Uric acid is a waste product found in the blood. It is created when the body breaks down chemicals called purines that are associated with some high protein foods. Most often people take notice of high uric acid when it progresses towards Gout.  It progresses to gout stage in less than 1% of HUA sufferers. In the rest, HUA, even when slightly above normal causes more serious health issues like permanent bone, joint and tissue damage, kidney disease and heart disease.

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‘Eat less protein’ is the course of action taken by most Indians for high uric acid. High proteins may be the cause of HUA among people in the west whose staple diet is meat in every meal of the day. However, most Indians are grainarians (people whose staple food is grains), whether it is vegetarians or non-vegetarians, and Indians are protein deficient. Most Indians even though we are non-vegetarians, depend on dhals, some dairy sources like milk, curd for our protein requirements while most non-vegetarians consume protein sources like chicken and meat occasionally a couple of times a week. However, protein is a food group that should be consumed in every meal.

There are many scientific studies that suggest HUA increases Insulin Resistance (IR) and reducing the protein consumption in a bid to combat HUA by Indians will only aggravate other LSDs like Heart diseases, Diabetes, BP, fatty liver by further increasing Insulin Resistance and / or Obesity.

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Causes of HUA:

HUA may be either due to (a) Overproduction of Uric acid (b) Decreased uric acid excretion and (c) Combination of both.

1. Overproduction of Uric acid:

• Purine Rich Foods (Purines are mostly associated with high protein foods. Hence, the suggestion to eat less protein)

• Genetics – accounts only for around 7% of HUA cases.

• Medical conditions like psoriasis and cancers.

• Vigorous exercise/ dehydration can also be factors in HUA

1. Decreased uric acid excretion:

• Chronic Kidney Disease (CKD)

• High PRAL (Potential Renal Acid Load) diet.

• Excessive use of alcohol and medicines like Diuretics, Aspirin and Beta blockers etc.

 

Over Production of Uric Acid caused by Purine Rich foods: Purines do increase HUA. Given below is the list of high purine foods many of which, is not part of an Indian’s daily consumption.

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So, HUA among Indians for most of the cases may not be due to excess production of urates but due to decreased excretion of Urate. Other causes of overproduction are not dealt with in this article, either because, they are less significant as in Genetics, or a medical condition as in psoriasis or voluntary as in exercise / dehydration.

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Purines in some foods are shown below:

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Decreased Uric Acid excretion: This is the basic reason for Indians suffering with HUA. Different aspects involved in it are discussed below.

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Chronic Kidney Disease (CKD): CKD causing the HUA is a scientific fact. The mention of CKD evokes the images of Dialysis among general public. Stage 1 of CKD starts when eGFR slips below 90 mL/minute, while Dialysis is required only when eGFR reaches 15 or below. So, even Stage 1 of CKD can cause HUA which in turn increases the Insulin Resistance that causes all the modern diseases from Obesity to stroke. CKD, whether it is Stage 1 or Stage 5. High PRAL Diet is one of the main reasons for CKD.

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High PRAL (Potential Renal Acid Load) Diet: The Blood pH (a measure of acidity) of humans is tightly regulated between 7.35 and 7.45 i.e. slightly Alkaline, while bulk of the foods we eat are acidic in nature and have a PRAL. Several body processes besides Kidney and Liver are involved in maintaining the desired alkalinity. Higher the PRAL of the diet more the load on the kidneys and resultant injury, because of which Uric acid excretion by the kidneys decreases. In our experience of working with Indians across the globe, a high PRAL diet is one of the main reasons for HUA amongst Indians.

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PRAL of some foods is listed below.

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1. Red numbers indicate acidifying effect on the kidneys, while green numbers indicate alkalizing effect.

2. Protein/PRAL ratio indicates the load put on the kidney to maintain the desired Alkalinity for 1 gram of protein.

From the above table it can be noticed that high protein foods can cause kidney related conditions resulting in HUA due to decreased uric acid excretion. Avoiding these foods will cause protein deficiency which increases IR that results in HUA. So, balancing the acidic foods with alkalizing foods is the long term healthy solution.

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Our Support:

• Holistic approach that integrates the four elements – Adequate Nutrition, Appropriate Physical Activity, Stress management, Sound sleep for effective and sustainable results throughout lifetime.

• Provide a nutrition plan that is alkalinizing for the body with Low PRAL

• Recommend appropriate physical activity that benefits the medical condition

• Monitor water intake to improve the alkalinity of the body

• Balance health outcomes & pleasure foods to ensure sustainability in longer run

• Customize the program to support your current lifestyle & design a program that suits your pace of transition.

• Educate you so that you can independently make informed food choices & make sound decisions that support your overall health.

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