Gout and Metabolic Syndrome

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I did a little research on gout for a friend who had been given the standard advice for treating this painful condition: eat a low-fat diet, cut out red meat, seafood, fish, beans, and other purine-rich foods, and take medication. Purines can be broken down into urate, which can crystallise out to cause pain in the joints, so a reduction in purine-containing foods is standard advice, in spite of the fact that most uric acid is made in the body and does not come from the diet.

Although much of what I found when I Googled the subject repeated the conventional litany, many of the studies and articles also said that gout is part of the metabolic syndrome and is related to insulin resistance, obesity, and high levels of fats in the blood (all of which are caused by sugar, not fat, in the diet). Here is a sample from Nature Clinical Practice Rheumatology (2007), titled: High prevalence of metabolic syndrome in patients with gout or SLE

Studies have indicated an increased prevalence of metabolic syndrome in patients with gout or systemic lupus erythematosus (SLE), and two independent quantitative studies have now confirmed these findings.” Source: Nature Clinical Practice Rheumatology (2007) 3, 250-251.

One thing that seems to be unanimous is that alcohol is a risk factor and that beer is the worst offender. Beer, often called “liquid bread,” is high in both alcohol and carbohydrates so that fits the hypothesis that gout is just another manifestation of the metabolic syndrome.

Here are two recent articles about sugar and fructose that may be on the right track:

1. This article says soft drinks, fruit, and fruit juices increase the risk of gout–
http://www.medicalnewstoday.com/articles/96164.php –“Link Found Between Gout In Men And Sugar In Soft Drinks” (notice how they have to get in the caveat that they’re not telling anyone not to eat fruit or drink fruit juice–no matter what the science shows!)

2. This article says fructose and soft drinks are worse than alcohol for causing gout–
http://www.medicalnewstoday.com/articles/96073.php –“Pop Goes The Question Of Gout”

I also found two articles on Dr. Briffa’s blog that are from a couple of years ago, but they are well worth reading. If you go to his blog at http://www.drbriffa.com/ and search for “gout” you will find them.

Here’s a quote from Dr. Briffa:
“Excesses of insulin have been shown to raise uric acid levels, and there is evidence that eating less carbs is effective in tempering uric acid levels in the system. In one study, a 16-week long carb-restricted diet significantly reduced uric acid levels. Other side-benefits of a lower carb diet were reduced blood fat levels and satisfying weight loss to boot. Those keen to restore health to the system in the New Year might consider a diet lower in foodstuffs likely to boost uric acid levels such as alcohol, refined sugar and starches that tend to cause considerable insulin induction (such as bread, potatoes, rice, pasta and breakfast cereals).. In practice, such a diet is often effective in neutralising the effects of uric acid in the system.”

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  1. Thank you for the interesting post. FYI, I am building a kind of “cross-reference” blog, and have referenced your post here

  2. Can’t we have moderation? I consume 1/3 glass of grapefruit juice and a few apples a week without any ill effects. If you say fruits and juice is dangerous, then at least explain what’s the cutoff and don’t just say any amount is harmful, because that’s a lie.

  3. Hi Alex.
    Thanks for the comment. I wouldn’t dream of telling you how much fruit or juice you can safely consume. If you are not having any problems, then obviously you are not eating too much. Personally, I think some fruit is good (unless you are a type-1 diabetic), especially berries, but I don’t agree with the conventional wisdom that says “the more the better.”

    The article I cited is about a study that showed a connection between high fructose consumption and metabolic syndrome, which I think is valid. If you want to cut down on carbs, you can’t eat unlimited amounts of anything that contains a lot of sugar.

  4. Other factors in gout are medications that raise blood sugar, such as prednisone, and diuretics that alter the fluid concentration in the body. Both are bad news, as I know from personal experience. My rheumatologist put to rest the anti-purine theory for me, stating that any food with protein has some purines. Obviously, stay away from any that you know will surely trigger an attack, but I’ve had major relief from avoiding carbs.

  5. I did a post on gout a while back

    http://trinkwasser.wordpress.com/2009/11/08/gout/

    If I did it again I'd have added a link to a site I've now lost again which related gout also to gluten intolerance

  6. Dr. Olaf Adelt, MD

    I’ve been one of the test rabbits for these guys: http://www.adsalutem.com, 4 years ago. The gave me a 3-weeks diet and told me what to avoid. That was nearly identical with your advises. After that diet I didn’t have any gout attack, and I started to eat and drink again … It was all about food, and no medication.

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