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The Not-So-Sweet Truth About Sugar: Its Effects on Uric Acid Levels and Disease Risk

Updated: Jan 21

Have you ever experienced sudden and excruciating pain in your joints? Did it feel like your big toe was on fire? If so, you might have been a victim of a gout attack, a condition caused by high levels of uric acid in the body.


Gout is a form of inflammatory arthritis that affects millions of people worldwide. It is characterized by intense pain, redness, and swelling in the joints. But did you know that two thirds of individuals with high uric acid levels do not experience any joint pain or gout, yet they suffer from the same chronic conditions as someone who has gout? High blood uric acid level is a warning sign of potential underlying health issues.


In this article, we will explore the dangers of high uric acid levels and how it can affect your health. From increased risk of heart disease to impaired kidney function and gout, understanding the potential consequences of elevated uric acid levels is key for prevention and management, ultimately improving your quality of life. Let's delve into the world of uric acid crystals and uncover its hidden dangers.


From Juice to Uric Acid!

juice contains high amounts of fructose

Previously, patients with gout were recommended to avoid high "purine" foods, which are found in organ meats, small shelled marine organisms, and excessive alcohol consumption, especially beer or liquor. These foods are known to elevate uric acid levels and increase the risk of gout.


The main source of high blood urate levels in our bodies today is fructose, commonly known as fruit sugar. Consuming sugary drinks can lead to a higher absorption of fructose by the liver, resulting in increased uric acid production. Fructose can also be found in heavily processed foods under the name "high-fructose corn syrup".


how fructose turns into uric acid

Fructose is responsible for the production of uric acid in the body. Processing fructose requires energy, which can lower energy levels in cells. After consuming a sweet meal with fructose, the body needs to replenish energy levels inside its cells, stimulating appetite and promoting fat storage. This can also lead to high blood sugar and insulin resistance, making it difficult to maintain a healthy weight. Over time, these effects may contribute to chronic conditions like obesity, fatty liver, and hypertension.


It should be noted that whole fruits contain fructose. However, consuming whole fruits in moderation as part of a balanced diet, can slow down the absorption process due to their fiber content. Additionally, fruits also contain flavonoids, vitamin C and epicatechin, which can counteract some of the negative effects of fructose. Certain flavonoids can even act as inhibitors of xanthine oxidase, which blocks the production of uric acid.


What happens to uric acid in the body?

uric acid crystals

Our bodies have the ability to handle uric acid to some degree. The kidneys are responsible for excreting uric acid, while the gut also plays a role in this process. However, if the concentration of soluble urate exceeds its saturation point, it precipitates forming sharp crystals which trigger inflammation and disease.


The most known consequence of high urate in the body is gout, a form of arthritis, known to cause acute attacks of severe pain and discomfort. We observed that people with gout are also prone to develop other medical conditions which require long-term treatment such as chronic kidney disease, hypertension, diabetes, metabolic syndrome, heart disease or stroke.


Not everyone with elevated uric acid levels will develop gout; however, these people experience similar common conditions. Let's understand why!


1. Chronic Inflammation leads to atherosclerosis.

a woman with heart disease

Atherosclerosis is the buildup of plaque in arteries, causing them to thicken or harden.


Even in the absence of symptoms of gout, these sharp urate crystals remain in the joints and other body tissues, contributing to ongoing low-grade inflammation. It is this persistent inflammation, coupled with high cholesterol levels, that accelerates the progression of atherosclerotic disease, and represents a major cardiovascular risk factor.


Over time it may lead to heart attacks, strokes, even congestive heart failure in the affected individuals. A proof to this hypothesis is that uric acid was found to be a component of the coronary artery plaques.


2. Uric acid and hypertension.

Numerous studies have shown a correlation between elevated uric acid levels and high blood pressure in both animals and humans. 


Uric acid has been found to contribute to hypertension by influencing the "renin-angiotensin system", which regulates blood pressure. It can also negatively affect endothelial function and impair the production of "nitric oxide", which keeps blood vessels open and prevents clotting.


Further research is needed to confirm whether lowering uric acid levels may lead to better blood pressure control, particularly if administered early in the medical history of the disease.


3. Uric acid and Kidney Disease. 

uric acid causing kidney stones

The kidneys play a vital role in the body's filtration system. They are responsible for filtering out excess uric acid.


When uric acid crystals build up in the kidneys, they cause chronic inflammation which contributes to hypertension, the formation of kidney stones and chronic kidney disease.

Acute kidney failure can occur, particularly when treating gout flares with nonsteroidal anti-inflammatory drugs, which may pose a risk for people with kidney disease. Drinking plenty of water when taking nonsteroidal anti-inflammatory drugs may help mitigate this risk. 


Studies have shown that patients with chronic kidney disease (stage 3 or above) have a higher likelihood of being diagnosed with gout compared to those without the disease. Moreover, a substantial number of chronic kidney disease patients (stage 3 or above) also display elevated levels of uric acid (hyperuricemia).


Hyperuricemia and chronic kidney disease have a two-way relationship. Chronic kidney disease is associated with an increased risk of gout, and gout contributes to the development of chronic kidney disease through the formation of acid stones and inflammation, well known for its adverse reactions.


4. High uric acid levels linked to weight gain, diabetes, and fatty liver.

high uric acid level link with obesity

The link between high urate and weight gain is intriguing and often overlooked. According to research there is a close connection between diabetes, obesity, and high levels of uric acid.


Over the years, the fructose content in our foods has increased. When we consume fructose, our body expends energy to convert it into calories, which produces uric acid and depletes cellular energy levels. This depletion stimulates hunger, but also leads to insulin resistance and impaired glucose tolerance. Consequently, higher insulin levels are required to counteract this resistance, ultimately leading to increased fat deposits.


Take away points:

To summarize, it's important to understand the impact of high urate levels on your health. By recognizing this association you can take proactive steps to prevent future attacks of gout, kidney stone pain, chronic kidney disease and other related health conditions. It is also important to remember that monitoring uric acid levels has become a useful tool for disease prevention.


Here are some key takeaways to consider:







6. A healthy diet, low in fructose and avoiding foods rich in purine is the first line treatment.


7. If you have a history of gout or are experiencing gout symptoms, it's essential to consult your healthcare provider for an accurate diagnosis and treatment of gout. You may need physical examination and treatment for acute gout. You may benefit from urate lowering therapy to prevent chronic gout.


Here is a good book on this subject:

"Nature Wants Us to Be Fat" by Richard J. Johnson, MD


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