

3. What does fructose do in the liver?                          Answer: It floods it too fast and drains the supply of ATP, our principal energy molecule. Make uric acid is a byproduct of that, further draining ATP because it reduces the core molecule by half.

4. How do you treat gout?                            Answer: Oh, that's a tale of woe. Queen Victoria soaked in the warm waters of Bath, so everyone else in England followed her. ER visits, rheumatology visits, agonizing toe pain, and joint pains......lots of various drugs......lab tests for lead levels, and other causes. Allopurinol lowers uric acid. Did you know that it, allopurinol, also reduces the risk of cognitive decline?

5. What is the first, most effective thing you can do to reduce your uric acid?                        Answer: Become a fructose detective and rid it from your food chain. Then, work on high-purine foods......(next week).