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Monday, February 26, 2024

Uric acid and gout as reflections of dysbiosis


Higher blood and urine ranges of uric acid could cause gout (painful uric acid crystal deposition in joints) and kidney illness. Extra not too long ago, uric acid has additionally been related to elevated danger for metabolic syndrome, sort 2 diabetes, heart problems, kidney and liver illness even within the absence of gout assaults, i.e., “asymptomatic hyperuricemia” or asymptomatic will increase in blood ranges of uric acid. Standard “remedies” contain lowering the dietary consumption of purines, i.e., the genetic (DNA and RNA) materials current in animal merchandise, and prescription drugs that block the enzyme, xanthine oxidase, that yields uric acid. As in so many different circumstances, the traditional options deal with “downstream” phenomena however fail to handle the precise trigger—not weight loss plan, however disruptions of bowel flora composition with lack of microbial species which are vigorous in metabolizing uric acid, thereby lowering blood and urine ranges. This science has been unfolding for in regards to the previous decade, however it has not too long ago galloped ahead with a flood of recent observations which are yielding therapeutic prospects in managing uric acid. (It additionally addresses a basic flaw in standard pondering: Why would people, genetically-adapted over three million years to consuming animal merchandise reminiscent of meats, organs, and seafood, develop an intolerance to them? The issue will not be animal merchandise; it’s the capability to metabolize parts reminiscent of uric acid, disrupted by shifts in gastrointestinal (G) microbiome composition as a result of fashionable life and maybe worsened by a nutrient- and polyphenol-poor fashionable weight loss plan.)

Folks with gout and hyperuricemia have been proven to have 1) disrupted gastrointestinal microbiome composition with elevated Proteobacteria (fecal species) and mucin-degraders reminiscent of Bacteroides caccae, 2) elevated intestinal permeability, and three) elevated endotoxemia, all of which additional provides to irritation, insulin resistance, and susceptibility to heart problems. You’ll be able to recognize that gout and hyperuricemia are usually not nearly uric acid, however a constellation of phenomena, a lot of which might be backtracked to a disrupted GI microbiome.

The checklist of gastrointestinal microbes that metabolize uric acid in varied methods is rising quickly, largely Lactobacillus species which have advanced to be environment friendly metabolizers of purines and different genetic materials. Among the many species/strains which were related to decreased blood and urinary ranges of uric acid embrace:

  • Lactobacillus brevis DSM9218
  • Lactobacillus plantarum WCFS1
  • Lactobacillus paracasei S12
  • Limosilactobacillus fermentum GR-3
  • Lacticaseibacillus paracasei MJM60396
  • Ligillactobacillus salivarius CECT 30632

A human research of the final microbe listed, L. salivarius CECT 30632 at a every day dose of 1 billion CFUs per day for six months, demonstrated a marked discount in gout episodes, reliance on gout medicine, and decreased blood ranges of uric acid in comparison with placebo.

Along with over proliferation of fecal microbes and mucin-degrading species, lack of vital butyrate-producing species, Faecalibacterium prausnitzii and Bifidobacteria species, has additionally been documented. Though F. prausnitzii and Bifidobacteria species don’t themselves metabolize uric acid, they in some way help those who do. Recall that prebiotic fibers reminiscent of inulin/FOS trigger a “bloom” in these species, which will additionally add additional benefit. Additional, microbial metabolism of purines and different genetic materials is considerably elevated when glucose (sugar) is much less accessible; in different phrases, a scenario wherein insulin resistance and blood glucose are introduced underneath management might additional improve the microbiome’s capability to rid your physique of purines and thereby uric acid.

In fact, you possibly can attempt to receive and ferment a few of these species, as we do with our L. reuteri and L. gasseri yogurts to acquire excessive bacterial counts to make sure significant organic results reminiscent of eradication of SIBO, smoother pores and skin, elevated libido, decreased intestinal permeability and decreased endotoxemia. However, as you may recognize, it turns into impractical to ferment each species we need to colonize our GI tracts. Apparently, the vast majority of species that metabolize purines and thereby cut back uric acid come from fermented meals reminiscent of sauerkraut, pickles, and kimchi. Maybe in future we will receive a number of of these microbes reminiscent of L. salivarius CECT 30632 that you possibly can ferment as yogurt to amplify uric acid-reducing results. There’s sometimes a a number of 12 months lag going from laboratory commentary to business availability, so these microbial strains are usually not but accessible. Keep tuned.

By the way in which, uric acid will not be the one issue that’s proving to be a metabolic consequence of a disrupted gastrointestinal microbiome. Add oxalates, homocysteine, vitamin B12 deficiency, folate deficiency and quite a few different conditions which are yielding to insights into the microbiome that, like uric acid, ought to trigger us to rethink all we thought we knew about these phenomena.

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