Higher Uric Acid Levels in Vegans

I’m going to take a brief break from the antioxidant discussion to report on a cross-sectional study just released from EPIC that shows vegans to have higher levels of uric acid than lacto-ovo and pesco-vegetarians (people who eat no meat other than fish).

To quote the authors, “Uric acid is the end product of purine metabolism, generated from the breakdown of DNA, RNA and ATP… High circulating concentrations of uric acid can lead to gout, a common form of arthritis, and have also been linked to chronic kidney disease, cardiovascular disease and cancer.”

In the model adjusted for age and alcohol intake (but not body mass index), the results were (µmol/l):

Men
Meat-eaters – 323
Pesco – 307
Lacto-ovo – 301
Vegan – 336

Women
Meat-eaters – 239
Pesco – 224
Lacto-ovo – 228
Vegan – 243

In our correspondence, author Paul Appleby told me that the differences between the vegans and the pesco/lacto-ovo groups were statistically significant for both genders, and the differences between the vegans and meat-eaters were statistically significant for men only.

How could this be?! Apparently, dairy products have been shown to lower uric acid levels. And in this study, there was a significant positive correlation between uric acid and soy protein intake in men.

The good news is that these levels are still within the normal range which is 202-416 µmol/l for men and 143-357 µmol/l for women (2). And even though the differences were statistically significant, they were not huge (about 11% in men and 8.5% in women).

These levels do not appear to be associated with an increased risk of kidney disease (3) or cardiovascular disease (4). One study found an increase in risk of stroke for uric acid levels above 297 µmol/l, but another did not find a statistically significant difference for levels above 410 µmol/l (4).

Uric acid is an antioxidant and has been studied for its potential to prevent cancer, but the findings have not been in that direction. One study found an increased risk for cancer above the normal levels (5), while another found an association of cancer in men (women were not in the study) in the range of the vegans in the EPIC study (6). The authors (6) noted that vitamin B12 deficiency can increase uric acid levels and also stated, “we hypothesize that elevated [serum uric acid] acts as a valuable, long-term, surrogate parameter, indicative for a life-style which is at increased risk for the development of cancer, but does not function as an independent risk factor or even carcinogenic substance by itself.”

Given all the above, I do not think there is much to worry about, though it would be interesting to see if cancer deaths are related to uric acid levels among vegans in EPIC (if there are enough participants to determine this).

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References

1. Schmidt JA, Crowe FL, Appleby PN, Key TJ, Travis RC (2013) Serum Uric Acid Concentrations in Meat Eaters, Fish Eaters, Vegetarians and Vegans: A Cross-Sectional Analysis in the EPIC-Oxford Cohort. PLoS ONE 8(2): e56339. doi:10.1371/journal.pone.0056339 | link

2. Uric Acid in Blood. WebMD. Last Updated: December 09, 2010. Accessed February 15, 2013. | link

3. Feig DI. Uric acid: a novel mediator and marker of risk in chronic kidney disease? Curr Opin Nephrol Hypertens. 2009 Nov;18(6):526-30. | link

4. Gagliardi AC, Miname MH, Santos RD. Uric acid: A marker of increased cardiovascular risk. Atherosclerosis. 2009 Jan;202(1):11-7. | link

5. Strasak AM, Lang S, Kneib T, Brant LJ, Klenk J, Hilbe W, Oberaigner W, Ruttmann E, Kaltenbach L, Concin H, Diem G, Pfeiffer KP, Ulmer H; VHM&PP Study Group. Use of penalized splines in extended Cox-type additive hazard regression to flexibly estimate the effect of time-varying serum uric acid on risk of cancer incidence: a prospective, population-based study in 78,850 men. Ann Epidemiol. 2009 Jan;19(1):15-24. | link

6. Strasak AM, Rapp K, Hilbe W, Oberaigner W, Ruttmann E, Concin H, Diem G, Pfeiffer KP, Ulmer H; VHM&PP Study Group. Serum uric acid and risk of cancer mortality in a large prospective male cohort. Cancer Causes Control. 2007 Nov;18(9):1021-9. | link

27 Responses to “Higher Uric Acid Levels in Vegans”

  1. Amanda Says:

    It’s interesting to see so much research being done that differentiates between vegans and lacto-ovo vegetarians! It seems like with a lot of your older blog posts, you had to speculate about how things applied to vegans because either there were no vegans in the studies or the authors did not differentiate between different types of vegetarians.

    Anyway, I was actually wondering about uric acid recently because of observations of my own urine that I won’t discuss in detail. I didn’t know it could possibly be associated with B12 deficiency. I have actually been eating less fortified food than I was the last time I got my nutrient levels tested.

  2. Josh Latham Says:

    “And in this study, there was a significant positive correlation between uric acid and soy protein intake in men.”

    Is there any way to know if the soy they consumed in this study was isolated or not? Also how much soy was consumed.

  3. Jack Norris RD Says:

    Josh,

    I calculate that the vegans averaged 12.7 g of soy protein per day for women (3.0% of energy, energy was 7076 kj/d (1691 kcal)) and 12.4 g per day for men (2.6% of 8001 kg/d (1912 kcal)).

  4. Jack Norris RD Says:

    Josh,

    I forgot – no the study didn’t distinguish between isolated soy protein and other soy protein.

  5. Bertrand Russell Says:

    >The authors (6) noted that vitamin B12 deficiency can increase uric acid levels and also stated, “we hypothesize that elevated [serum uric acid] acts as a valuable, long-term, surrogate parameter, indicative for a life-style which is at increased risk for the development of cancer, but does not function as an independent risk factor or even carcinogenic substance by itself.”

    If vegans had been lower, you can bet your bottom dollar certain groups would be screaming that vegans have less cancer! (Not just lower risk of cancer, they’d actually say “less cancer!”)

  6. Syd Baumel Says:

    Hi Jack,

    Did the EPIC study have the data to check for a negative correlation between B12 status and uric acid levels? What if it’s mostly down to more plant protein (low B12, unless fortified) and less B12 = higher uric acid?

  7. Jack Norris RD Says:

    Syd,

    The EPIC authors didn’t mention the correlation between B12 deficiency and uric acid and they did not report measuring it in that study. You might ask Paul Appleby on IVU-Sci.

  8. Idan Says:

    mine is 315 after 4.5 years of veganism .
    i do consume soy but i can’t say that alot .
    some tofu occasionally and regular consumption of soy milk

  9. Stefan Says:

    Hi Jack,

    is there a danger in consuming too much soyprotein? I’m an endurance athlete and I’ve got a protein intake of 120-130g per day, about 50-60g are from soy (Soyproteinisolate, Tofu, Soymilk).
    Many thanks for your answer and your blog.

  10. Jack Norris RD Says:

    Stefan,

    That’s about 5-7.5 servings. Soy intakes that high have not been studied much, but up to 3 servings a day have not been shown to be harmful to anyone except people with subclinical hypothyroidism (in which case less than one serving was shown to be harmful).

    Here is an article I wrote examining the dangers of soy: http://veganhealth.org/articles/soy_wth I haven’t updated it since 2011, but I’m not aware of any new research that would change the conclusions.

  11. Andrea Says:

    But I know that uric acid is an antioxidant, is correct?

  12. Jack Norris RD Says:

    Andrea,

    Yes – the authors of one of the cancer studies said that they were investigating uric acid levels and cancer to see if it could prevent cancer, but they found uric acid to be correlated with cancer instead.

  13. Ron Says:

    I’ve had gout while on a long-term (30+ yrs.) vegan diet. My uric acid level was and is high normal; curiously, one can have gout while within the normal range. Luckily, mine was in a joint where it could be treated surgically; that isn’t usually the case. Now I only have pain in that toe if I get dehydrated. I’ve never found that plant purines were a problem. I eat soy, but rarely consume isolated soy protein.

  14. David Says:

    About 15 years ago I read an article warning that nutritional yeast will raise uric acid levels (it’s ridiculously high in protien). I was consuming moderate amounts daily so I went and had my uric acid level taken. Sure enough, it came back high. I stopped using it for 6 weeks (this was torture because I love it on popcorn), and had my u.a. level re-checked and it came back well within normal. I still use nutritional yeast, but very sparingly and my u.a. levels remain in the high normal range. I now usually warn new vegans to take it easy on the nutritional yeast. It’s easy to go overboard if you’re suffering cheese withdrawal!

  15. ultrarunner Says:

    Stefan –

    If your soy protein isolate is in the form of protein powder, you can try other plant-based protein powders that contain protein from pea, brown rice, hemp, etc.

  16. Craig Says:

    Were the vegans consuming more fruit? Uric acid is a by-product of fructose metabolism.

  17. Jack Norris RD Says:

    Craig,

    Yes, the vegans were eating 275 g/d of fruit compared to 181 g/d in the meat-eaters. Sorry it took me so long to respond, this one got buried.

  18. JenInFrance Says:

    For me the bigger question is – do vegans get more gout or not compared to the rest of the population. Is Uric acid the cause or only part of a bigger equation. It could help answer that questions to know the correlation between diet choices and incidences of gout and uric acid levels. I have heard of people saying this diet greatly reduced or cured their attacks of gout, but of course it is just the people who decide to write to forums. I have never had it but my husband is starting to get attacks, and he is a massive meat eater (I am vegan) and drinker of beer. He also has kidney failure – hard to know the chicken and egg there so to speak. But if they were doing a study on uric acid in general perhaps they did not log information on gout.

  19. Jack Norris RD Says:

    JeninFrance,

    I just did a PubMed search for any studies on “vegetarian” or “vegan” and gout and I found nothing. However, anecdotally, it seems that people who get gout tend to be on very high animal-product diets and I’ve heard of people going vegan getting relief. If you look at what Mayo Clinic says patients with gout should eat, it appears to be very vegan friendly:

    http://www.mayoclinic.com/health/gout-diet/MY01137

  20. Latch Says:

    I have gout and its cause is more than merely dietary, as is the case with many illnesses, there has to be a potential, an activation of the potential, and a failure of the defenses against the condition.

  21. Auggiedoggy Says:

    Is there a correlation between fructose and high uric acid?

  22. Jack Norris RD Says:

    > Is there a correlation between fructose and high uric acid?

    It’s not clear to me. You might be interested in this study:

    http://www.nutritionandmetabolism.com/content/7/1/16

  23. Laura Slitt Says:

    Three weeks ago, my big toe on my right foot swelled and I could not sleep it hurt and burned so badly. The top of my foot also swelled. Gout was suspected. It feels like I broke by toe. Tough since my three jobs are on my feet.

    The conventional doctor prescribed a potent anti-inflammatory which helped hugely and in a few days, after taking only one a day instead of recommended four, I took myself off it. The pain came back with a vengance and I’m at a loss what to do.

    I’m vegan but do est tons of Nutritional yeast and fruit, which I’m seeing here might be bad.

    Any natural remedies?

  24. Mackie Says:

    Laura – you note you are “at a loss what to do” because when you stopped taking the anti-inflammatory the pain came back. Logically, don’t you think you should go back to taking the anti-inflammatory, because it worked? I get continually baffled by the anti-medical/science. Not everything from science and doctors is bad! I’m vegan, and my husband is as well. He has had 2 gout attacks in the last 2 years. It’s genetic, as his father and brother both suffer (both omni). It also is a buildup, he likely has been building the crystals up for years.It can be controlled by drinking lots of fluids, eating tart cherries daily and wine/spirits in moderation. However, when he has an attack the only thing that helps him through it is the anti-inflammatory so he takes it, and it works. I really don’t understand why you stopped and now don’t know what to do.

  25. Laura Slitt Says:

    Mackie, thanks for the thoughtful and useful response. I felt that taking the pills, very strong pills, was not the best treatment holistically.
    Yes, they helped but not what caused the problem.

    I did start taking them again but only for a couple days. That was a week ago and so far, no huge flare up and no pain.
    I read about foods that are highest in uric acid, and had to cut back. I am a huge user of nutritional yeast and I eat tons of cauliflower, both very high in UA. Tart cherries? Yum.

  26. munjal Says:

    i was having uric acid level at 10 and B12 26. but after taking medicine, uric acid is now 7.4 and B12 is 366.
    but, yet i am suffering from pain in lower leg and at many joints.

    i am pure vegetarian. i dont take beer or any liquor. i am not taking any high protein food. Although, i am not getting any relief from pain.

  27. Brian Says:

    Thanks for the article. Vegan 8 years here. I just received blood test results with above normal urate of 540. A year ago it was 660 and a year before that 420. Dr says I may need to be concerned about gout, but no problems yet. Everything else normal (B12 etc) but BMI currently 30 so am working on losing 20kg. The article doesn’t say much about gout but I see some vegan commenters mention having suffered from it. I guess it is something I should watch.

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