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Normal Uric Acid but Still Have Gout - The Gout BLACK BOX Theory!

Gout, despite the level of understanding we gained through experience and advancement of medical knowledge, is still an obscure medical condition. The locations of the next gout attack is usually a mystery. Even the joints and non-joints it attacks is covered in mist as well. In fact, even its complications are not fully understood.

Here is another weirdness to add to the long list: you can suffer from gout even if your uric acid level is normal!

This article aims to explain why people can suffer from gout despite the fact that they have normal uric acid level.

Uric Acid Levels. What Does it mean?

Uric acid is the end product of purine metabolism.  Purine is found all throughout your body since it is the building block of the DNA. All cells have preprogrammed “self-destruction” called apoptosis. Furthermore, all the foods you eat contains purine. Hence, purine will normally exist in the body. Unfortunately for you, your body can not excrete purine. Purine has to be broken down into uric acid to be excreted.

So, what does the presence of uric acid indicate? Congratulations! You are a normal person. That is, if the level of your uric acid is normal.

There are two ways two test uric acid levels: one is through a uric acid urine test, and the other is through a uric acid blood test. In a blood test, the normal uric acid level of a male is 4.0 to 8.5 mg/dL. For females, the normal uric acid level is 2.5 to 7.5 mg/dL.

Uric acid urine test is done by collecting your urine for an entire 24 hour period. The normal uric level is supposed to be 250 to 750 mg per day.

Having above average uric acid level is usually a sign of bad health, such as damaged kidneys, hyperuricemia and gout!

Here is the catch: some people, even if they fall perfectly within the bounds of those limits, suffer from gout attacks. Others far exceed those normal values, yet they do not suffer from gout. This is where the “gout black box theory” comes in.

The Gout Black Box Theory

It only takes a single shot of beer for some people to suffer from gout attack, while others can endure an all-night beer party without any joint pain. The reason for this is the pathway of uric acid is like a mysterious black box, just like those used in magic shows. The illusionist puts his hands in the box and voila! He draws some random stuff from the box. The audience will never know what is happening inside the box, just like how they will never know what will appear. A bunny? A pair of bunny? Or maybe an alligator!? It is full of surprises! Just like how you put too much uric acid in your body. You’ll never know how much uric acid you will need to produce a negative result, and you’ll never know what you’ll get. Gout? Gout in the fingers? Gout in the elbow? Gout in multiple joints? Gout inside the ear? Or maybe diabetes!

The main point is the “normal” uric acid level is not always normal for everyone. Your supposedly normal uric acid can deviate from those recommended. The reason behind this is the unique factors. Several aspects are to be considered for the precipitation of gout and the ignition of pain and inflammation. There are two main reasons why even people suffer from gout despite the normal uric acid level.

1.)   Your normal uric acid level is different from the standard range – there is a multitude of reasons behind this. For instance, the solubility of uric acid may vary from individual to individual mainly because of the presence of different solutes in the blood. For instance, a person with high sodium diet has a lower supersaturation point for uric acid crystals. Hence, gout forms easier!
It is also possible that an individual has low glomerular filtration rate, or the filtering capacity of the kidney. This lessens uric acid excretion rate. Such conditions require medical attention because this may indicate some kidney problems. This possibility is more likely if you have high uric acid serum level but that of the urine is subpar.

The uric acid output rate can also be reduced if your body is too acidic since the excretory system have to take care of all those excess acids to balance the body’s pH. For instance, the liver’s attentions is divided between granting uric acid the clearance and converting lactic acid into glucose.

2.)   The uric acid is hidden- if both serum and urine uric acid is below average and you get gout, this is the most likely reason. Chances are, the tophaceous deposit has formed some time ago, hence the uric acid is in the joint. Furthermore, to balance your body’s pH, the bod has to store excess acids, such as uric acid to the interstitial space. This is not traceable through ordinary serum uric acid test.


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