Last review and updae: December 2, 2020.
A short summary.
Several notes on hyperuricemia.
An important paper on uric acid by Bardin and Richette, 2014 (1).
Bardin and Richette, 2014 (1), wrote a good paper on hyperuricemia, or elevated levels of uric acid in blood, and gout.
Definition of gout.
Bardin and Richette, 2014 (1):
Gout is defined as an arthritic condition resulting from the deposition of monosodium urate (MSU) crystals in and/or around joints, following long-standing hyperuricemia.
The level at which uricemia becomes abnormal is still disputed.
Bardin and Richette, 2014 (1):
Several recent ultrasound studies disclosed MSU deposits in a large proportion of asymptomatic hyperuricemic patients. A gout condition defined by asymptomatic MSU deposits can therefore be individualized. Such asymptomatic deposits appear to precede the occurrence of flares, which seem to be triggered by mobilization of preformed crystals. Hyperuricemia appears to be the main, if not the only, risk factor for gout. Recent studies also support the view that hyperuricemia is an independent risk factor for renal and cardiovascular diseases. The level at which uricemia becomes abnormal is still disputed.
A long-standing uricemia above 6 mg/dl may be enough to increase the risk of gout, even if the increase is more obvious and observed at a younger age for higher uricemia values.
Bardin and Richette, 2014 (1), cite multiple studies that investigated levels of uric acid in different cohorts of subjects. It appears that the risk of gout is associated with serum uric acid levels above 6 mg/dL.
Bardin and Richette, 2014 (1):
In the Framingham study [40], more than 5000 subjects were followed for 12 years and had repeated measures of their uricemia; 5 of the 11 women and 15 of the 65 men diagnosed with gout had their maximum measured uricemia between 6 and 6.9 mg/dl; in these men the first attack of gout occurred at an older age than in those with higher maximum uricemia (55.4 years as compared with 50.4, 40.4 and 38.8 years in the 7–7.9, 8–8.9 and> 9 mg/dl maximum uricemia groups, respectively). This may lead to the hypothesis that a long-standing uricemia above 6 mg/dl may be enough to increase the risk of gout, even if the increase is more obvious and observed at a younger age for higher uricemia values, the risk of gout being determined by the level and duration of hyperuricemia, which both govern MSU crystal deposition.
The risk of developing hypertension started from the threshold values of 5.7 mg/dL in men and 4.5 mg/dL in women.
Grayson et al. (3), 2011:
The link between hypertension and hyperuricemia appears to increase continuously with the level of hyperuricemia.
Gaffo et al., 2013 (2) concluded that the risk of developing hypertension started from the threshold values of 5.7 mg/dL in men and 4.5 mg/dL in women.
Some of our previous comments on uric acid.
Similar effects of alcohol and ketosis on uric acid metabolism.
The New Neander’s Medical on September 6, 2019:
Physiological Literacy: “Ethanol is metabolized to acetaldehyde and then to acetate. This increases hepatic formation of uric acid and inhibits renal urea excretion, thus causing an increase of uric acid in plasma. …Together with lactate, acetate decreases plasma bicarbonate, resulting in mild to severe metabolic acidosis, (depending on the amount of ingested alcohol.)
Ref.: Tietz Textbook of Clinical Chemistry.
Many are proud of their high levels of ketosis.
Food for thought: Ketone and uric acid levels durig prolonged fasting.
From another post on this website:
“Healthy fat” consumed on a “high-fat low-carb diet”, carnivore diet, as MCT-oil or in other forms, can produce ketosis and an elevation of serum uric acid.
“Amazing benefits” of ketosis.
The New Neander’s Medical on November 19, 2020:
Amazing benefits of ketosis: “High resting uric acid has been associated with … vulnerability to tendon injury.”
The New Neander’s Medical on October 19, 2019:
Metabolic profile of Eskimo on traditional diet.
Uric acid: normal, even lowish at 3.8mg/dL. Modern Carnivores have higher uric acid levels. Why? BUN: 28mg/dL on average. High and consistent with the observations in modern Carnivores. Ref.: Rabinowitch and Smith, 1936. Kevin Stock.
Consulting practice: uric acid is not necessarily always high on low carb diets.
In our consulting practice, we do not necessarily see elevated uric acid in all clients on carnivore or other low carb diets. Some have uric acid levels below 6mg/dL despite their high-meat diets.
Other key points in the study by Bardin and Richette, 2014 (1).
Ultrasound scan examination of long-term asymptomatic
hyperuricemic patients discloses frequent MSU crystal
deposits, leading to the individualization of a subset of
patients with asymptomatic MSU deposition.MSU deposition in joints (particularly in cartilage) or
tendons antedates the occurrence of gout flares, which
appears to be triggered by crystal mobilization from
preexistent deposits.There is no consensus on the definition of
hyperuricemia; we propose to define hyperuricemia as
SUA level above 6 mg/dl, which appears to be the
limit above which clinical gout may appear and
matches the SUA target of urate-lowering treatments in
gouty patients.Hyperuricemia is a risk factor for cardiovascular and
kidney diseases, but the uricemia level from which this
risk starts to increase is still unknown and could be
lower than 6 mg/dl.
The study by Bardin and Richette, 2014 (1), is recommended for reading/listening to.
Periodically reviewing interesting studies is something that we recommend to medical practitioners, researchers, people who follow our courses in Physiological Literacy. The study by Bardin and Richette, 2014 (1), is a study worth periodic reviewing. We add it to the list of our recommendations.
Selected references:
1. Thomas Bardin and Pascal Richette. Curr Opin Rheumatol2014, 26:186–191
2. Gaffo AL,et al. Ann Rheum Dis 2013; 72:1321–1327.
3. Grayson et al. Arthritis Care Res (Hoboken) 2011; 63:102– 110
4. Ivrivng et al. Metabolism, Vol. 25, No. 5 (May), 1976 551
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