Purine breakdown in body results in the formation of uric acid. Most of the uric acid is transported to the kidneys through blood and excreted in urine. Uric acid accumulation can lead to kidney stones and various other conditions that can affect our health; therefore maintaining normal uric acid levels is of immense importance. Purine is found in a number of foods and drinks like animal liver, anchovies, mackerel, dried beans, peas and beer.

Normal Levels of Uric Acid

Blood uric acid level is measured in a lab. Every lab has its own reference range or in simple words a range of digits within which if the results fall, they’re considered normal. The test doesn’t take much time and results are obtained in 1-2 days. Reference range of normal uric acid levels for men, women and children are given in the following table:

Your doctor decides if your test result is normal for you or not and this decision is made by considering certain factors like health condition and existing co-morbids. For example, even though 7mg/dl falls in the normal range, it may precipitate a gout attack, which is why your doctor may take it as an abnormal result. Past history and co-morbids may have a significant effect on the results.

High Uric Acid Levels

Uric acid levels are a function of balance between the rate at which uric acid is excreted and purine is broken down. An abnormally high blood uric acid level or hyperuricemia is dangerous and requires appropriate treatment.

Causes

High uric acid levels as already mentioned are either due to over production of purine or under excretion of uric acid. However, there are certain conditions which may also be responsible for hyperuricemia and these include:

• Kidney disease
• Increased cell break down in conditions like hemolytic anemia, sickle cell anemia, heart failure, cancer (e.g. leukemia, lymphoma, multiple myeloma) and cancer treatment.
• Alcohol dependence
• Pre-eclampsia
• Obesity
• Liver disease (cirrhosis)
• Hypothyroidism
• Psoriasis
• Low parathyroid hormone levels
• Malnutrition
• Starvation
• Malnutrition
• Lesch-Nyhan syndrome
• Medications (like few diuretics, vitamin C (ascorbic acid), lower doses of aspirin, niacin, warfarin, cyclosporine, levodopa, tacrolimus and drugs used for treating TB, lymphoma and leukemia)
• Consumption of purine rich food, like organ meats (liver and brain), red meat (beef, lamb), game meat (deer, elk), sea food (sardine, herring, scallops), beer, etc.

Treatments

While doctors will obviously give the best advice on how to maintain normal uric acid levels and considering other factors as well, there are a number of tried and tested ways to treat hyperuricemia.

1. Plenty of fluids

By increasing water intake, you flush out excess uric acid and prevent formation of kidney stones. Yet another way of preventing stone formation due to high uric acid level is by drinking citrus drinks like lemonades and orange juices, which also reduce uric acid levels.

2. Reduce purine-rich food consumption

Consuming purine-loaded animal protein and foods like organ meats, red meat, sardines and herring will eventually lead to increased uric acid formation and hyperuricemia. Instead consume foods like milk, lettuce and green vegetables.

3. Low sodium diet

Excess sodium in diet increases the levels of uric acid and oxalate, leading to stone formation. A healthy diet or a diet routine like DASH used for controlling hypertension have an added benefit of maintaining normal uric acid levels by encouraging consumption of fresh vegetables and healthy food, which prevent purine accumulation.

Note: DASH diet suggests to decrease sodium intake and to eat lots of foods abundant in nutrients which help control blood pressure, like calcium, potassium and magnesium.

4. Medications

This is the ultimate solution to hyperuricemia. Medicines along with dietary modifications control hyperuricemia in a jiffy. Uricosuric drugs containing sodium bicarbonate block urate reabsorption to prevent high levels of uric acid levels.

5. Other Methods

• Avoid Vitamin C and D supplements: Both the vitamins increase the risk of kidney stone formation and elevate uric acid levels as well.
• Reduce alcohol and caffeine: Both the drinks encourage production of Purine, eventually leading to an increased amount of uric acid in blood.

For more information on dietary routine to follow and preventive measures, watch the following video: 

Low Uric Acid Levels

Hyperuricemia is a consequence of a disrupted balance or a disease process. Likewise, hypouricemia, a low blood level of uric acid is also a result of specific conditions.

Causes

Low uric acid levels can be caused by the following conditions:

• Severe liver disease, like Wilson’s disease and cancers
• SIADH (syndrome of inappropriate antidiuretic hormone) resulting in fluid retention
• Inadequate protein intake
• Sulfinpyrazone
• Aspirin (large quantity like >1500mg)
• Probencid (Probalan)
• Allopurinol (zyloprim)

Symptoms

While the cause of hypouricemia clearly guides the clinical features of the condition, the symptoms are often not noticed in cases of lower than normal uric acid levels. The following symptoms may be experienced;

• People suffering hypouricemia due to fanconi syndrome usually complain of bone pain and unusual weakness
• Increased risk of dehydration due to excretion of large volumes of urine
• Wilsons disease can causes symptoms like body aches, diminished appetite, depression, fatigue, limb swelling, shakiness, walking difficulties, swallowing difficulties, trouble sleeping, etc.

Treatment

While the healthcare provider may provide appropriate treatment to raise the levels back to normal, low uric acid levels do not cause much concern. Hypouricemia can be managed by:

• Dietary modifications, like increasing the consumption of purine-rich foods
• Medications to raise the level back to normal
• Medications to address the cause of low uric acid levels