A 37-year-old, Mumbai-based sales executive was hospitalized with severe pain in the left flank. Tests showed multiple stones in the kidney, compromised kidney function and hypertension. He had also been ignoring the multiple episodes of joint pain he had been suffering for years.

His uric acid levels were found to be quite high.

“We put him on regular medicine, along with dietary changes. While his pain and swelling disappeared in a few months, his kidney function did not improve much. This could have been prevented had he visited a doctor on time to get the regular episodes of joint pain and swelling treated instead of just taking painkillers," says K. Mahesh Prasad, a nephrologist and transplant physician at Wockhardt Hospital, Mumbai. Dr Prasad treated the sales executive.

In most cases, high levels of uric acid tend to be detected when people are diagnosed with other disorders, like heart disease, says Rajinder Yadav, director and head (urology and kidney transplantation) at the Fortis Hospital in Shalimar Bagh, Delhi. Dr Prasad agrees: “People often come late because many of them ignore initial signs and symptoms. Joints and muscular pain are often attributed to fatigue or exertion, which is not true in many cases."

Know when it’s too much

Uric acid is a chemical produced in the body when it breaks down foods that contain organic compounds called purines, a kind of amino acid. Most uric acid gets dissolved in the blood; it is filtered through the kidneys and expelled through urine. Sometimes, however, the body produces too much of it or doesn’t filter out enough.

Accumulation of uric acid can, over time, lead to gout and the formation of kidney stones, even damaging the kidneys in the long run. “A family history of uric acid, physical inactivity and high intake of non-vegetarian food are some of the factors that make a person prone to high uric acid," says Dr Prasad. Early detection, however, can help control the levels faster and prevent damage.

A simple blood test can tell you if there is a problem. “For males, normal uric acid levels fall between 3-7, and for females, it is 2.5-6. One must get their uric acid levels tested if they suffer from joint pain or swelling or suffer from frequent kidney stones," says Neeraj Tulara, specialist in internal medicine and infectious diseases at the Dr LH Hiranandani Hospital in Mumbai. He recommends yearly check-ups for uric acid.

Painful indications

High uric acid levels are also associated with obesity and high blood pressure, and can even lead to diabetes and heart disease, says Haresh Dodeja, consultant nephrologist at the Currae Specialty Hospital in Thane.

A study published in the American Journal Of Medicine in 2010, which looked at close to 9,000 people (age not specified), reported that those who had higher uric acid levels than normal were more likely to get type 2 diabetes.

“Arthropathy (commonly known as gout) is a form of arthritis and is typically characterized by large, swollen joints, mainly the ankle joint towards the inner side of the leg. A person with arthropathy has tender ankles, which are warm to touch, and it gradually becomes difficult to walk because of the pain. Sometimes, skin rashes and skin hyper-pigmentation in any part of the body are also seen," says Dr Tulara. “In this painful condition, uric acid gets deposited in the form of crystals in the joints, leading to sudden, severe bouts of redness, swelling, warmth and pain in one or more joints. This is increasingly being seen in young people (as young as 20) due to excessive protein intake (high consumption of non-vegetarian food) and alcohol consumption," Dr Yadav says.

Uncontrolled uric acid can lead to multiple health problems. Dr Yadav recalls the case of two brothers who visited him a year ago. They were suffering from renal failure. Their uric acid serum was as high as 9.4 and further tests showed the presence of kidney stones. “They were both operated upon, but because of the damage already done, their kidneys still function poorly," he says.

High uric acid levels lead to the depletion of endothelial nitric oxide, an important molecule in the body that is needed to prevent hypertension. Moreover, says Dr Yadav, “high uric acid levels might lead to high blood pressure, which is a big risk factor for heart disease."

A 2012 study by scientists at the University of London, published in the journal Nature Genetics, found a genetic link to gout. The study analysed the genetic data of more than 140,000 people from more than 70 individual studies from Europe, the US, Japan and Australia, and identified 18 new genetic variations that lead to increased levels of uric acid in the blood.

Make lifestyle changes

The good news is that uric acid levels can be managed with medicines. “But diet restriction and lifestyle modification always come first, except in cases where the levels are too high," says Dr Prasad.

One of the first things you need to do is keep a check on weight. There is a strong association with obesity—fatty tissues enhance the production of uric acid. “Adipose tissue (fat cells) leads to higher levels of an enzyme called xanthine oxidoreductase that is responsible for high uric acid production in the body," says Dr Prasad.

Limit the intake of red meat, poultry and fish to twice a week—animal proteins are high in purine, which leads to high uric acid levels in the body. Choose vegetarian protein sources, such as dairy products, as alternatives. “Consumption of milk products, particularly low-fat, is inversely associated with gout risk and is, therefore, recommended," says Shalini Garwin Bliss, executive dietitian at the Columbia Asia Hospital in Gurgaon, adjoining Delhi. “Also, consume less mushrooms, spinach and all types of lentils. One should not have more than one purine source in a day," she adds.

The question is: How do you define less? An Indian meal typically comprises dal sabzi. And it might be hard for lovers of non-vegetarian food to give up on meat or fish. So it’s advisable to consult a nutritionist to chalk out a diet plan to manage uric acid levels, ensuring that the body gets enough protein.

In addition, cut down on alcohol because it interferes with the elimination of uric acid from the body. “Drinking too much beer, in particular, has been linked to gout attacks," warns Bliss.

“There is a myth that drinking beer will help in removing kidney stones. Instead, beer consumption may lead to high uric acid levels, leading to stone formation," says Dr Dodeja.

Drink plenty of non-alcoholic fluids, especially water—they help flush out toxins.

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