Are hyperuricemia and gout the same thing? Is eating meat or drinking soup the main culprit behind gout? Why do young people develop gout? Does consuming alkaline foods help?

Today, I’ve invited a specialist professor to address common questions about gout and hyperuricemia, explain how to avoid hidden triggers of gout, and highlight how small lifestyle changes can improve overall health.

What is the difference between gout and hyperuricemia?
Many people assume that elevated uric acid levels in blood tests automatically mean they have gout. For example, some patients claim, “I’ve had gout for years,” when they actually only have hyperuricemia. Others experience joint swelling and pain but fail to realize it’s gout, mistaking it for hyperuricemia.

Hyperuricemia is diagnosed when two separate blood tests (on different days) show uric acid levels exceeding 420 μmol/L. Gout, however, develops when prolonged hyperuricemia leads to the formation and deposition of urate crystals in joints and surrounding tissues. These crystals trigger inflammation, causing acute symptoms like joint swelling, pain, redness, and limited mobility. This is “gout” in the narrow sense. Broadly, gout encompasses systemic damage, such as kidney impairment (uric acid nephropathy). Typically, “gout” refers to gouty arthritis.

In rare cases, patients may develop gout even if their uric acid levels are below 420 μmol/L. This can occur due to individual factors like increased crystal deposition, pre-existing joint damage, or genetic predisposition.

Where does purine come from?
Uric acid in the body has two sources: 80% is produced through internal metabolism, and 20% comes from diet. All foods contain some purines, but levels vary significantly. A critical point is that purines are water-soluble. This explains why meat broth, thick soups, and seafood broth are strongly discouraged—they concentrate purines during cooking.

Fruits: A hidden risk for hyperuricemia
With improved living standards, people often consume large amounts of fruit, assuming it’s universally healthy. However, modern fruits are often high in sweetness and fructose. Excessive fructose intake is a major contributor to elevated uric acid.

Current guidelines increasingly emphasize limiting fructose. Unlike purines (e.g., from meat broth), which rapidly convert to uric acid, fructose’s metabolic effects are delayed. This makes it harder for people to link occasional fruit consumption to gout flares.

Are people with high uric acid levels “smarter”?
Low uric acid levels are associated with neurodegenerative diseases, humorously leading to the saying that “high uric acid individuals are smarter.”

Humans uniquely develop hyperuricemia among animals that consume red meat. This is due to the evolutionary loss of the uricase gene, which prevents uric acid breakdown. While medications can lower uric acid, levels should not drop below 180 μmol/L to avoid neurological risks.

Is baking soda effective for lowering uric acid?
Many self-prescribe baking soda (sodium bicarbonate) for hyperuricemia, risking side effects like bloating, digestive issues, or worsened hypertension (due to high sodium content).

Baking soda does not directly lower uric acid. It alkalizes urine, reducing the risk of uric acid crystallization and kidney stones. However, any perceived benefit is likely due to concurrent lifestyle changes (e.g., diet adjustments). Doctors only recommend it for high-risk kidney stone cases, and alternatives like citrate formulations may be safer, especially for hypertensive patients.

Why are young men increasingly affected by hyperuricemia?
Hyperuricemia is rising among young males aged 18–29, with a prevalence of 32.3%. Many have severe levels (500–600 μmol/L), increasing their gout risk.

Estrogen in premenopausal women promotes uric acid excretion, offering protection. Post-menopause, women’s uric acid levels approach those of men. Young women with severe gout should undergo medical evaluation.

Men’s higher muscle mass contributes to uric acid production. Additionally, anaerobic exercise generates lactic acid, which competes with uric acid for renal excretion, temporarily elevating uric acid levels. Dietary habits (e.g., alcohol, red meat) and less restrained eating patterns also play roles.

What should parents do if their child has high uric acid?
Routine pediatric checkups often exclude uric acid testing, but risk factors are rising: academic stress, sedentary lifestyles, poor sleep, excessive red meat/fructose intake, and overconsumption of bone broths.

Parents should prioritize balanced nutrition, outdoor activities, and avoiding overindulgence in red meat or sugary fruits. Early lifestyle interventions are crucial to prevent long-term complications.