If you suffer from gout, or you know someone who has, you’ll be well aware of how painful and debilitating it can be. 

Gout doesn’t strike randomly. It’s usually a consequence of another serious condition: hyperuricemia. 

Hyperuricemia (HU) is a metabolic disorder affecting around 21% of American adults and is fast becoming a serious public health problem. 

Hyperuricemia occurs in people who have excess levels of uric acid in their blood. It can lead to a range of health issues including not only gout but heart disease, diabetes, and various kidney problems. 

It’s considered to be a major risk factor for gout arthritis, cardiovascular diseases, type 2 diabetes, hypertension, and chronic kidney disease. 

Although the exact cause of HU is not entirely certain, a number of dietary factors are thought to contribute. Uric acid is a waste product formed in the body following the breakdown of purines (adenine, guanine, and xanthine), which are naturally present within the body's cells and in certain foods.

While gout is often associated with poor diet and being overweight, hyperuricemia itself isn’t necessarily a disease that “unhealthy people” get. Cases of hyperuricemia have increased dramatically over the last 50 years. It’s estimated that around 43.3 million Americans are now affected. 

What’s more, recent research suggests that the risk of developing hyperuricemia could be as simple as a B vitamin deficiency, which is more common than most people realize. 

A 2018 study published in the Journal of Clinical Medicine sought to identify the impact that folate, B6, and B12 could have on hyperuricemia. It was the first study to show an association between intakes of folate, vitamin B6, and vitamin B12 with hyperuricemia . 

The study included 24,975 US adults aged 20 between 85 years, which was the largest population-based study using a nationally representative sample in the US. 

The results provided important insights into just how valuable B vitamins are to our overall health. 

What the researchers found was this: supplementation with folate and vitamin B12 could be the key to preventing and treating excess uric acid levels in both men and women. 

The study used data from National Health and Nutrition Examination Survey (NHANES), an ongoing survey administered by the Centers for Disease Control and Prevention, to represent the total civilian population of the US.

Uric acid samples were taken from a total of 3,215 adults aged between 20–85 years provided UA samples for NHANES 2001–2014. This included 12,218 women and 12,757 men. 

All the B-vitamin intake indicators were significantly different between hyperuricemia and non-hyperuricemia for males and females. 

• The researchers found that men with higher daily folate intake were more likely to have lower BMI, glucose, and uric acid levels. They were also less likely to have hypertension, diabetes, and hyperuricemia compared with those consuming less than 400 mcg folate daily.
• Females consuming 400 mcg folate or greater were also less likely to have hypertension, diabetes, or hyperuricemia. They were also likely to be of lower weight and BMI, and have lower levels of serum cholesterol, blood glucose, and uric acid.
• In both men and women, those with hyperuricemia were found to have lower intakes of folate, vitamin B6, and vitamin B12. 
• This suggested that a low intake of folate intake can increase the risk of hyperuricemia even after other factors, such as age, race/ethnicity, smoking, drinking, hypertension status, diabetes status, and diet and other nutritional intakes, are accounted for. 
• The researchers found no associations between higher vitamin B6 intake and risk of HU in either males or females.
• There was an important link between vitamin B12 intake and hyperuricemia in males but no such link in females.

The researchers concluded that low intake of folate and B12 increased the risk of hyperuricemia in men. 

Higher intakes of total folate also appeared to reduce the risk of hyperuricemia in women. However, there appeared to be no association between intakes of folic acid, vitamin B6, or vitamin B12 in women.

Prior to the current study, there was little research into the relationships between folic acid and serum uric acid, and no known studies investigating the link between intakes of folate, vitamin

B6, vitamin B12, and hyperuricemia.

While overall nutrient intake is crucial for the maintenance of healthy uric acid levels, the most important of these nutrients appears to be folate. There are many reasons for this. 

Firstly, folate and its derivatives has been found to inactivate the enzyme xanthine oxidoreductase (XOR), which is responsible for two important processes: 

1. the oxidation from hypoxanthine to xanthine

2. and the oxidation from xanthine to uric acid