Uric acid is normally carried in your blood, passed through your kidneys, and then removed from your body in your urine. High levels of uric acid — called hyperuricemia — occur when excessive amounts of uric acid accumulate in your blood.
There are a number of causes of hyperuricemia. Treating the underlying cause, making dietary changes and taking medications are some of the best ways to lower uric levels.
Address the Cause of High Uric Acid
Eliminating the primary cause, when possible, may cure high uric acid. Hyperuricemia can occur for a number of reasons. Kidney disease can elevate uric acid levels by interfering with uric acid removal through the urine. An underactive thyroid gland, overactive parathyroid glands or even just dehydration can also interfere with uric acid excretion by the kidneys.
Obesity and high cholesterol may increase uric acid production by the body. Cancer treatment may produce tumor lysis syndrome — a condition in which a large number of cancer cells are killed in a short period of time, releasing large amounts of purines into the body. In other people, the culprit is consuming foods and drinks that tend to raise uric acid levels.
An article in the February 1999 edition of American Family Physician notes that a number of medications may increase uric acid levels, including:
- Thiazide diuretics — hydrochlorothiazide (Hydrodiuril,
Microzide), chlorthalidone (Thalitone) and methyclothiazide
- Furosemide (Lasix)
- Low dose aspirin
- Some anti-rejection medications like cyclosporine
- Levodopa (Larodopa)
- Ethambutol (Myambutol)
- Nicotinic acid (Nicolar)
- Vitamin B12 supplements
Some people have a genetic predisposition to develop hyperuricemia. As noted in a 2018 review article published in Frontiers in Medicine, mutations in several genes have been identified as risk factors for high uric acid levels. The exact way these mutations promote hyperuricemia is mostly unknown, but at least some seem to act by reducing uric acid excretion through the urine.
Beware of What You Drink
Alcohol often increases uric acid levels. Alcohol-containing drinks — especially beer — have high amounts of purines. Alcohol can also increase purine production in your body and reduce uric acid excretion by your kidneys. According to a 2004 study published in Arthritis Care and Research, beer increases uric acid levels the most, hard liquor increases uric acid a moderate amount and wine causes the least increase.
Avoid High-Purine Foods
Purine content is especially high in organ meats like liver and kidneys. All of these foods should be avoided or consumed in limited quantities if you have hyperuricemia.
Most fruits and vegetables will not affect uric acid levels or may even help lower your uric acid. Some vegetables, however, contain moderate amounts of purines. These include peas, lentils, beans, cauliflower, spinach and asparagus. A 2017 review article in the Journal of Advanced Research notes that they can increase uric acid levels, but not much as purine-rich meats and seafood. Avoid large amounts of these vegetables if your uric acid is high.
Lose Weight and Consider Supplements
If you're overweight, losing weight will often reduce uric acid levels. In fact, weight loss in an obese person is generally more effective than major reductions in dietary purines, according to an article in the November 2012 issue of Therapeutic Advances in Chronic Disease.
Vitamin C may reduce uric acid production in your body and increase uric acid excretion through your urine. A 2012 study in Arthritis Care and Research, which combined the results of several previous studies, found that vitamin C supplements — 500 milligrams per day on average — significantly decreased uric acid levels.
Folic acid supplements may also reduce uric acid production and thus decrease uric acid levels, according to a study published in a 2017 issue of American Journal of Clinical Nutrition.
Medications for High Uric Acid Levels
Several prescription medications are available to reduce high uric acid levels. The choice depends on a number of factors, including whether you have kidney problems. Some medications act by reducing the production of uric acid in your body.
These include allopurinol (Zyloprim or Lopurin) and febuxostat (Uloric). Another group of medications, called uricosuric agents, increase the removal of uric acid through your urine. They include probenecid (Probalan or Benemid), sulfinpyrazone (Anturane) and lesinurad (Zurampic).
Newer drugs — pegloticase (Krystexxa) and rasburicase (Elitek) — break down uric acid to allantoin, a substance that is more easily excreted by your kidneys. Unlike the other medications, which are available in pill form, pegloticase and rasburicase must be administered through a vein.
Talk to Your Doctor
High uric acid levels should not be ignored. The excess uric acid may accumulate in your kidneys, producing kidney stones or chronic kidney disease. Uric acid crystals can also collect in your joints, causing a type of arthritis called gout.
Hyperuricemia may even increase your chances of developing high blood pressure, high cholesterol, heart disease, strokes and diabetes, note the authors of an article published in the April 2013 issue of Current Pharmaceutical Design.
Your doctor will help determine the underlying cause of your high uric acid and the best treatment for you. Depending on the cause, it may not be possible to permanently cure your hyperuricemia, but appropriate treatment will help lower your uric acid levels.
- Mayo Clinic: High Uric Acid Level
- Chemocare: Hyperuricemia (High Uric Acid)
- American Journal of Kidney Diseases: Management of Gout and Hyperuricemia in CKD
- American Family Physician: Gout and Hyperuricemia
- Therapeutic Advances in Chronic Disease: Latest Evidence on Gout Management: What the Clinician Needs to Know
- American Journal of Clinical Nutrition: Folic Acid Therapy Reduces Serum Uric Acid in Hypertensive Patients -- A Substudy of the China Stroke Primary Prevention Trial (CSPPT)
- StatPearls [Internet]: Tumor Lysis Syndrome
- Arthritis Care and Research: Effect of Oral Vitamin C Supplementation on Serum Uric Acid: A Meta-analysis of Randomized Controlled Trials
- Current Pharmaceutical Design: Chronic Hyperuricemia, Uric Acid Deposit and Cardiovascular Risk
- Frontiers in Medicine: Physiology of Hyperuricemia and Urate-Lowering Treatments
- Myrtue Medical Center: Low Purine Diet -- Gout Diet Treatment
- Journal of Advanced Research: Uric Acid in Plants and Microorganisms -- Biological Applications and Genetics -- A Review
- Arthritis Care and Research: Beer, Liquor, and Wine Consumption and Serum Uric Acid Level -- The Third National Health and Nutrition Examination Survey
- American Journal of Medicine: Update on the Importance of Diet in Gout
- Rheumatic Disease Clinics of North America: Gout -- A Review of Non-modifiable and Modifiable Risk Factors