Question: My husband suffers from uric acid kidney stones and episcleritis, which we understand are related, and is currently taking potassium citrate. Are the stones a metabolic disorder? What else can or should be done to prevent re-occurence? What else should he change? Any and all help will be GREATLY appreciated!!

Larry’s Response: Elevated uric acid levels suggest an increased potential for stones and gout. At body temperatures, purines are converted to uric acid and its salts. The salts are not very soluble and have a tendency to build up in various parts of the body.

The most well known is in the foot. The deposited salts are sharp and cause pain. There are two traditional approaches to elevated uric acid; reducing the sources of purines, and increasing the potential for dissolving the salts (more water).

One thing that is often not considered is the role that testosterone plays in the metabolism of the offending substances. Testosterone levels decline with age and the protection afforded by this hormone diminishes, possibly resulting in more flare-ups. It isn’t just testosterone, but the resultant levels of iron and copper (used in the metabolism and excretion of xanthines – a general category that includes uric acid).

Purines are found in high amounts in animal food products, such as liver and sardines. A moderate amount of purine is also contained in beef, pork, poultry, fish and seafood, asparagus, cauliflower, spinach, mushrooms, green peas, lentils, dried peas, beans, oatmeal, wheat bran and wheat germ. There is a significant hereditary component for elevated uric acid. There is nothing a person can do about changing their hereditary predispositions, of course. That leaves prevention and treatment of flareups as the only viable, non-drug, approaches to relief.

I suggest:

  1. Avoiding foods that provide purines – as much as possible.
  2. Make every effort to maintain hydration by drinking clean water (and avoiding beer and wine).
  3. When testosterone levels are low, treatment with a good quality supplement can help. Injections and transdermal creams are superior to oral doses.