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HACK MY LABS - ELEVATED BUN, URINE URIC ACID

Answered on February 12, 2015
Created August 22, 2012 at 7:53 AM

Current stats: Male - Age: 52 Height: 5-7 Weight: 167lbs - approx. 130lbs fat-free mass - Bodyfat: 18.4%

Average Macros: Calories: 1400 Protein: 135g Carbs: 40g (<10g of that from fructose, mostly berries) Fat: 75g

I have been eating VLC paleo and doing intermittent fasting for about the last 6 mos. as I am trying to lose bodyfat. My goal is to get to 10% bodyfat first before I can start adding more lean mass. I resistance train 4 x's/week.

My latest CMP showed elevated BUN (36 - ref range: 6-24), elevated BUN/Creatinine ratio (39 - ref range:9-20), and elevated urinary uric acid (1118.0 - ref range: 250.0-750.0) which qualifies as hyperuricosuria (http://emedicine.medscape.com/article/444866-overview).

I also showed elevated serum calcium (10.9 - ref range: 8.7-10.2). My serum uric acid (UA), however, is normal (4.6 - ref range: 3.7-8.6) as is my creatinine (0.92 - ref range 0.76-1.27) and eGFR (95 - ref range >59). There is no protein in my urine. I do not have gout. This would indicate there is no incidence of CKD or kidney failure and that my kidneys are able to remove the UA effectively. These levels have gradually increased over the last 6 mos.

I understand that the elevated levels are a direct result of purines from increased protein metabolism and its waste products. However, 135g of daily protein to maintain lean mass is by no means excessive, especially for someone who trains, so I cannot understand these markers being increasingly elevated. In fact, according to this excerpt from the following link, increased protein intake DOES NOT translate in increased uric acid excretion:

"The excretion of uric acid bears no relationship to the extent of protein metabolism, for an excessive consumption of nitrogenous food (free from nuclein) does not increase the amount of uric acid excreted, even although the metabolism may be increased. Thus from 18 grams of protein food 433 mgr. uric acid were excreted, whereas from 80 grams of protein food not more than 442 mgr. uric acid were excreted."

Read more: http://chestofbooks.com/health/nutrition/Diet-Theory/Metabolism-Of-Uric-Acid.html#ixzz24EKRQQF8

On a side note, I had passed a 3mm calcium oxalate kidney stone back in March. For stone prevention, I am drinking about 12 cups of water daily and taking approx. 5g potassium citrate to alkalinize urine. I urinate 1500-2000cc daily. I also take magnesium citrate. For many years I've had a problem taking pancreatin in that it made my urine very acid and caused mouth sores. Pancreatin is known to increase UA. In addition, my urine pH has always been about 5.0 (acid).

I realize that red meat is moderately high in purines (which can elevate uric acid), but I love my grass-fed beef and buffalo and would hate to give them up or reduce them!

The good news is that any excess UA is not being retained and is being excreted in the urine, otherwise my serum UA would be elevated. Still, this is a warning sign of possible gout or other dysfunctions.

I have a tendency toward hypertension. There is a link between elevated uric acid, kidney stone formation and hypertension: http://www.ncbi.nlm.nih.gov/pubmed/11812875

Possible causes/explanations:

  • serum UA seems to have an inverse relationship to urine UA; decrease of serum uric acid levels seems to increase the urinary excretion of uric acid.

  • when you eat more protein, your kidneys will extract more UA acid in your urine to compensate which is why my serum UA acid is normal.

  • imbalance in the ratio of protein to low-protein foods (i.e. fats, vegetables, fruits); not enough low-protein foods to compensate for increase in BUN and UA.

  • fasting increases UA excretion, but the increase in ketones cancels it out: http://www.researchgate.net/publication/223149335_Uric_acid_excretion_and_ketosis_in_fasting

  • both potassium and magnesium citrate increase rate of UA excretion: http://www.nutritionj.com/content/9/1/45 http://www.ehow.com/facts_5903307_supplements-remove-uric-acid.html

  • exogenous high doses of zinc and iron can elevate UA.

  • breakdown of fats by the liver produces several byproducts, including uric acid. I have NAFLD (fatty liver) and have read that VLC paleo and IF can accelerate the clearance of FFAs, especially when combined with exogenous choline.

    • other supplements causing elevated urinary UA excretion.
  • It also appears that uric acid increases the storage of body fat. Perhaps this is a factor in my inability to burn fat: http://donmatesz.blogspot.com/2011/08/my-ancestral-health-symposium.html

Possible Solutions (since reducing protein intake would be counterproductive to anabolism):

  • To balance out the overload of UA, I would increase veggies and healthy fats. If I increase fruits, then fructose increases which is counterproductive to fat loss and itself increase uric acid.

  • Maintain Vitamin C intake @ 5-7g daily.

  • drop the zinc to 50mg daily; should I drop the iron (I am taking 33mg from supps to raise serum ferritin)?

Any reason why serum calcium is elevated? My last PTH was normal.

Before resorting to meds like allopurinol to decrease urinary UA levels, any other pearls you guys can share??

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4 Answers

0
6e26507f7a6e39eeae3ec6262cd997c5

on February 12, 2015
at 06:20 PM

 excess protein intake and heavy gymnastics lead to elevated UA in the blood for starters. Alkalising your urine (through the alkalinization of your whole body) by Potassium citrate and MAgnesium Citrate disolves more UA in your urine and clears yor serum UA effectively. If you stop taking them you will probably see elevated levels of UA in your blood, hypertension, and decreased renal function. 5-7 g of Vit C is with no purpose as only some mgs are really absorbed from your Gastrointestinal sysytem. Vit C is also alkalising your urine!

0
13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on March 30, 2013
at 04:03 PM

What are your ferritin levels? Do you know why your ferritin needs to be raised?

This blog might interest you (archives) http://eatingoffthefoodgrid.blogspot.com

And why the pancreatin?

0
A402a961303d312055dc0b253f29deac

(320)

on February 16, 2013
at 12:46 PM

Here's the link that helped me most: http://www.emotionsforengineers.com/2009/09/causes-of-gout.html

To the best of my knowledge, there is no evidence for using allopurinol in asymptomatic hyperuricemia.

0
23f8b06a1844782baaa929df204596e0

on December 07, 2012
at 11:31 PM

I am sorry I have no answers for you. I am in search of answers myself and came across this page. You are almost identical to me in dilemmas. I would not change anything if I were describing myself. Have you found any answers ? I am on Hotmail
Fayerae1220 . Thanks !

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