NEED INPUT - ELEVATED BUN, URINE URIC ACID

[mcs5309]

Current stats:
Age: 52
Height: 5-7
Weight: 167lbs - approx. 130lbs fat-free mass
Bodyfat: 18.4%


Average Macros:
Calories: 1400
Protein: 135g
Carbs: 40g (<10g of that from fructose, mostly berries)
Fat: 75g

I have been eating VLC paleo and doing intermittent fasting for about the last 6 mos. as I am trying to lose bodyfat. My goal is to get to 10% bodyfat first before I can start adding more lean mass. I resistance train 4 x's/week.

My latest CMP showed elevated BUN (36 - ref range: 6-24), elevated BUN/Creatinine ratio (39 - ref range:9-20), and elevated urinary uric acid (1118.0 - ref range: 250.0-750.0).

I also showed elevated serum calcium (10.9 - ref range: 8.7-10.2). My serum uric acid (UA), however, is normal (4.6 - ref range: 3.7-8.6) as is my creatinine (0.92 - ref range 0.76-1.27) and eGFR (95 - ref range >59). There is no protein in my urine. I do not have gout. This would indicate there is no incidence of CKD or kidney failure and that my kidneys are able to remove the UA effectively. These levels have gradually increased over the last 6 mos.

I understand that the elevated levels are a direct result of purines from increased protein metabolism and its waste products. However, 135g of daily protein to maintain lean mass is by no means excessive, especially for someone who trains, so I cannot understand these markers being increasingly elevated. In fact, according to this excerpt from the following link, increased protein intake DOES NOT translate in increased uric acid excretion:

"The excretion of uric acid bears no relationship to the extent of protein metabolism, for an excessive consumption of nitrogenous food (free from nuclein) does not increase the amount of uric acid excreted, even although the metabolism may be increased. Thus from 18 grams of protein food 433 mgr. uric acid were excreted, whereas from 80 grams of protein food not more than 442 mgr. uric acid were excreted."

On a side note, I had passed a 3mm calcium oxalate kidney stone back in March. For stone prevention, I am drinking about 12 cups of water daily and taking approx. 5g potassium citrate to alkalinize urine. I urinate 1500-2000cc daily. I also take magnesium citrate. For many years I've had a problem taking pancreatin in that it made my urine very acid and caused mouth sores. Pancreatin is known to increase UA. In addition, my urine pH has always been about 5.0 (acid).

I realize that red meat is moderately high in purines (which can elevate uric acid), but I love my grass-fed beef and buffalo and would hate to give them up or reduce them!

The good news is that any excess UA is not being retained and is being excreted in the urine, otherwise my serum UA would be elevated. Still, this is a warning sign of possible gout or other dysfunctions.

Possible causes/explanations:

- serum UA seems to have an inverse relationship to urine UA; decrease of serum uric acid levels seems to increase the urinary excretion of uric acid.

- when you eat more protein, your kidneys will extract more UA acid in your urine to compensate which is why my serum UA acid is normal.

- imbalance in the ratio of protein to low-protein foods (i.e. fats, vegetables, fruits); not enough low-protein foods to compensate for increase in BUN and UA.

- fasting increases UA excretion, but the increase in ketones cancels it out.

- both potassium and magnesium citrate increase rate of UA excretion.

- exogenous high doses of zinc and iron can elevate UA.

- breakdown of fats by the liver produces several byproducts, including uric acid. I have NAFLD (fatty liver) and have read that VLC paleo and IF can accelerate the clearance of FFAs, especially when combined with exogenous choline.

- other supplements causing elevated urinary UA excretion.

- It also appears that uric acid increases the storage of body fat. Perhaps this is a factor in my inability to burn fat.

Possible Solutions (since reducing protein intake would be counterproductive to anabolism):

- To balance out the overload of UA, I would increase veggies and healthy fats. If I increase fruits, then fructose increases which is counterproductive to fat loss and itself increase uric acid.

- Maintain Vitamin C intake @ 5-7g daily.

- drop the zinc to 50mg daily; should I drop the iron (I am taking 33mg from supps to raise serum ferritin)?

Any reason why serum calcium is elevated? My last PTH was normal.

Before resorting to meds like allopurinol to decrease urinary UA levels, any other pearls you guys can share??

[Medical420]

As a severe arthritis person I Can say Malic Acid (apple cider vinegar) has the ability to reduce Uric acid. In the beginning you will need to take it every meal. After a balance is achieved maintain with 1 - 2 tbs a day depending on your diet. I am strict hunter gather Paleo and find balance very easy without the dairy, grains and sugars.

[mcs5309]

As a severe arthritis person I Can say Malic Acid (apple cider vinegar) has the ability to reduce Uric acid. In the beginning you will need to take it every meal. After a balance is achieved maintain with 1 - 2 tbs a day depending on your diet. I am strict hunter gather Paleo and find balance very easy without the dairy, grains and sugars.

Thanks, I have been taking ACV for the last couple years now. This is the first time I've tested for urine uric acid, so I have no idea of what my level was before.

[Medical420]

Interesting, you deff sound like you need to alkalize. I too am Paleo(strict) 70%20%10% for 1.5y, I do not refeed and have not ever, but I will be in October for mass.

Are you complete Paleo, ie grains, dairy and sugars removed?

My knowledge is base on digestion and the intestinal tract --> organs. Everything starts and ends from diet. Personally I believe (oen experience) it's organisms out of balance or un welcome to our intestinal tract that throws us out of wack.

[mcs5309]

Interesting, you deff sound like you need to alkalize. I too am Paleo(strict) 70%20%10% for 1.5y, I do not refeed and have not ever, but I will be in October for mass.

Are you complete Paleo, ie grains, dairy and sugars removed?

My knowledge is base on digestion and the intestinal tract --> organs. Everything starts and ends from diet. Personally I believe (oen experience) it's organisms out of balance or un welcome to our intestinal tract that throws us out of wack.

Grain-free, sugar-free, no cow's milk dairy (I will occasionally eat raw goat milk cheese or kefir). Take lots of probiotics.

[Medical420]

Awesome,

Any other conditions / symptoms you don't mind mentioning if any?

[mcs5309]

Awesome,

Any other conditions / symptoms you don't mind mentioning if any?

Occasional gas, dull headaches, hypertension.

[Medical420]

Don't give up on meats yet, but look into the link i sent you, since I can't post them yet.

Check out the reviews, i have used it with great results i had major kidney and liver damage from the prescriptions. Between diet, my natural meds and products from them have given me a second chance at health.


I am currently doing the SmartCleanse with paragone and fibre smart. I have done,Candigone, candizyme, lung therapy, total Kidney, Liver cleanse, critical liver and the bowel cleanse. I recommend the 30 day kidney to you first, then maybe do the SmartCleanse for30 after to clean the rest if your organs.


I swear to you only great results. My wife HAD chronic UTI's, almost monthly. She did this cleanse and went symptom free for 8 months. It happened again she did the cleanse with the Female Flora enzymes and has been clear for 6 months now.

Also, I take 2 500mg unrefined ACV every meal. This has reduced daily swelling(uric acid) in my remaining joints quiet a bit

[mcs5309]

Just a theory, but does anyone know if intermittent fasting could increase BUN and uric acid because with a shorter feeding window (as opposed to throughout the day), and thus with protein consumption being condensed/concentrated, the kidneys have less time and work harder to process a larger amount of protein which results in elevated BUN and uric acid levels?

[vassille]

Current stats:
Age: 52
Height: 5-7
Weight: 167lbs - approx. 130lbs fat-free mass
Bodyfat: 18.4%


Average Macros:
Calories: 1400
Protein: 135g
Carbs: 40g (<10g of that from fructose, mostly berries)
Fat: 75g

I have been eating VLC paleo and doing intermittent fasting for about the last 6 mos. as I am trying to lose bodyfat. My goal is to get to 10% bodyfat first before I can start adding more lean mass. I resistance train 4 x's/week.

My latest CMP showed elevated BUN (36 - ref range: 6-24), elevated BUN/Creatinine ratio (39 - ref range:9-20), and elevated urinary uric acid (1118.0 - ref range: 250.0-750.0).

I also showed elevated serum calcium (10.9 - ref range: 8.7-10.2). My serum uric acid (UA), however, is normal (4.6 - ref range: 3.7-8.6) as is my creatinine (0.92 - ref range 0.76-1.27) and eGFR (95 - ref range >59). There is no protein in my urine. I do not have gout. This would indicate there is no incidence of CKD or kidney failure and that my kidneys are able to remove the UA effectively. These levels have gradually increased over the last 6 mos.

I understand that the elevated levels are a direct result of purines from increased protein metabolism and its waste products. However, 135g of daily protein to maintain lean mass is by no means excessive, especially for someone who trains, so I cannot understand these markers being increasingly elevated. In fact, according to this excerpt from the following link, increased protein intake DOES NOT translate in increased uric acid excretion:

"The excretion of uric acid bears no relationship to the extent of protein metabolism, for an excessive consumption of nitrogenous food (free from nuclein) does not increase the amount of uric acid excreted, even although the metabolism may be increased. Thus from 18 grams of protein food 433 mgr. uric acid were excreted, whereas from 80 grams of protein food not more than 442 mgr. uric acid were excreted."

On a side note, I had passed a 3mm calcium oxalate kidney stone back in March. For stone prevention, I am drinking about 12 cups of water daily and taking approx. 5g potassium citrate to alkalinize urine. I urinate 1500-2000cc daily. I also take magnesium citrate. For many years I've had a problem taking pancreatin in that it made my urine very acid and caused mouth sores. Pancreatin is known to increase UA. In addition, my urine pH has always been about 5.0 (acid).

I realize that red meat is moderately high in purines (which can elevate uric acid), but I love my grass-fed beef and buffalo and would hate to give them up or reduce them!

The good news is that any excess UA is not being retained and is being excreted in the urine, otherwise my serum UA would be elevated. Still, this is a warning sign of possible gout or other dysfunctions.

Possible causes/explanations:

- serum UA seems to have an inverse relationship to urine UA; decrease of serum uric acid levels seems to increase the urinary excretion of uric acid.

- when you eat more protein, your kidneys will extract more UA acid in your urine to compensate which is why my serum UA acid is normal.

- imbalance in the ratio of protein to low-protein foods (i.e. fats, vegetables, fruits); not enough low-protein foods to compensate for increase in BUN and UA.

- fasting increases UA excretion, but the increase in ketones cancels it out.

- both potassium and magnesium citrate increase rate of UA excretion.

- exogenous high doses of zinc and iron can elevate UA.

- breakdown of fats by the liver produces several byproducts, including uric acid. I have NAFLD (fatty liver) and have read that VLC paleo and IF can accelerate the clearance of FFAs, especially when combined with exogenous choline.

- other supplements causing elevated urinary UA excretion.

- It also appears that uric acid increases the storage of body fat. Perhaps this is a factor in my inability to burn fat.

Possible Solutions (since reducing protein intake would be counterproductive to anabolism):

- To balance out the overload of UA, I would increase veggies and healthy fats. If I increase fruits, then fructose increases which is counterproductive to fat loss and itself increase uric acid.

- Maintain Vitamin C intake @ 5-7g daily.

- drop the zinc to 50mg daily; should I drop the iron (I am taking 33mg from supps to raise serum ferritin)?

Any reason why serum calcium is elevated? My last PTH was normal.

Before resorting to meds like allopurinol to decrease urinary UA levels, any other pearls you guys can share??

Your fat intake is too low for what you trying to do.Your body uses protein for energy.

[mcs5309]

Your fat intake is too low for what you trying to do.Your body uses protein for energy.

How's this - looking more keto (65% fat, 30% pro, 5% carbs):

CALS: 1900
PRO: 143g
CHO: 24g
FAT: 137g

[vassille]

How's this - looking more keto (65% fat, 30% pro, 5% carbs):

CALS: 1900
PRO: 143g
CHO: 24g
FAT: 137g

better and yes you are venturing into keto, but think of it as low carb because you could increase carbs up to 100g if you do enough physical activity. If you dont, then stick with 50g of carbs per day.
protein should not be higher than 20- 25% of total caloric intake. Dont worry you will not lose lean mass.
Once a week have a meal with anything you want...and I mean anything! Pizza, ice cream etc
Sometimes I eat uppwards of 2500cal at that meal so you get the idea

[mcs5309]

better and yes you are venturing into keto, but think of it as low carb because you could increase carbs up to 100g if you do enough physical activity. If you dont, then stick with 50g of carbs per day.
protein should not be higher than 20- 25% of total caloric intake. Dont worry you will not lose lean mass.
Once a week have a meal with anything you want...and I mean anything! Pizza, ice cream etc
Sometimes I eat uppwards of 2500cal at that meal so you get the idea

what's your bf at now?

[vassille]

8-9%

[mcs5309]

8-9%

How do you measure and what was it before your diet?

For me, it would only make sense to cut since I'm >15%. I just cannot see bulking when I'm 18-19%.

[mcs5309]

better and yes you are venturing into keto, but think of it as low carb because you could increase carbs up to 100g if you do enough physical activity. If you dont, then stick with 50g of carbs per day.
protein should not be higher than 20- 25% of total caloric intake. Dont worry you will not lose lean mass.
Once a week have a meal with anything you want...and I mean anything! Pizza, ice cream etc
Sometimes I eat uppwards of 2500cal at that meal so you get the idea

I think I will keeps cals same, but add a modified keto carb cycle to my IF and bump carbs this way only on wo days:

(60% fat, 25% pro, 15% carbs):

CALS: 1900
PRO: 119g (25%)
CHO: 72g (15%)
FAT: 127g (60%)

Again, with 18-19% bf, I fear going past 75g carbs may reverse my fat loss goals.

[vassille]

I think I will keeps cals same, but add a modified keto carb cycle to my IF and bump carbs this way only on wo days:

(60% fat, 25% pro, 15% carbs):

CALS: 1900
PRO: 119g (25%)
CHO: 72g (15%)
FAT: 127g (60%)

Again, with 18-19% bf, I fear going past 75g carbs may reverse my fat loss goals.

THis one seems a bit better although cal still seem a bit low but the break down is much better. Try it out and see if it works.
THe rule is that if you lower carbs increase the fat intake. Dont just cut calories that's a mistake. I would argue that your cal intake should be around 2500. But I need more info to say for sure.

[mcs5309]

No, I wasn't cutting cals at all, just cycling macros depending on physical activity level. I'm not a big guy (see stats on first post) and 2300 is above my low active TEE, and my RMR is 1500. To lose fat, I chose to be 400 below my low active TEE which puts me @ 1900. I was @ 1400 which is probably too low.

I am going to try and few things outside of diet to speed up lipolysis while adding lean mass:

Before I train fasted, Alpha-T2/T3 stack, and down the road, I will be looking into peptides like GHRP-2, 6, CJC-1295 and look into bumping my T from the 500s to at least 800. I'm 52, after all.

Thoughts?

[mcs5309]

THis one seems a bit better although cal still seem a bit low but the break down is much better. Try it out and see if it works.
THe rule is that if you lower carbs increase the fat intake. Dont just cut calories that's a mistake. I would argue that your cal intake should be around 2500. But I need more info to say for sure.

No, I wasn't cutting cals at all, just cycling macros depending on physical activity level. I'm not a big guy (see stats on first post) and 2300 is above my low active TEE, and my RMR is 1500. To lose fat, I chose to be 400 below my low active TEE which puts me @ 1900. I was @ 1400 which is probably too low.

I am going to try and few things outside of diet to speed up lipolysis while adding lean mass:

Before I train fasted, Alpha-T2/T3 stack, and down the road, I will be looking into peptides like GHRP-2, 6, CJC-1295 and look into bumping my T from the 500s to at least 800. I'm 52, after all.

Thoughts?

[vassille]

How do you measure and what was it before your diet?

For me, it would only make sense to cut since I'm >15%. I just cannot see bulking when I'm 18-19%.

Yes you have the right idea to lean out first then try to put on a bit of mass.

As for body fat I used a caliper. I have abs and I have veins in my lower abdomen and my legs, arms.
This is not a diet for me, is how I eat all the time. The past years I've stayed stayed lean but when I started to eat like this I was 12-13% around 275lbs.
Then I decided that it wasnt healthy to be that heavy and I shed some mass and fat to stay under 250 which I feel great for a number of years now. As I got older I preffer being lean than super heavy.