Uric acid is a waste product formed when the body breaks down purines — compounds found naturally in cells and in certain foods. When too much uric acid accumulates in the blood, it can crystallise in joints, causing gout, or accumulate in the kidneys, contributing to kidney stones.
A uric acid blood test (serum urate) is one of the more commonly ordered chemistry tests — yet many patients who receive a raised result don't fully understand what it means or whether they need to do anything about it. The short answer is: a high number alone is not a diagnosis of gout, and not everyone with a raised level will ever experience a flare.
This guide explains what the test measures, what different result ranges mean, and what steps — dietary, lifestyle or medical — are worth taking. If you're new to reading blood test results, our guide to making sense of lab results is a useful starting point.
What counts as a normal uric acid level?
Reference ranges vary slightly between labs, but as a general guide, normal serum urate is considered to be under 360 µmol/L (6 mg/dL) for women and under 420 µmol/L (7 mg/dL) for men. Levels above these thresholds are called hyperuricaemia.
Importantly, hyperuricaemia is common — roughly one in five adults has elevated levels at some point — and most never develop gout. Uric acid tends to rise with age, body weight, alcohol intake and a diet rich in red meat, shellfish and organ meats.
| Level | Approximate risk |
|---|---|
| Below 360 µmol/L (6 mg/dL) | Target for patients already treated for gout |
| 360–480 µmol/L (6–8 mg/dL) | Elevated; lifestyle changes recommended |
| Above 480 µmol/L (8 mg/dL) | Significant; discuss medication with your doctor |
What causes uric acid to rise?
- Diet high in purines — red meat, organ meats, shellfish, anchovies
- Alcohol — particularly beer and spirits; wine has a smaller effect
- Sugary drinks and foods containing high-fructose corn syrup
- Certain medications — diuretics (water tablets), low-dose aspirin, some immunosuppressants
- Kidney disease — reduced ability to excrete urate
- Rapid weight loss or crash dieting — releases urate from tissue breakdown
- Dehydration
Understanding a gout attack
Gout is caused by urate crystals forming in a joint — most commonly the big toe, but also the ankle, knee or wrist. An attack comes on quickly, often overnight, and produces intense heat, swelling and pain that is genuinely severe. The skin over the joint can turn red or purple.
A gout attack is diagnosed clinically, not purely from a blood test. Interestingly, uric acid levels can actually fall during a flare — so a normal result during an attack does not rule gout out. If your doctor suspects gout, they may aspirate the joint to look for crystals directly.
How to lower your uric acid level
For many patients, lifestyle changes alone can reduce serum urate meaningfully over two to three months.
- Drink at least 2–3 litres of water a day — hydration is the most effective single intervention
- Reduce or eliminate alcohol, particularly beer
- Cut back on red meat and shellfish; choose poultry and low-fat dairy instead
- Avoid fructose-sweetened drinks and foods
- Lose weight gradually — crash dieting paradoxically raises urate
- Exercise regularly: aerobic activity improves urate excretion
When medication is needed
If lifestyle changes haven't brought levels down, or if you have had more than two gout attacks in a year, your doctor may prescribe urate-lowering therapy — most commonly allopurinol or febuxostat. These don't treat an acute attack; they prevent future ones by keeping serum urate below the crystallisation threshold.
If you are on urate-lowering therapy, your doctor will monitor uric acid levels regularly. Keeping a trend of your results in a platform like Looms makes it easy to see whether treatment is working over time.