Final answer:
The initial therapy for asymptomatic hyperuricemia in a patient like Sean should be dietary counseling, as medication is typically reserved for symptomatic cases or those with frequent attacks of gout.
Step-by-step explanation:
The initial therapy for a 48-year-old patient like Sean with asymptomatic hyperuricemia should focus on non-pharmacological approaches prior to considering medication. Therefore, the correct answer to what the initial therapy should be is b - Dietary counseling. Gout, a condition associated with high uric acid levels, can be better controlled by making dietary changes that reduce the intake of purine-rich foods such as red meats and certain beverages. Since uric acid serves as an antioxidant in cells but can lead to health issues like kidney stones and gout when levels are too high, managing diet is crucial. Moreover, drugs like allopurinol may be used to lower uric acid production, but this is usually reserved for symptomatic cases or those with recurrent gout attacks; hence, it is not the first step in managing asymptomatic hyperuricemia.