High Uric Acid: What It Means and What to Do
Hyperuricaemia (high uric acid) affects approximately 20% of Australian adults. Not everyone with high uric acid gets gout — but understanding your level, triggers, and treatment options can prevent painful flares and long-term joint damage.
What Is Uric Acid and Why Does It Rise?
Uric acid is the end product of purine metabolism. Purines come from two sources: your body's normal cell turnover (endogenous, about two-thirds) and your diet (exogenous, about one-third). The liver processes purines into uric acid, and the kidneys excrete approximately 70% of it, with the gut handling the remaining 30%.
Hyperuricaemia occurs when uric acid production exceeds excretion. The saturation point for urate in blood is approximately 0.42 mmol/L at body temperature — above this, monosodium urate crystals can form in joints and tissues. These needle-shaped crystals trigger the intensely painful inflammatory response known as gout.
The normal reference range for uric acid in Australian pathology laboratories is 0.15–0.36 mmol/L for women and 0.21–0.42 mmol/L for men. Women tend to have lower levels due to the uricosuric effect of oestrogen — after menopause, women's uric acid levels rise toward male ranges, which is why gout becomes more common in post-menopausal women.
Understanding Your Uric Acid Level
Below 0.36 mmol/L (women) or 0.42 mmol/L (men)
Implication: No increased gout or kidney stone risk.
Action: No action required. Recheck if symptoms develop.
0.42–0.54 mmol/L
Implication: Increased risk of gout over time. Most people remain asymptomatic.
Action: Lifestyle modifications: diet, hydration, weight management. Recheck in 6–12 months.
0.54–0.72 mmol/L
Implication: Significant gout and kidney stone risk. May have urate crystal deposition.
Action: GP review. Lifestyle changes plus consider urate-lowering therapy if symptomatic or with comorbidities.
Above 0.72 mmol/L
Implication: High risk of acute gout, tophi formation, uric acid kidney stones, and cardiovascular events.
Action: Medical treatment indicated. Urate-lowering therapy (allopurinol or febuxostat) plus lifestyle changes.
Dietary Triggers: High vs Low Purine Foods
While diet accounts for only about one-third of uric acid production, dietary changes can lower uric acid by 0.06–0.18 mmol/L — enough to tip some people below the crystallisation threshold. Importantly, plant-based purines (vegetables, legumes) do not significantly raise uric acid levels, despite being high in purines on paper.
| Category | Avoid / Limit (High Purine) | Prefer (Lower Purine) |
|---|---|---|
| Protein Sources | Organ meats (liver, kidney), game meats, shellfish (prawns, mussels, scallops) | Eggs, low-fat dairy, tofu, chicken breast (moderate) |
| Seafood | Anchovies, sardines, herring, mackerel, scallops | Salmon (moderate), white fish (moderate) |
| Beverages | Beer (highest risk), spirits, sugar-sweetened drinks, fruit juice | Water, coffee (protective), low-fat milk, herbal tea |
| Other Foods | Yeast extracts (Vegemite in excess), gravy, meat-based stocks | Vegetables (including high-purine veg like spinach — plant purines are safer), wholegrains, nuts, cherries |
5 Evidence-Based Lifestyle Changes
Hydration
Aim for 2–3 litres of water daily. Adequate hydration helps the kidneys excrete uric acid and reduces kidney stone risk. Dehydration concentrates uric acid and is a common gout trigger.
Diet Modification
Limit high-purine foods (organ meats, shellfish, beer). Increase low-fat dairy, vegetables, and cherries (which lower urate levels). The DASH diet has been shown to reduce uric acid by up to 0.35 mmol/L.
Weight Management
Losing even 5–10% of body weight can significantly reduce uric acid levels. Obesity increases uric acid production and impairs kidney excretion. Avoid crash diets — rapid weight loss temporarily raises uric acid.
Alcohol Reduction
Beer is the worst offender (high in purines AND impairs uric acid excretion). Spirits are moderate risk. Wine appears to have the least effect. Reducing or eliminating alcohol is one of the most effective lifestyle changes.
Medication Review
Some medications raise uric acid: thiazide diuretics, low-dose aspirin, cyclosporine, and pyrazinamide. Never stop prescribed medications without discussing with your GP — the benefits may outweigh the uric acid effect.
When Is Medication Needed?
The Australian Rheumatology Association recommends urate-lowering therapy (ULT) when lifestyle changes alone are insufficient and the patient meets specific criteria:
Two or more gout flares per year
Presence of tophi (urate crystal deposits under skin)
Uric acid kidney stones
Chronic kidney disease with hyperuricaemia
Uric acid persistently above 0.54 mmol/L with gout history
Joint damage visible on imaging
Allopurinol is the first-line medication in Australia. It works by inhibiting xanthine oxidase, reducing uric acid production. It is started at a low dose (100 mg daily, or 50 mg if kidney impairment) and titrated upward every 2–4 weeks until the target uric acid of below 0.36 mmol/L is reached. Febuxostat is an alternative for patients who cannot tolerate allopurinol. Both require monitoring blood tests (uric acid, kidney function, liver function) every 3–6 months.
What to Ask Your GP
Script for your GP appointment:
“My blood test shows high uric acid. I'd like to understand my overall metabolic risk. Could we also check my kidney function, fasting glucose, and lipid profile? Should I be concerned about gout, and are there dietary changes that would help?”
| Test | Purpose | Cost (Australia) |
|---|---|---|
| Serum Uric Acid (Urate) | Measure blood uric acid level — the primary test | Bulk billed |
| Kidney Function (eGFR, Creatinine) | Assess kidney function (kidneys excrete 70% of uric acid) | Bulk billed |
| Full Blood Count (FBC) | Screen for haematological causes of high uric acid | Bulk billed |
| Liver Function Tests (LFTs) | Assess liver health (alcohol-related elevation) | Bulk billed |
| Fasting Glucose / HbA1c | Screen for diabetes and metabolic syndrome (associated) | Bulk billed |
| Lipid Profile | Cardiovascular risk assessment (hyperuricaemia linked to CV disease) | Bulk billed |
| 24-Hour Urine Uric Acid | Distinguish over-producers from under-excretors | Bulk billed |
| Joint Fluid Analysis | Definitive gout diagnosis — urate crystals under polarised light | Bulk billed |
Related Reading
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Reference ranges sourced from the Royal College of Pathologists of Australasia (RCPA) and Australian Rheumatology Association guidelines. SmarterBlood provides health information and AI-powered blood test analysis. It is not a substitute for professional medical advice, diagnosis, or treatment.