Doctors Can't Tell You What They Don't Know
Most Doctors don’t know anything of the information I am about to share with you and the science behind it is as completely contrary to what doctors are taught.
In fact, after formal schooling, pharmaceutical sales reps are the ones who educate doctors on new drugs.
Maybe it’s time we take a fresh look at some old and new science that suggest that meats have little to anything to do with causing gout attacks. You have questions, and we have answers.
How does a disease manage to be misunderstood and nearly forgotten while still affecting millions of Americans each year? Gout does just that, right under our noses. For those affected by gout and the excruciating pain that comes with it, there is no way to forget it.
Gout has been around for centuries. In the time of castles and knights, it was called the “ailment of kings”. Then it only had an effect on the rich. The rest of the population could barely afford to eat, let alone eat to excess.
Now things are different. America is one of the heaviest countries in the world with Mexico moving just ahead of us. The rise in obesity in countries like Mexico is attributed to the increasing availability of sugary convenience foods. This may result in a rise in gout patients in the coming years.
Wait?! I thought gout was caused by eating too much fatty meat? Isn’t that what we’ve always known? As with other medical knowledge, our understanding is moving forward. We know more about what causes gout and how to treat it than we ever have. The hard truth is that over consumption of sugars is a major contributing factor in gout patients.
What Is Gout?
Let’s back it up a little and examine what’s going on here. First, what is gout?
Gout is a very specific kind of arthritis. In normal arthritis, joints swell up and cause discomfort. Gout is usually focused on a single joint, often the big toe. That joint fills up with sharp uric acid crystals. The joint responds by swelling up. The swollen joint is very tender to the touch, the pain often being described as a fire. Patients sometimes wake from their sleep, unable to stand even the gentle touch of their sheets.
Those with gout suffer because of too much uric acid in their blood stream. We all have some uric acid, and it doesn’t cause a problem for us. Gout patients have more than 6 or 7 mg/dl of uric acid in their blood. Uric acid levels have been recorded at and over 12 mg/dl.
The uric acid crystals that build up in a joint and cause gout pain can have other effects as well, including kidney stones and kidney damage. These high levels are found in over 20% of people in the US.
Uric acid occurs in your blood stream as a byproduct of the breakdown of purines. Purines are necessary and a vital building block for your cells. As with everything, there can be too much of a good thing.
For years, a low purine diet and medication has been the solution to gout. This is generally described as a diet with less meat and fewer high purine foods. High purine foods include more than just meat. They include meat products, yeast, beer and booze, beans, peas, oats, spinach, and mushrooms.
Low purine foods are said to include refined bread products like white bread, processed cereals, and pasta. Also included are sugary sweets, milk, eggs, butter, fruit, nuts, and carbonated drinks.
Eating Junk Food Doesn't Help
Wow, sounds like you can eat a bunch of junk food and get rid of your gout right? This is not necessarily the case. Keep reading.
It’s also pretty old news that drinking a bunch of alcohol can bring on gout symptoms. Partying too hard is definitely off your schedule when you have gout. This isn’t your doctor being a spoil sport, and the science backs this up. Just a few drinks can push your uric acid levels up significantly.
Could It Be... Sugar?
Sometime in the late 1960’s, doctors figured out that fructose (sugar found in fruits) can raise your uric acid levels as well. Fruit, sugar, and corn syrup all have fructose in them. Just like beer, consuming these things can push your uric acid levels up in a real way. If you already have gout, your response to fructose will be more severe.
This is when doctors also noticed that poor people were getting gout more and more often. We thought this was a disease for the rich right? Sugar and sugary foods became cheap and readily available to the poor, changing the demographic that gout targeted.
Fructose Turns To Fat In The Body
This all sounds like a lot of conflicting information, but it’s really a simple shift in what we knew. We can now better explain things scientifically than just with anecdotal data. The simple explanation, scientifically, is that fructose is a sugar that turns to fat easily.
When your liver is busy doing that, it needs a lot of a compound called ATP. ATP has purines, lots of them. They get turned into uric acid. Alcohol breaks down just the same way!
This gets worse. While the sugar is busy making sure your blood has uric acid, your body is releasing insulin. Insulin sends a message to the kidneys and get it to put uric acid right back into your blood. Insulin wants you to grow. To grow you need to make a bunch of cells. To make a bunch of cells, you need purines. It’s a simple chain reaction.
You Can't Cut Both Carbs AND Meat
So you have gout, and you’ve started that low purine diet, cutting out meat and booze. Now you’re eating a bunch of easily affordable cheap carbohydrates in place of all that meat you were eating. Then you find out the sugar contributes to your gout even more! Do you cut out carbohydrates and meats? How does that work nutritionally? Very simply, it doesn’t!
There are plenty of cultures that consume a ton of meat, but have no problems with gout. If you look historically, before crops were as reliable as they are now, vegetables were not guaranteed. This meant that meat was necessary in every diet.
While meat is high in purines, protein is the thing that helps lower purines. To an effect, meat can clean up after itself in your bloodstream. Meat cannot clean up after itself AND a bunch of sugar though.
Studies that were just paying attention to meat consumption did not take into account that people eating more meat were also eating more of everything else too. They did not measure carbohydrate intake at all. This is how science sometimes misses something.
But, Where's The Research?
Real, clinical studies for gout are almost non-existent, and there are none that deal with what we’re talking about. Studies we have began to focus on medication, and the best study that dealt with diet (in Brazil) did not use actual gout patients.
A teeny tiny study was done exploring gout and sugar. In 2009, a few men with gout were chosen in South Africa. These men were put on a 1600 calorie diet. Purines were not measured, and alcohol was allowed. The diet was 40% (not refined) carbohydrates, 30% protein, and 30% fat. Four servings of fish a week kept their protein a little lean. The study lasted 16 weeks.
Uric acid levels went down, on average, 18%. Seven men left the study with a normal uric acid level. Gout attacks were reduced by 72% and 17lbs were lost.
Because dietary changes were sweeping, it’s hard to know which changes affected the patients the most, which is why more widespread studies are needed.
What kind of meat did they eat while trying to stay away from unsaturated fats? What were their diets like before the study began? These are details that could help us.
Fructose Contributes To Gout More Than Alcohol
Another study done on gout confirms that sugar intake, especially fructose, can be a major contributing factor in gout symptoms.
In a study of 51,529 professional males, a study of dietary habits monitored the possibilities of what could cause gout in men from ages of 40 to 75 years old during the years of 1986 to 1998. Only 49,166 participants mailed in their evaluations the first year of the study.
These men were given evaluation sheets to turn in of what they ate and didn’t eat by marking pre-assigned amounts on the sheets. They were dentists, optometrists, veterinarians, osteopaths, and pharmacists.
The study also accounted for the effects on any exercise, medication, or medical conditions that the participants might have had prior to starting the study. This also studied any changes in the participants exercise, medication, or developments of medical conditions during the study.
Along with keeping up with the BMI in the participants over the years. During this study, there were 755 newly diagnosed cases of gout in the participants. Participants that reported having a diagnosis of gout on a previous evaluation forms were dropped from the study.
Only 2,773 participants reported having gout at the beginning of the evaluations. Out of these participants, 50 medical records were evaluated by medical professionals to see if they had 6 out of 11 indicators for gout. Then they were checked to see if the diagnosis was self diagnosed, diagnosed with a doctor, or reported with a tophus or crystal proved gout.
The evaluation sheets were tabulated every 4 years, to see the progress of the study’s participants. The participants in the study could miss one report or check in for the study one year for a follow up evaluation, and turn in the sheets during the next evaluation. There was a follow up rating of over 90% for the two year period.
The study came out that the urate, found in gout patients tended to raise in participants that had instances of high fructose consumption. Such as soft drinks and fruits with high sugar levels. Diet soft drinks did not have the same rates as soft drinks had evaluated with.
Surprisingly, alcohol or spirits weren’t as high in causing gout as fructose, with results being 35% and 49% for soft drinks with sugar and 15% for beer and spirits.
The study also evaluated the effects of dairy, alcohol, and BMI as risk factors for developing gout. These proved to have no significant impact on the study findings. Also measuring the effects of carbohydrates (non-Fructose) and protein in regards to the energy produced in junction with Vitamin C. Even with all these variables, the study proved that high intakes of fructose and soft drinks caused higher levels of urate crystals in the joints.
From the data obtained during this study, it gives credibility to Dr. Osler’s prescription of low fructose diets for gout patients over 100 years ago. In which he wrote in 1893 that high sugar diets should be reduced to a minimum, and sweeter fruits should not be eaten.
There are limitations to this study, even though it was the highest participant based study to this date, due to the fact that dietary intakes were reported by the participants data, though a sampling of the evaluations further confirmed the results.
Gout Is Associated With Metabolic Syndrome
Another study was conducted that confirmed Dr. Osler’s ideas. This study was done over a slightly longer period of time, but it echos some similar thoughts. It also was opened up to include women, something not done in previous studies.
The nurses at American College of Rheumatology did this study to examine the relationship between high intake of fructose rich beverages and risk of gout. The study was 22 years long (1984 to 2006) and had 78,906 participants, who previous to the study had no history of gout.
The all had to take a food frequency questionnaire to validate their intake of beverages and fructose. During the 22 years, the follow up the nurses documented 778 confirmed cases of gout. The test results showed that, in women, the more sugary soda consumed, the higher the risk of gout is. Diet soda drinks were not corresponding to the study.
New evidence shows that gout is associated with the metabolic syndrome and may lead to a higher risk of heart attack), type 1 and 2 diabetes, and premature death. Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.
Gout studies and treatments have been long focused on men, but there is new evidence that suggest that it is more commonly found in elderly women over 70 years of age. The confirmed gout cases are beginning to become more frequent in women.
Sugar sweetened beverages contain low levels of purine, the precursor of uric acid, however they contain large amounts of fructose, a carbohydrate known to increase uric acid levels. When the uric acid levels rise it causes frequent attacks of gout, or it may never cause problems. A high uric acid level may also cause some people to develop kidney stones or kidney failure.
In this study, ingesting fructose was found to cause a sharp increase in serum uric acid. The rapid increase was exaggerated in individuals with a history of gout. Also, in a different study it was found that animal experiments and two National Health and Nutrition Examination Survey (NHANES) studies have suggested that the enormity of urate raising effect of sugar sweetened sodas may be weaker among women than among men, extrapolation of data on this important risk factor for gout from men to women should be done with caution.
More Validation of the Sugar Connection
The Nurses’ Health Study (NHS) began in 1976 when 21,700 female RNs who were predominantly white and were 30 and 55 years of age living in 11 different states completed a mailed questionnaire in which they provided detailed information about their medical history, lifestyles, and other risk factors. Their information was updated every two years to try to help identify any other risks, and newly diagnosed diseases.
After the women completed the questionnaire, they excluded women with a previous diagnosis of gout before 1984 or the participants who did not complete more than 10 items on the 1984 dietary questionnaire, leaving 78,906 women who were followed from 1984 to 2006.
The Partners Healthcare System institutional review board approved the study. The review board accepted a return of the completed questionnaire as implied informed consent.
The questionnaire consisted of average use of foods and beverages during the previous year, including sodas, juice, and the food that the participants ate. The NHS based their study on the average of products consumed from the questionnaire.
The Connection With Soda & Juice
The nutrient intakes were computed by multiplying the responses by the nutrient content of the specified portion sizes. The values for nutrients were derived from the US Department of Agriculture, and supplemented with information from manufacturers of the products consumed.
Half of the disaccharide sucrose is fructose, which is split from sucrose in the small intestine. So, total fructose intake is equal to the intake of free fructose plus half the intake of sucrose. Knowing this, the relationship between the questionnaire and multiple dietary records showed that the most consumed drinks were soft drinks and fruit juices.
After every two years, the participants provided information on weight, regular use of medication, and medical conditions. This data has proven to be very helpful in the study, validating the study, and have the ability to predict risk of relevant future diseases.
The questionnaires asked the participants had received a physician diagnosis of gout and, if so, the date of first occurrence. In 2001, NHS sent out a questionnaire to the participants with self diagnosed gout, and asked them to go to their physician and get a confirmed diagnosis.
The end point of the study was an occurrence case of gout in which 6 or more of 11 gout criteria were met. The gout criteria are as follows: more than one attack of acute arthritis; maximum inflammation developed within one day; oligoarthritis attack (arthritis affecting one to four joints during the first six months of disease) redness observed over joints; painful or swollen fingers, toes, or joints; tophus (a deposit of crystalline uric acid and other substances at the surface of joints or in skin or cartilage); hyperuricemia (an abnormally high level of uric acid in the blood); asymmetric swelling within a joint; complete termination of an attack.
The overall rate for gout questionnaire was 81%, which was a similar result to the Health Professionals Follow up Study. In this study two Board certified rheumatologists reviewed the medical records from 56 women in 2001. The similarities between the diagnosis of gout and the review of the relevant medical records was 91% (51/56).
Diet Sodas Don't Seem To Affect Gout Risk
In the study they used Cox proportional hazards modeling (PROC PHREG) to estimate the relative risk (RR) for occurrences in gout. They put consumption of soda and juices into six categories: <1 per month, 1 per month to 1 per week, 2 to 4 per week, 5 to 6 per week, 1 per day and 2 or more per day. Fructose intake were categorized into quintiles for percentage of energy.
Soda and juice consumption were adjusted for the following variables: age (continuous), total energy intake (continuous), alcohol consumption, body mass index (kg), menopause status, use of hormonal replacement, use of diuretics (thiazide or furosemide), history of hypertension, coffee intake, and daily mean intake of meats, seafood, dairy foods, and total vitamin C (quintiles).
They did the same for fruit and non dietary products. (alcohol, etc.). During the 22 years of follow ups the found 778 new diagnosed cases of gout, 638 with podagra (gout of the foot, especially the big toe),576 with hyperuricemia (abnormally high level of uric acid in the blood), 342 with tarsal joint involvement, and 109 with tophus (deposit of crystalline uric acid and other substances at the surface of joints or in skin or cartilage).
In this large study of women, it was found that the risk of gout increased with increasing intake of sugar sweetened soda. However, diet soda intake does not have any risk of gout. The study shows that women who consume 1 serving of sugar sweetened soda have a 74% higher risk of getting gout than women who consume two servings of orange juice.
The study shows the risk of gout was significantly increased with increasing intake of fructose, the main suspected ingredient behind the increased risk. These findings were separate from risk factors for gout such as body mass index, age, hypertension, menopause, diuretic use, alcohol, and intake of dairy, meat, seafood, coffee, and vitamin C.
These findings were confirmed by the recent prospective study of men and provide the first evidence among women that fructose and fructose rich beverages are important risk factors to be considered in the prevention of gout.
Gout Among Women Occurs Largely After Menopause
While the risk for gout associated with the fructose rich beverages, absolute risk differences were modest given the low occurrence rate of gout among women. The risk differences were less than one case per 1,000 person years.
Previous animal experiments and NHANES studies suggest that the high quantity of urate raising effect of fructose or sugar sweetened sodas may be weaker among females than among males. An analysis based on NHANES III found that the increase in serum uric acid level associated with sugar sweetened soda intake was larger among men than women, although the association among women was still significant.
This was thought to be because of sex hormones due to study in rats that have shown that female sex hormones protect against the development of hyperinsulinemia (a condition in which there are excess levels of insulin circulating in the blood than expected relative to the level of glucose) associated with high fructose intake.
Nevertheless, as gout among women occurs mainly after menopause, when the female hormonal influence greatly declines, the gender difference of the fructose effect on the risk of gout may be less apparent than that on serum uric acid levels observed in the general population that included premenopausal women.
Fructose Causes Uric Acid Production
Fructose induces uric acid production by expanding ATP (a nucleotide that is composed of adenosine and three phosphate groups and releases energy when hydrolyzed to ADP) and deteriorating it into AMP. Fructose in the liver uses ATP, and the accompanying phosphate deterioration limits the regeneration of ATP from ADP (an ester of adenosine that is converted to ATP for the storage of energy) which serves as surface for the catabolic pathway to uric acid formation.
Therefore, within minutes after fructose infusion, plasma uric acid concentrations are increased. In opposition, glucose and other simple sugars do not have the same effect. Fructose could indirectly increase serum uric acid level and the risk of gout by increasing insulin resistance and circulating insulin levels.
Due to animal experimentation, from short term feeding studies suggest that higher fructose intake provides to insulin resistance, impaired glucose tolerance, and hyperinsulinemia. The NHS studies have practical instructions for the prevention of gout in women.
They have dietary recommendations and restrictions on purine intake. Low purine diets are often high in carbohydrates including fructose rich foods. Their data stresses the importance of restricting fructose intake. Osler’s diets prescription as a means to prevent gout over 100 years ago, as reflected in his 1893 book supports this study.
Also, fructose intake is related to increased serum insulin levels, insulin resistance, and increased adiposity. The general negative health impact from fructose is larger in women with a history of gout, 70% of those women suffer from the metabolic syndrome.
There were a relatively large number of cases in the high fructose groups. The numbers in the top consumption categories of fructose rich beverage items were small. It was comforting that the next top categories also showed large positive associations with a dose response relationship. Biased recall of diet was avoided in this study because the intake data was collected before the diagnosis of gout.
Gout Risk Is Higher For African Americans
The use of repeated dietary assessments in the study not only accounts for changes in dietary consumption over time but also lowers measurement error.
The restriction of RNs in the study is both a limitation and a strength. The study of well educated women reduces the potential for surprises associated with socioeconomic status, and they were able to obtain high quality data with minimal loss to the follow ups.
Their study was generalized towards middle aged white women with no history of gout. Prevalence of risk factors for gout occurrences are higher in African Americans, the enormity of the risks increase with the sugar sweetened beverages might be bigger than the increase that they observed.
In conclusion, their findings provided the prospective verification that intake of sugar sweetened sodas, orange juice, fruit juice, and other fructose is associated with an expanded risk of gout among the participated women.
Their contribution to the study and risk of gout in the population is likely humble giving the low occurrence rate among these women. However, diet soda consumption was not associated with this study or the risk of gout.
Physicians should acknowledge of the significant impact of these sugar sweetened sodas and fruit juices on the risk of gout which is a common and excruciatingly painful arthritis.
We Were Never Meant to Eat This Much Sugar
So how does all of this affect you, a member of normal society living long past the age of kings? Well, lay off the booze. It is consistently a problem for gout across the board, so it’s an easy change to make. Even a few beers can throw you way off track, so exercise some self discipline.
Research doesn’t know it all yet. We look very hard to doctors and science for our cures, but when their information is incomplete, we can take some steps on our own and see what works for us as individuals.
First, this means knowing your diet. Record what you eat, and record when you get your gout attacks. You might find a pattern there. Self awareness is the first barrier of defense we have against something wrong medically.
We don’t know why some things happen, even when we know that they do happen. We don’t know why only some people with high uric acid levels end up with gout. Saying that we don’t know might seem scary. It’s hard to not know something in an age where there’s an answer for everything, but science continues to push forward. This means that we have to get up and help ourselves where we can.
Take the science that you know and add in some of your basic common sense. If you have a bad diet, you will suffer the consequences of a bad diet. Purines come in our natural food and are produced in our bodies.
Cut The Carbs & Check Your Blood Sugar
While you’re making a record of your diet and your gout attacks, record other medical data too. Knowing your blood sugar is a good thing, and meters are readily available. Sometimes meters are even free, and your doctor is unlikely to object to this. Doctors want you to be as aware medically as you can be so that you can take responsibility for your health.
Cut out refined sugars like white bread, sugar cereals, table sugar, sodas, candy, and junk food. Then wait and see what happens, recording the results. Do your gout attacks decrease? How do your blood sugar levels fare? Remember to follow the rules you set for yourself. You are acting as your own scientist, and deviating from your plan will alter your results. Consistency is the path to change.
If nothing else, your doctor will be thrilled as your health gets better overall. There are other small things you can do too. Taking Vitamin C has been shown to reduce uric acid just a little, so pop 500mg a day of it.
Make sure you replace those refined carbs with some good stuff. Whole grains and yummy vegetables will fill your meals back out. Cauliflower is amazing, and people are learning to use it in place of potatoes in all kinds of dishes. It can be steamed and turned into a substitute for rice too! In a food processor with a bit of butter and some plain yogurt, it turns into a substitute for mashed potatoes that’s as good as the real thing.
Don’t take your produce section for granted, and don’t just use your computer for games. Recipes low in refined carbohydrates are easily found online, leaving you with very few excuses not to change your health for the better, staving off a painful disease in the process.
Gout was once an ailment only felt by royalty. It now effects millions of people worldwide, and our knowledge is expanding on the subject.
Diet Is The Ultimate Solution
It’s becoming clear that the solution for many of our illnesses begins with our diet. Don’t eat blindly. Instead, take into account what you are eating and what went into making your meal.
To be effective you need to understand more about diet and have some good recipes or you will fail.
The good news? I already failed enough for all of us and have been gout attack free for over 5 years.
I figured you may want to know how I stopped my extremely vicious battle with gout.
Here are my guides (cookbooks) below that help me eat right for someone who suffers from gout. It cuts carbs (sugars) and my gout just magically disappeared.
You only need to pick one to get started, but having more gives you more variety.