High uric acid doesn’t need medication, says a nephrologist, and this is what he recommends instead

High uric acid is a common complaint among most patients and is often detected in several medical tests. Before it develops into a full-blown problem, it starts showing symptoms that appear even before.

In India and globally, this number often pushes people into seeking medication. Dr. Arjun Sabharwal, a respected nephrologist and kidney specialist, reminds us that most of these cases do not require pharmaceutical intervention, and instead, science and clinical experience recommend a patient-centered and practical approach. Here’s what really works.

It's easy to blame high uric acid on protein powders or plant-based diets, but Dr. Sabharwal is clear: these aren't the major drivers. In fact, the real issue comes from your body's management of purines. Purines are in abundance in animal foods, anything from red meat to seafood. When you eat these, your body breaks down purines into uric acid.

Further, these factors can drive up uric acid levels:
Regular consumption of beer or sweet drinks
Obesity, particularly abdominal fat
Insulin resistance or poorly managed diabetes
Certain diuretic medications for blood pressure
Impaired excretion due to kidney dysfunction

On the other side, plant-based proteins and low-fat dairy can actually lower uric acid, so you don't have to fear every protein source if you're trying to manage levels.

The answer for most people is no. Dr. Sabharwal advises- only certain patterns justify drug therapy. Medication is reserved for:

Two or more gout attacks a year

Tophi-visible, occasionally painful uric acid crystal deposits under the skin

Kidney stones caused by uric acid

Radiographic evidence of joint damage

Chronic kidney disease coupled with uric acid consistently above 9 mg/dL

Without these, the pursuit of drugs adds cost and risk without proven benefit. Guidelines from international expert panels support this selective approach, as rightly quoted by Dr. Sabharwal.

Various prestigious journals highlight the fact that routine medication for symptom-free high uric acid levels has no clear benefit. It is only when symptoms or complications arise, such as gout, kidney stones, or damaging deposits, that medication becomes warranted. For the healthy person or someone with mildly high numbers, lifestyle improvement and monitoring come into play over the pills.

Uric acid by itself is not a cardiovascular risk factor unless there are other problems such as uncontrolled hypertension or diabetes. Focused treatment targets those who actually develop complications.

Disclaimer: This is for informational purposes only

Medication is not a cure-all. The best results usually come from more sustainable changes, and here's how you do it, step by step:

Revamp your diet

Increase your intake of foods that help lower uric acid, including fruits, vegetables, whole grains, and low-fat dairy. Reduce foods that are high in purines, such as red meat, shellfish, sugary drinks, and alcohol-especially beer.

Eliminate excess weight

Obesity fuels uric acid production and impairs excretion. Even a modest reduction in body weight can reduce the risk of gout and lower uric acid, often eliminating the need for drugs.

Stay well hydrated
Adequate water intake is important in helping kidneys flush out toxins, including uric acid. Aim for two litres per day unless restricted by your doctor. Consider your medications. Some common blood pressure medicines (diuretics) can increase uric acid.

Talk to your doctor about whether alternatives may be available for you. Improve insulin sensitivity. Good blood sugar regulation, through diet or medication management, in turn fosters better uric acid regulation. Regular movement—whether that be walking, yoga, or strength training—builds metabolism and allows the kidneys to function more smoothly.

Use vitamin C judiciously

About 500 mg per day may lower uric acid modestly, but it’s not a replacement for medication in high-risk cases.