DR. HOOK- Stoned: Uric acid can wreak havoc

Does Rush Limbaugh have a neurological movement disorder and Oxycontin withdrawal? When he mocked Hillary Clinton's emotional talk during the New Hampshire primaries, his body movements were jerking around as he did when he mocked Michael J. Fox, who suffers from Parkinson's Disease. Why is he so polarizing?

Most Americans I know respect the opinions of others. But it takes only a few bad apples to make the pie sour. One of my nurses has a bumper sticker in support of someone for US President. She takes care of patients, cares about people, and brightens everyone's day. But some Rush Limbaugh-like man pulled up to her, pointed to her bumper sticker, and flipped her the bird. (Why does Rodney King's stutter stick in my head? "Can't we... can't we... can't we all just get along?") Do people have to be so polarized about things that we can't be civil to one another?

Uric acid crystals under a polarized microscope look yellow, like much of today's (yellow) journalism. This is how doctors can tell if a kidney stone or the fluid in a gouty joint has uric acid crystals. 

Uric acid isn't ingested in our diet. Purines (not Purina, as in Dog Chow) are in our diets, like red meat and seafood. Uric acid is the "digested" product of purine compounds, and if it gets too high in the blood it can precipitate out (i.e. form crystal deposits) to form kidney stones and cause gout. I've heard women say passing a kidney stone (though really it's a ureter stone at this point) is more painful than childbirth. (Joel McHale on The Soup said Jennifer Holiday looked like she was passing a kidney stone when she tried to out-sing Jennifer Hudson at the BET Awards. Oooh, child! You have nothing to prove. Show some self-restraint, girlfriend!)

Other conditions can lead to high uric acid levels, in particular obesity (which is more common in the USA than bloggers vomiting out their emotions), alcohol, fructose, certain cancers, certain medicines, in particular HCTZ (a diuretic to treat high blood pressure), psoriasis, and B12 deficiency. 

Other folks have high uric acid levels because they don't pee enough, such as in chronic kidney disease, hypothyroidism, hyperparathyroidism, lead poisoning, and those taking certain medications. For ladies who hate menopause, here's another reason: the lack of estrogen can decrease the amount of uric acid excreted.

So gout occurs in men usually around 30-45 years of age, and in women 55-70 years of age (probably because of the estrogen issue). In my practice, some men who drink too much not only wake up with a hang-over but also a painful gouty toe. (Remember when Fred Flintstone stubbed his big toe, grabbed it in pain, and yelled, "Yabba dabba die, Yi yi yi?" That's how tender the toe is if gout hits this region.)

Most people with high uric acid levels don't ever have symptoms. One study in men showed the annual incidence of gout with high uric acid is less than 5 percent. So treating high uric acid is not really recommended in most people, unless there are certain risk factors. The problem is there's an association between high uric acid levels and bad-boy problems like heart disease, hypertension, insulin resistance, and chronic kidney disease. But like the chicken and the egg, which comes first? High uric acid can just be a marker of an underlying problem and not the cause of these diseases.

For polarizing people like the guy who flipped off my nurse– if he put his middle finger under a polarized microscope, I wonder if it would turn yellow. I'm pretty sure his belly already is.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.