First, we need to understand where uric acid comes from. Animal cells (including human cells) have structures called DNA that are located in the cell nucleus. This DNA breaks down into components called amino acids when a cell dies due to the action of the immune system. Some of these amino acids are called purines, which, in turn, are converted to other chemicals. Our body processes some of these chemicals with those who remain, continuing to turn into uric acid, in some ways are waste products that are then excreted by our kidneys into urine. This article will discuss how to lower uric acid levels.
This is a very complex process, but with this concept in mind, you can understand why certain diseases are associated with high uric acid levels. For example, if a person has a heavy burden of dying cells, for example, some types of cancer or those who are undergoing chemotherapy to treat cancer, then more DNA is split into purines, which leads to its excess production.
And vice versa, when it cannot be effectively excreted from the body, as, for example, with many diseases of the kidneys or because of many drugs that interfere with this process of excretion. This is especially true for diuretics, which remove water from our body through other products, such as uric acid. Rarely, a person is born with a defective stage of uric acid metabolism, after which gout develops at a young age, sometimes associated with heredity.
When the degree of uric acid is very high in the blood circulation, this is called hyperuricemia. This situation is also closely linked to obesity. It is believed that adipose tissue enhances the production of uric acid. Hyperuricemia is part of the “metabolic syndrome”, which is associated with an increased risk of heart attacks and strokes.
We also get purine amino acids from our diet. It is estimated that 10-15% of our purine load is of dietary origin. High purine foods include offal, seafood (especially crustaceans), red meat, and alcohol.
How to lower uric acid levels
Most patients need medication to treat the inflammation that occurs during an acute attack. These include anti-inflammatory drugs, corticosteroids, and colchicine.
There are many anti-inflammatory drugs on the market. Some are over-the-counter (such as Nurofen, Bruffen, and Voltaren), while others require a prescription. You must tell your doctor if you are already taking the drug without a prescription, otherwise, you will be taking two anti-inflammatory drugs at the same time, and ultimately unpleasant complications.
A corticosteroid is a compound that is made in our adrenal glands. We need a corticosteroid to survive. When our body goes through stress, such as infection or damage, our adrenal glands pump out a large amount of corticosteroids to increase metabolism and modulate the inflammatory response so that it does not get out of control and does not damage our body tissue. You can think of it as an anti-inflammatory drug that works in a different way, with a very different spectrum of side effects. Corticosteroids can be prescribed as tablets or even injections into an inflamed joint.
Colchicine is a drug derived from plants, which is also used to treat gout attacks. In fact, acute attacks can be interrupted with very early use of this medication. Early clinical studies used high doses to treat an acute attack (two tablets every two hours), but this approach was associated with significant side effects, including nausea, vomiting, diarrhea, and in some patients, dehydration and multiple organ failure. Subsequent studies have shown that lower doses are equally effective (two to three tablets per day) and have a much lower chance of adverse events.
All of the above drugs do not lower the level of uric acid in the blood. They are used to treat an acute outbreak of gout. They can also be used during the initiation of therapy to prevent acute inflammation.
The course of treatment for gout is to lower the level of uric acid in the blood.
How to lower uric acid levels with a diet. Dietary changes can be extremely beneficial. Patients with early illness can avoid lifelong pharmacotherapy if a dietary change is combined with regular weight loss exercises. An experienced nutritionist can analyze your set of foods and give you advice on which foods should be reduced or avoided. And also provide practical alternatives. They will also help you with your weight loss program and will work with you to optimize your long-term commitment to these lifestyle changes.
Unlike popular belief, a diet that strictly limits purine intake is not essential. Many people believe that such a diet is unacceptable and in itself not effective enough to lower uric acid levels below the target range. Instead, emphasis should be placed on limiting calories, increasing the intake of the right type of protein, and replacing refined carbohydrates with complex carbohydrates.
How to lower uric acid – drink more water and less caffeine or alcohol. High concentrations of uric acid can result from excessive alcohol and caffeine consumption. Alcohol and caffeine contribute to the production of purines, which increases the concentration of uric acid in the blood. Drinking citrus drinks, such as orange juice, can lower uric acid levels in the case of kidney stones from these sources, however, consult your doctor to determine the type of stone formed. The National Center for the Study of Kidney and Urological Diseases suggests drinking plenty of water to flush uric acid and prevent the formation of uric acid stones.
The most commonly used drug for reducing uric acid is allopurinol. It lowers its blood level very quickly, and this creates a gradient for uric acid in our joints to return to the blood circulation and then be removed by our kidneys.
Therefore, it is very important that allopurinol begins in a small dose along with prophylactic treatment. Such as an anti-inflammatory, colchicine, or even a small dose of corticosteroids. This approach aims to prevent an outbreak of gout, while allopurinol is initiated and then increased to lower its level to a level below the target.
Finally, we must not forget that gout is part of the “metabolic syndrome”. Hyperuricemia is considered an independent risk factor for cardiovascular events such as stroke or heart attack. Your rheumatologist will work with your doctor to resolve other medical problems associated with this syndrome. Such as hypercholesterolemia (high cholesterol), diabetes and hypertension (high blood pressure).
Symptoms and signs of gout
The first outbreak of gout often occurs on the thumb. Historically, it was called “podagra” and was considered the “king of the diseases and diseases of the kings.” The onset of the disease is usually turbulent, with the development of pain, redness, swelling and delicate soreness of the affected joint, often within a few hours. Sometimes an initiating factor can be identified, such as recent drinking of alcohol or eating purine foods, local trauma, or the start of certain medications. Without treatment, an attack of gout is usually resolved within seven to ten days.
As uric acid levels continue to build up, attacks become more frequent, with each attack lasting longer and more joints being involved.
Sometimes inflammation can lead to fever, which makes it very difficult to distinguish from an infected joint and sometimes cellulitis, which is an infection of the soft tissues under the skin.
In the end, crystals accumulate in large visible nodes under the skin called tofus, in addition to their presence inside the joints. The inflammation caused by the accumulation of these crystals ultimately causes erosion of the affected bones, which leads to irreversible deformation of the joints and sometimes rupture of the skin that covers the tofu (which are then at risk of infection).
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