Dumaguing: The hazards of high uric acid

HYPERURICEMIA or elevated blood levels of uric acid is a health issue among folks in the North--Ilocos, Cordillera and our nearby neighbor Pangasinan, because of our diet, innards or visceral internal organs which are parts of our daily food fare e.g. igado, bopis, dinakdakan, dinuguan, kilawen and the likes.

Beans of all colors, sizes and shapes are commonly seen in the tables of our mountain brothers and sisters. Our favorite fruit strawberry has seeds in and out and we savor the fleshy taste of ripe tomatoes as well as eggplants in our torta not minding all the seeds in them. Indeed, what do all these culinary delights have in common? They are all rich in the so-called "purines" which from a biochemical standpoint are rich sources of proteins but at the same time, when broken down and metabolized, yield uric acid or urate, which unlike urea, which is water soluble, is easily excreted in the urine thru the kidneys.

Excessive uric acid in the blood could be due to two factors- overproduction of uric acid which means dietary overload of purine-rich foods- innards, seeded fruits and vegetables, sauces, alcohol or under excretion of uric acid thru the kidneys.

Various laboratories may have different ranges of normal blood or serum uric acid. However, in general, a uric acid higher than 7 mg% or 7 mg/dl is already considered hyperuricemia. Thus, the doctor must have a thorough discussion with the patient as to certain do's and don’ts. Of course, the most logical sensible advice is to minimize or cut down on the intake of purine-rich food.

While it's true that uric acid is not water-soluble, drinking 8-10 glasses of water would send the person to the bathroom thus decreasing the possibility of whatever little uric acid sediments to collect and coalesce to form stones.

The crystals formed from the sediments of uric acid is called Tophus (tophi-plural). These could be deposited on soft tissues in our body like ear lobe, nose, joints in our hands particularly fingers. However, the most common site of deposition of uric acid crystals is the big toe called podagra, which patients themselves would admit, it is an extremely excruciating painful form of arthritis which would prevent them from wearing shoes, or even cover their body with blanket because the more touch would send them screaming in pain.

Aside from the gouty arthritis, there is also the risk of gouty nephropathy- deposition of uric acid crystals in the kidneys affecting its excretory function, and worse if the crystal would have become a stone to exert obstruction or blockade of urine flow especially in the ureters, ten it might lead to swelling of the kidneys called hydro nephrosis. Many doctors now acknowledge, that aside from diabetes and chronic hypertension as major causes of dialysis, gouty nephropathy is now a worrisome cause, especially among the males.

Lately, there is also that disturbing finding that high uric acid is associated with a 62 percent increase in the risk of hip fracture among older men. A plausible mechanism being forwarded by both orthopedic surgeons, rehab doctors and endocrinologists is that uric acid affect activation of vitamin D. We have two sources of vitamin D. Ergocalciferol or vitamin D2 is sourced from dairy products like milk, cheese, yogurt, also sea foods.

Vitamin D3 or cholecalciferol is obtained from exposure to early morning sun, converting the so-called 7-dehydrocholesterol in our skin to Vit D3. Inside the body, both D2and D3 undergo initial activation in the liver into Calcidiol and the final activation occurs in the kidneys to Calcitirol- the most potent form of activated vitamin D. through the help of a critical enzyme called renal-l-alpha hydroxylase- which many researchers now believe is inhibited by excessive amounts of uric acid.

The claim that uric acid does direct harm to the bone, is at best, speculative, thus more research and clinical studies must be done.
Be that as it may, it would make sense for older men- myself included- to be more careful in bending as when lifting heavy loads or sudden stretching as done upon waking up. Forewarned is forearmed.
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