Gout is a form of arthritis that usually affects your big toe.  It’s the result of acute inflammation due to the accumulation of uric acid in joint fluid over the years.  Its incidence has increased  in proportion to the spread of the Metabolic Disorder across the world.  

Its victims are all too familiar with its unpleasantries:  it hurts like hell!  My father has dealth with the issue for several years and at its worst he’d be paralyzed because the inflammation in his foot was so bad that he couldn’t walk.

Through some experimentation he eventually found a way to make it go away without medication, and compared to other lifestyle diseases it seems fairly straightforward to treat.

However, there are several misconceptions about how the disease is caused, and what you can do to make it go away.  Let’s take a look at what makes the condition tick, and what (if anything) the curious layperson might want to try to deal with the issue.

Disclaimer: I am not a doctor and nothing I’m about to say constitutes medical advice. I’m merely stating my own opinion and your experiences may differ.  Please take my writing as nothing more than my own observations.  Be cautious and use good judgment whenever necessary.

A Metabolic Disorder Made Worse by Diet and Genes

To me gout looks like a manifestation of the metabolic syndrome.  Its the result of a lifetime of gradual metabolic disregulation, and the severity of its occurrence is tipped by dietary factors and a genetic disposition.

The root cause of gout is too much uric acid pumping through your blood.  After a while it builds up and coagulates around your joints, periodically making them lock up and go into violent fits.  It hurts.  The seeds of gout also accrue over a long period of time.

As you can see it happens almost entirely among the elderly:

Your body synthesizes uric acid on its own and gets about 1/3 of its supply from your diet.  Excess uric acid therefore boils down to two different causes:

1. Your body takes in too much
2. Your body can’t excrete the uric acid that it has

Issue 1 is a problem of consumption, issue 2 a problem of metabolic regulation.

Well, guess what?

90% of all gout is due to an inability to excrete the uric acid that the body produces. 

The traditional remedy for gout was to cut out alcohol, meat, seafood, and certain legumes likes lentils and nuts because they contain a lot of uric acid.  With the  case of protein and vegetables this is almost certainly bullshit.  It doesn’t affect the incidence rate of gout one iota.  With the case of meat and alcohol there’s more truth to it.  For example 1/2 of all gout victims drink too much.

However your body adjusts how much uric acid it produces based on how much it takes in through the diet, so the effect of purines through the diet is somewhat rate limiting.

It’s the combination of a purine rich diet combined with a metabolic state that inhibits the excretion of uric acid that’s the real culprit.

Consider the following facts:

1. 90% of gout victims have some form of insulin resistance syndrome
2. People at the 80th percentile of weight are 300% more likely to get gout than people at the 20th
3. Changing your purine intake through your diet appears to change your uric acid levels by 120 micromols at most.  (Not enough to reverse the condition for many people).
4. High blood triglycerides are found in about 20-60% of gout patients

It would appear to me that the presence of purines (the raw material for uric acid) is a secondary, and not primary cause of gout.

Fructose and Insulin: The Hidden Menace

High levels of insulin and blood lipids reduce your body’s ability to sweep uric acid out of your body’s system.  This may have to do with something intrinsic to the insulin mechanism itself, but at least part of it is due to the reason insulin gets secreted in the first place: too much sugar!

The relationship between alcohol and gout is well documented.  Drinking alcohol increases lactic acid, which inhibits uric acid excretion.  It also increases the turnover rate of an important biological molecule called adenosine triphosphate (ATP), which increases the amount of purine in your body.

Fructose and ethanol are very similar metabolically.  They’re both digested in the liver, and their digestive pathways produce the same substrates which increase uric acid levels.  The biggest difference between the two is that ethanol is used by your brain but fructose isn’t.

So what’s true for alcohol and uric acid is similarly true for fructose and uric acid, and therefore gout.

Take a look at the following graphs:

Fructose intake increases fasting uric acid levels:

It also reduces uric acid excretion because fructose metabolism produces lactic acid:

And it increases your tri-glyceride levels:

All tables taken from this paper.

Given that your body adjusts the level of uric acid it produces in response to your diet (similar to cholesterol), it would appear to me that the inhibition of your body to get rid of the uric acid it creates is the root cause of the prevalence of gout.  (Evidence cited here would support this conclusion).  The levels of purine in meat, seafood, and other stuff are just the turd topping on the shit sandwich.

Eating to Get Rid of Gout: Getting the Story Straight

So when it comes to gout, my interpretation of the evidence looks like this:

1. Eat to improve your insulin resistance, primarily by cutting back on sugar and alcohol.  This will allow your body to increase the rate it excretes uric acid from its system.  Culprit no. 1.
2. Decrease your dietary intake of purine rich foods such as meat and seafood.  This is a clear #2, but can be implemented more quickly than option number 1, which takes time.  Consumption of meat and alcohol does seem to have a positive correlation to the prevalence of gout.  So in the short run it can help you out.  But it’s a multiplier, not the root cause!

The consumption of purine rich vegetables and legumes has no effect on gout.  They do provide purines, but not enough to make a difference, and their other health benefits more than make up whatever extra purine you might consume.

Cherry Juice: The Old Wive’s Tale Worth Talking About

I’ll wrap this up with a home remedy that seems to work.  I’m speaking both from my own research and anecdotal evidence in my personal life.

When my dad had a scorching case of gout he went to his health food store and made a concoction of all sorts of juice concentrates that made the pain in his toe stop.  It consisted primarily of cherry juice.  It cost him $100 a month, but as soon as he stopped drinking it his gout came back with a vengeance.   We called it forever juice.

It would appear that this isn’t a fluke.  Cherries really do clear uric acid from your body.  I don’t know that there’s anything “definitive” about how reliable this effect is, but almost every study I’ve looked at that examines cherry juice and gout finds good things. More about that here, here, and here.

In general I’d suppose that well known anti-inflammatory substances will help as well.  So make sure to add some turmeric, oregano, or ginger to your meals whenever possible…..can’t hurt.

Research and References

Fam, Adel.  “Gout: Excess Calories, Purines, and Alcohol Intake and Beyond. Response to a Urate-Lowering Diet”

URL: http://jrheum.com/subscribers/05/05/773.html

Fam, Adel. “Gout, Diet, and the Insulin Resistance Syndrome”

URL:  https://www.jrheum.com/subscribers/02/07/1350.html

Seegmiller, J.E., et. al. “The Renal Excretion of Uric Acid in Gout”

URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC291015/pdf/jcinvest00314-0162.pdf

Arromdee, Emvalee, et. al. “Epidemiology of Gout: Is the Incidence Rising?”

URL: http://www.jrheum.org/content/29/11/2403.short

Scott, J.T. “Alcohol and Gout”

URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1836465/?page=1

Doherty, Michael, et. al. “New Insights Into the Epidemiology of Gout”

URL: http://rheumatology.oxfordjournals.org/content/48/suppl_2/ii2.full.pdf+html

Nakagawa, Takahiko. “A Causal Role for Uric Acid in Fructose-Induced Metabolic Syndrome”

URL: http://ajprenal.physiology.org/content/290/3/F625.full

Schlesinger, Naomi, et. al. “Pilot Studies of Cherry Juice Concentrate for Gout-Flare Prophylaxis”

URL: http://www.omicsgroup.org/journals/JAHS/JAHS-1-101.php?aid=3643?aid=5434