What uric acid is
Uric acid is the end product of purine metabolism. Purines come from food (meat, seafood) and from cell turnover. Most uric acid is excreted by kidneys.
What drives it up
- Fructose intake (especially high-fructose corn syrup)
- Alcohol (especially beer)
- Purine-rich foods (organ meat, anchovies, sardines)
- Kidney dysfunction
- Insulin resistance
- Diuretics
- Genetics
- Dehydration
Beyond gout
Elevated uric acid associates with:
- Hypertension
- Metabolic syndrome
- Cardiovascular events
- Chronic kidney disease
- Insulin resistance
- Non-alcoholic fatty liver disease
Optimal ranges
- Optimal: below 5.5 mg/dL
- Reference upper: 6.0 women, 7.0 men
- Gout risk: above 7.0
How to lower it
- Reduce fructose intake (sodas, sweetened beverages)
- Reduce alcohol (especially beer)
- Lose weight
- Address insulin resistance
- Adequate hydration
- Tart cherry / cherry juice (some evidence)
- Allopurinol for severe cases
GLP-1 therapy often lowers uric acid through metabolic improvement.
The clinical pearl: Uric acid is a metabolic marker, not just a gout marker. Track it as part of comprehensive metabolic evaluation. Lowering it through metabolic improvement has cardiovascular benefit beyond gout prevention.
Bottom line
Uric acid reflects metabolic health and oxidative stress. Elevated levels associate with cardiovascular and kidney disease beyond gout. Optimal below 5.5 mg/dL. Lowering through metabolic improvement has broad benefit.
<5.5
mg/dL optimal uric acid
Fructose
major dietary driver
Beyond gout
cardiovascular and kidney implications