Gout: The Missing Chapter from Good Calories, Bad Calories

Total read time (bolded sections): 2-3 minutes

Total read time (complete): 12 minutes

Last week, I had a wonderful conversation with Gary Taubes, my favorite science journalist and author of the incredible (and I consider definitive), Good Calories, Bad Calories. His ability to synthesize and recall research, both in writing and in speaking, is one of the most amazing feats I’ve ever witnessed.

It is with great pleasure, therefore, that I offer you the director’s-cut chapter that didn’t make it into the book.

The chapter addresses important misconceptions about diet, fructose, blood pressure, and diabetes through the lens of gout.

If you don’t know someone with gout, you probably will. It is common and becoming more so. The misguided prescriptions from misinformed doctors, which Taubes addresses, have affected my family, and I’d rather save you the trouble if I can.

But what the hell is “gout” anyway?

Like many, I’d heard it a million times but never knew. Here it is…

British physician Alfred Garrod, in the mid-19th century, identified uric acid as the causative agent; the idea being that uric acid accumulates in the circulation [and] crystallizes into needle-sharp urate crystals. These crystals then lodge in the soft tissues and in the joints of the extremities –- classically, the big toe — and cause inflammation, swelling and an excruciating pain that was described memorably by the 18th century bon vivant Sydney Smith as like walking on one’s eyeballs.

Sound like something to avoid?

Disclaimer as requested by Gary: This chapter is in draft form and has not gone through the same fact-checking as the rest of Taubes’ published work, even though there are 32 citations (some incomplete). I wanted to show the writing process at its mid-point. The only deletions I’ve make are “TK”, which–for unknown reasons–is traditional shorthand in publishing for indicating that something is “to come”.

I have bolded several sections for those who would like a 2-3-minute skim of content highlights before digesting the entire piece, which is 7 pages long.

Enter Gary Taubes:


Gout and the condition known technically as hyperuricemia, or elevated levels of uric acid, are the most recent examples of this kind of institutional neglect of the potential health effects of fructose, and how pervasive it can be.

Gout itself is an interesting example because it is a disease that has gone out of fashion in the last century and yet the latest reports suggest it is not only as prevalent as ever, but becoming more so. Recent surveys suggest that nearly 6 percent of all American men in their fifties suffer from gout, and over ten percent in their seventies. The proportion of women afflicted is considerably less at younger ages but still rises over 3 percent by age 60.(1) Moreover, the prevalence of gout seems to have doubled over the last quarter century, coincident (perhaps not coincidentally) with the reported increase in obesity, and it may have increased five- or even six-fold since the 1950s, although a large portion of that increase may be due to the aging of the population.(2)

Until the late 17th century, when the spread of gout reached almost epidemic proportions in Britain, the disease afflicted almost exclusively the nobility, the rich and the educated, and so those who could afford to indulge an excessive appetite for food and alcohol. This made gout the original example of a disease linked to diet and over-consumption, and so, in effect, the original disease of civilization.

But once gout became easily treatable, in the early 1960s, with the discovery of the drug allopuranol, clinical investigators and researchers began to lose interest. And the pathology of gout has been understood since the British physician Alfred Garrod, in the mid-19th century, identified uric acid as the causative agent; the idea being that uric acid accumulates in the circulation to the point that it falls out of solution, as a chemist would put it, and so crystallizes into needle-sharp urate crystals. These crystals then lodge in the soft tissues and in the joints of the extremities – classically, the big toe — and cause inflammation, swelling and an excruciating pain that was described memorably by the 18th century bon vivant Sydney Smith as like walking on one’s eyeballs.(3) Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.

The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels. A nearly vegetarian diet, for instance, is likely to drop serum uric acid levels by 10 to 15% percent compared to a typical American diet, but that’s rarely sufficient to return high uric acid levels to normality, and there is little evidence that such diets reliably reduce the incidence of gouty attacks in those afflicted.(4) Thus, purine-free diets are no longer prescribed for the treatment of gout, as the gout specialist Irving Fox noted in 1984, “because of their ineffectiveness” and their “minor influence” on uric acid levels.(5) Moreover, the incident of gout in vegetarians, or mostly vegetarians, has always been significant and “much higher than is generally assumed.” (One mid-century estimate, for instance, put the incidence of gout in India among “largely vegetarians and teetotalers” at 7%.)(6) Finally, there’s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.

The alternative hypothesis is suggested by the association between gout and the entire spectrum of diseases of civilization, and between hyperuricemia and the metabolic abnormalities of Syndrome X. In the past century, gout has manifested all of the now-familiar patterns, chronologically and geographically, of diseases of civilization, and so those diseases associated with western diets. European physicians in World War I, for instance, reported a reduced incidence of gout in countries undergoing food shortages.(8) In primitive populations eating traditional diets, gout was virtually unknown or at least went virtually unreported (with the conspicuous exception of Albert Schweitzer who says he saw it with surprising frequency.) The earliest documented cases reported in Asia and Africa were in the late 1940s.(9) And even in the 1960s, hospital records from Kenya and Uganda suggested an incidence of gout lower than one in a thousand among the native Africans. Nonetheless, by the late 1970s, uric acid levels in Africa were increasing with westernization and urbanization,(10) while the incidence of both hyperuricemia and gout among South Pacific islanders was reportedly sky-rocketing. By 1975, the New Zealand rheumatologist B.S. Rose, a colleague of Ian Prior’s, was describing the native populations of the South Pacific as “one large gouty family.”(11)

Gout has also been linked to obesity since the Hippocratic era, and this association is the origin of the assumption that high-living and excessive appetites are the cause. Gouty men have long been reported to suffer higher rates of atherosclerosis and hypertension, while stroke and coronary heart disease are common causes of death.(12) Diabetes is also commonly associated with gout. In 1951, Menard Gertler, working with Paul Dudley White’s Coronary Research Project at Harvard, reported that serum uric acid levels rose with weight, and that men who suffered heart attacks were four times as likely to be hyperuricemic as healthy controls.(13) This led to a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)

These observations would suggest that anything that raised insulin levels would in turn raise uric acid levels and might cause gout, which would implicate any high carbohydrate diet with sufficient calories. But this neglects the unique contribution of fructose. The evidence arguing for sugar or fructose as the primary cause of gout is two-fold. First, the distribution of gout in western populations has paralleled the availability of sugar for centuries, and not all refined carbohydrates in this case. It was in the mid-17th century, that gout went from being exclusively a disease of the rich and the nobility to spread downward and outward through British society, reaching near epidemic proportions by the 18th century. Historians refer to this as the “gout wave,”(16) and it coincides precisely with the birth and explosive growth of the British sugar industry(17) and the transformation of sugar, in the words of the anthropologist Sydney Mintz, from “a luxury of kings into the kingly luxury of commoners.”(18) British per capita sugar consumption in the 17th century was remarkably low by modern standards, a few pounds per capita per year at the turn of the century, but the change in consumption over the next century and a half was unprecedented: between 1650 and 1800, following the British acquisition of Barbados, Jamaica and other “sugar islands”, total sugar consumption in England and Wales increased 20- to 25-fold.(19)

The second piece of evidence is much less circumstantial: simply put, fructose increases serum levels of uric acid. The “striking increase” in uric acid levels with an infusion of fructose was first reported in the Lancet in the late 1960s by clinicians from Helsinki, Finland, who referred to it as fructose-induced hyperuricemia.(20) This was followed by a series of studies through the late 1980s confirming the existence of the effect and reporting on the variety of mechanisms by which it came about. Fructose, for instance, accelerates the breakdown of a molecule known as ATP, which is the primary source of energy for cellular reactions and is loaded with purines. (ATP stands for adenosine triphosphate; adenosine is a form of adenine, and adenine is a purine.) And so this in turn increases formation of uric acid. Alcohol apparently raises uric acid levels through the same mechanism, although beer also has purines in it.(21) Fructose also stimulates the synthesis of purines directly, and the metabolism of fructose leads to the production of lactic acid, which in turn reduces the excretion of uric acid by the kidney and so raises uric acid concentrations indirectly by that mechanism.(22)

These mechanistic explanations of how fructose raises uric acid levels were then supported by a genetic connection between fructose metabolism and gout itself. Gout often runs in families, so much so that those clinicians studying gout have always assumed the disease has a strong hereditary component. In 1990, Edwin Seegmiller, one of the few veteran gout researchers in the U.S., and the British geneticist George Radda, who would go onto become director of the Medical Research Counsel, reported that the explanation for this familial association seemed to be a very specific defect in the genes that regulate fructose metabolism. Thus, individuals who inherit this defect will have trouble metabolizing fructose and so will be born with a predisposition to gout. This suggested the possibility, Seegmiller and Radda concluded, that this defect in fructose metabolism was “a fairly common cause of gout.”(23)

As these observations appeared in the literature, the relevant investigators were reasonably clear about the implications: “since serum-uric-acid levels are critical in individuals with gout, fructose might deserve consideration in their diet,” noted the Helsinki clinicians in The Lancet in 1967, and so the chronic consequences of high-fructose diets on healthy individuals required further evaluation.(24) Gouty patients should avoid high-fructose or high-sucrose diets, explained Irving Fox in 1984, because “fructose can accelerate rates of uric acid synthesis as well as lead to increased triglyceride production.”(25) Although none of these investigators seemed willing to define what precisely constituted a high-fructose or a high-sucrose diet. Was it 50 pounds of sugar a year? 100 pounds? 150 pounds? 300 pounds? And would high-fructose diets induce gout in healthy individuals or would they only exacerbate the problem in those already afflicted? In 1993, the British biochemist Peter Mayes published an article on fructose metabolism in the American Journal of Clinical Nutrition that is now considered the seminal article in the field. (This was in the special issue of the AJCN dedicated to the health effects of fructose.) Mayes reviewed the literature and concluded that high-fructose diets in healthy individuals were indeed likely to cause hyperuricemia, and he implied that gout could be a result, as well, but the studies to address that possibility had simply never been done. “It is clear,” Mayes concluded, “that systematic investigations in humans are needed to ascertain the precise amounts, both of fructose consumption and of its concentration in the blood, at which deleterious effects such as hyperlipidemia and hyperuricemia occur.”(26) Add to this Reaven’s research reporting that high insulin levels and insulin resistance will increase uric acid levels, and it suggests, as Mayes had remarked about triglycerides, that sugar (sucrose) and high fructose corn syrup would constitute the worst of all carbohydrates when it comes to uric acid and gout. The fructose would increase uric acid production and decrease uric acid excretion, while the glucose, through its effect on insulin, would also decrease uric acid excretion. Thus, it would be reasonable to assume or at least to speculate that sugar is a likely cause of gout, and that the patterns of sugar consumption explain the appearance and distribution of the disease.

Maybe so, but this hypothesis has never been seriously considered. Those investigators interested in gout have focused almost exclusively on alcohol and meat consumption, in part because these have historical precedents and because the implication that gouty individuals and particularly obese gouty individuals shy away from meat and alcohol fit in well with the dietary prescriptions of the 1970s onward.

More than anything, however, this sugar/fructose hypothesis was ignored, once again, because of bad timing. With the discovery and clinical application of allopurinol in the 1960s, those clinical investigators whose laboratories were devoted to studying the mechanisms of gout and purine metabolism – James Wyngaarden’s, for instance, at Duke and Edwin Seegmiller’s at NIH – began focusing their efforts either on working out the nuances of allopurinol therapy, or to applying the new techniques of molecular biology to the genetics of gout and rare disorders of hyperuricemia or purine metabolism. Nutritional studies were simply not considered worthy of their time, if for no other reason than that allopuranol allowed gout suffers to eat or drink whatever they wanted. “We didn’t care so much whether some particular food might do something,” says William Kelley, who is a co-author with Wyngaarden of the 1976 textbook, Gout and Hyperuricemia and who started his career in Seegmiller’s lab at NIH. “We could take care of the disease.”(27)

This exodus, however, coincided with the emergence of research on fructose-induced hyperuricemia. By the 1980s, when the ability of fructose and sucrose consumption to raise uric acid levels in human subjects was demonstrated repeatedly, the era of basic research on gout had come to an end. The major players had left the field and NIH funding on the subject had dwindled to a trickle. Wyngaarden published his last research paper in 1977 and spent the years 1982 to 1989 as director of the National Institutes of Health. Kelley published his last papers on the genetics of gout in 1989, when he became dean of medicine at the University of Pennsylvania. Irving Fox, who did much of the basic research on fructose- and alcohol-induced hyperuricemia in Kelley’s lab, went to work in the biotechnology industry in the early 1990s. Only Edwin Seegmiller remained interested in the etiology of gout, and Seegmiller says that when he applied to the NIH for funding to study the relationship between fructose and gout, after elucidating the genetic connection with Radda in 1990, his grant proposals were rejected on the basis that he was too old and, as an emeritus professor, technically retired.(28) “In the 1950s and 1960s, we had the greatest clinical scientists in the world working on this disease,” says Kelley. “By the 1980s and 1990s, there was no one left.”

Meanwhile, the medical journals would occasionally run articles on the clinical management of the gout, but these would concentrate almost exclusively on drug therapy. Discussions of diet would be short, perhaps a few sentences, and confused about the science. On those occasions when the authors would suggest that gouty individuals might benefit from low-purine diets, they would invariably include “sugars” and “sweets” as among the recommended foods with low-purine contents.(29) In a few cases – a 1996 article in the New England Journal of Medicine, for instance (30)– the articles would also note that fructose consumption would raise uric acid levels, suggesting only that the authors had been unaware of the role of fructose in “sugars” and “sweets.” Even when the New England Journal published a report from Walter Willett and his Harvard colleagues in March 2004, this same kind of nutritional illiteracy manifested itself. Willett’s article had reported that men with gout seemed to eat more meat than healthy men. But Willett, who by this time was arguably the nation’s most influential nutritional epidemiologist, later explained that they had never considered sugar consumption in their analysis because neither he nor his collaborators had been aware of the hyperuricemic effect of fructose. Willett’s co-author, Gary Curhan, a nephrologist and gout specialist with a doctorate in epidemiology, said he might have once known that fructose raised uric acid levels, but it had slipped his mind. “My memory is not what it used to be,” he said. He also acknowledged, in any case, that he never knew sucrose was half fructose.

The addenda to this fructose-induced hyperuricemia story may be even more important. When the New England Journal of Medicine published Willett’s gout study, it ran an editorial to accompany it written by the University of Florida nephrologist Richard Johnson. Over the past decade, Johnson’s research has supported the hypothesis that elevating the uric acid concentration in the circulation also damages the blood vessels leading into the kidneys in such a way as to raise blood pressure directly, and so suggests that fructose consumption will raise blood pressure.

This is another potentially harmful effect of fructose that post-dates the official reports exonerating sugar in the diet. And it is yet another mechanism by which sugar and high fructose corn syrup could be a particularly unhealthy combination. The glucose in these sugars would raise insulin levels, which in turn would raise blood pressure by inhibiting the kidney’s secretion of sodium and by stimulating the sympathetic nervous system, as we discussed in an earlier chapter, and the fructose would do it independently by raising uric acid levels and so damaging the kidney directly. If this were the case, which has never been tested, it would potentially explain the common association of gout and hypertension and even of diabetes and hypertension.(31) Johnson is only now looking into this possibility, however. Unlike Willett and his colleagues, Johnson had long been aware of the ability of fructose to raise uric acid levels, and so was studying that phenomenon in his laboratory. But it was only in the summer of 2004, he explained, three months after his NEJM editorial was published, that he realized that sucrose was half fructose and that his research of the past years was even relevant to sugar.(32)

A decade later, Thomas Benedek described the epidemiology of gout in The Cambridge World History of Human Disease this way: “Worldwide the severity and prevalence of gout have changed paradoxically since the 1940s. In the highly developed countries, as a result of the advent of effective prophylactic drug therapy, the disease is now rarely disabling. Elsewhere, however, it has become more prevalent, predominantly as a result of `improved diets.’”

###

Footnotes and endnotes:

The economist and historian Ralph Davis estimates that the supply of sugar from the Caribbean into Britain rose from three or four thousand tons a year in the late fifteenth century to over two hundred thousand tons by the 1770s, or an increase of over fifty-fold. (davis r, the rise of the atlantic economies, cornell university press, 1973, p. 251, 255)

1 Kramer hm, curhan g, the association between gout and nephrolithiasis: the national health and nutrition examination survey III. 1988-1994. Am J Kidney Dis 2002;40:37-42

2 Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002 Nov;29(11):2403-6.

2Interview with choi, sept 16, 2004

2Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.

2Arthritis Rheum. 1998 May;41(5):778-99.

3 gout, the patrician disease, p. 3

4

5 hydrick and fox, p. 748-749.

6 Duncan’s diseases of metabolism, p. 632.

7 Hydrick cr and fox ih, nutrition and gout, in present knowledge in nutrition, fifth edition, the nutrition foundation, Washington dc, 1984, p. 743

8 duncans diseases of metabolism, p. 638

9 Traut ef, rheumatic diseases, diagnosis and treatment, the C.V. Mosby Company, St. Louis, 1952 p. 303.

9benedek, in Cambridge history of diseases

9Trowel hc, a case of gout in a ruanda African, the east African medical journal, oct. 1947, p. 346-348

10 Beighton p et al, 1977, rheumatic disorders in th south African negro, part IV. Gout and hyperuricemia. South Af Med J. 51(26):969-72

11 Gout in the Maoris, B.S. Rose, Seminars in Arthritis and Rheumatism. Vol. 5, no. 2, (November) 1975, pg. 121-145.

12 duncan’s diseases of metabolism, 1947, p. 631

13 gertler mm, et al, erum uric acid in relation to age and physique in health andin coronary ehart disease, Ann Intern Med. 1951 Jun;34(6):1421-31. Reiser S, Uric Acid and Lactic Acid, in REISER S AND HALLFRISCH J, METABOLIC EFFECTS OF FRUCTOSE, crc press, boca raton fl, 1987 p. 113-134

13

14 duncan’s diseases of metabolism, p. 631

14 reaven gm, The Kidney: An Unwilling Accomplice in Syndrome X, Am J Kid Dis, Vol. 30, n0 6, December, 1997: pp. 928-931.

15 Facchini F et al, Relationship Between Resistance to Insulin-Mediated Glucose Uptake, Urinary Uric Acid Clearance, and Plasma Uric Acid Concentration, JAMA, December 4, 1991, vol. 266, no. 21, 3008-3011

16 Wyngaarden and Kelley p. ix

17 mintz

18 Sydney Mintz, Sweetness and Power, The Place of Sugar in Modern History, penguin books, ny 1985 p. 96.

19 mintz p. 64, 66

20 perheentupa j raivio k, fructose-induced hyperuricaemia, lancet, September 9, 1967, p.528531

21 emmerson bt, getting rid of gout

22 mayes pa, metabolism of fructose, ajcn, 1993

22hydrick c fox i, nutrition and gout, in modern reviews of nutrition

23 Seegmiller JE, Dixon RM, Kemp GJ, Angus PW, McAlindon TE, Dieppe P, Rajagopalan B, Radda GK. Fructose-induced aberration of metabolism in familial gout identified by 31P magnetic resonance spectroscopy.

23Proc Natl Acad Sci U S A. 1990 Nov;87(21):8326-30

24 peerheentupa ibid

25 hydrick and fox, p. 748-749.

26 Mayes pa, metabolism of fructose, ajcn 1993

27 Kelley interview

28 seegmiller interview

29 See for instance, fam ag, gout, diet and the insulin resistance syndrome, j. rheum. 2002;29, 1350-55

30 Emmerson BT. The management of gout.

30N Engl J Med. 1996 Feb 15;334(7):445-51

31 get citation from Richard Johnson articles on uric acid and hypertension.

32 Johnson interview, june 3, 2004

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265 Replies to “Gout: The Missing Chapter from Good Calories, Bad Calories”

  1. Tim,

    I’m about 1/3 through Taubes book. Fascinating. I would like to ask him, based on the assumption that I’m not going to entirely quit drinking alcohol, and have had gout once or twice and don’t want to repeat that, what in his opinion is my best option for the occasional drink?

  2. Health is a hot topic, especially in the media, because it pricks many raw emotions in us. If we were to sit down with an average African or Indian native from a poor part of the country, and start informing them about the fructose content or GI range of different foods, he/she would think we’d been possessed by the devil or had been smoking too many herbs.

    What works for one person, doesn’t work for another. If we follow a nutrient-packed diet for weeks but then go out for beers one weekend, is this better than someone who eats a not-so-healthy diet but never drinks alcohol? What about age or wealth… does that have an influence?

    I think we can sometimes look too far into things and loose all common sense. Health is not just about the foods we eat, it’s about much much more. Optimal health is when everything is working in sync: nervous, muscular, skeletal, circulatory, digestive, lymphatic, hormonal etc. There are certain foundations, or principles, that apply to everyone and need to be learnt (should be taught in schools). Once these are understood, it’s much easier to build on them and keep a rational perspective on what we’re fed via the media.

  3. Robbie Trinidad: Caffeine might be a problem, but I would add phosphoric acid to the list of suspects. You might try getting your caffeine fix from some other source, and see if the effect is different.

    I simply stopped drinking any beverage that contains phosphoric acid when I found it was the principal cause of my restless leg syndrome.

    BTW, I’m starting back on week 1 of Dr. Eades Six-week Cure as of this morning. I’m down 12 lbs for the month, which is a bit disappointing, but 1) I didn’t get fat overnight, and 2) my wife had bariatric surgery, and except for the first month, she never lost more than 13 lbs in a month. So 12 lbs is ok, even if not spectacular.

  4. I self-diagnosed gout at age 38, about 4 years ago (my GP now agrees with the diagnosis).

    In my case, I’m convinced it was excessive consumption of rich beers (microbrews, Beligian ales, etc.) over many years and an increasing amount of beef in my diet prior to the first attack.

    After a little online research, I immediately began avoiding foods high in purines (shellfish, tuna, beer, beef, etc.), and I switched from beer to vodka or scotch as my alcoholic beverages of choice. I’ve been mostly symptom-free ever since. Now the only times I have a flair-up anymore are when I eat beef and/or tuna more than once in a week *and* drink several pints of beer over only a few days.

    By the way, ibuprofin does wonders to alleviate the pain of a gout attack, while aspirin will make it worse.

  5. When you are deciding what food to eat at a restaurant or at the grocery store, I think it is important to think of what your body needs. Lots of really fit and trim people have an intuitive sense of what is going on in their body when they choose what to eat. Others blessed genetically. Still others exercise a lot.

    Protein repairs muscle fiber. If you eat zero protein, over time your muscles deteriorate, unless you can think of some way to not move. When you use your muscles, you create tiny tears that break them down. This occurs even when you are not doing some intense exercise or workout. It happens as you breath (in your lungs) and as you walk (in your leg muscles).

    Carbohydrates supply energy to the muscle. They fuel your body’s muscles much in the same way gasoline fuels your car. Marathoners often talk about “hitting the wall” around mile 20-22. Lots of people hit this “wall” around that mile mark because most people have a similar capacity to integrate carbohydrates into their muscles. The reason they hit it here is because they fail to consume the proper amount of carbohydrates at the right time in order to finish the race (with any amount of energy). Even runners who consume carbs during marathons often hit this wall, but they might get a second wind when the carbs move from their gut through their blood stream and refuel their muscles. Some runners don’t hit this wall because they train more and because they know their body so well that they consume carbs during the race (usually before they ever actually feel the deficiency) in time for the carbs to work their way into their bloodstream and into their muscle fibers. And also, some runners muscles have a high capacity of storing fuel, and no, it isn’t stored as fat, it is stored in the muscle cells. These guys are what the “weekend-warrior” marathoners (like me) call the “elite.”

    Carbs are good. They give you fuel. But if your car has a full tank, why would you store gasoline in separate containers inside your trunk? I’d say if this happens frequently, pretty soon you are going to have to get a bigger trunk. Also, lots of runners get gout. I’d imagine this is because of their genetic disposition in combination with consuming carbs that are more likely to cause gout.

    a side note: most excess protein that doesn’t get used gets expelled as waste, but it can be converted into carbs, but this isn’t a good thing for your liver or kidneys. Eating/drinking tons of protein won’t make you magically lose weight. It’ll make your blood pressure increase and damage your liver and kidneys.

    If you are trying to gain muscle mass and fiber, it’s best to consumer small quantities of protein throughout the day and then a larger portion of protein at night before you go to sleep. Taking the protein right before bed works well because your metabolism slows down and the protein stays in your stomach and intestines for a longer period of time, allowing for more absorption. If you take it all in one big lump right after your workout, only a small percentage gets absorbed into your blood and transferred to your muscles. If you are considering a high protein diet regardless of your physical level of activity, you should do a thorough family medical history to see if anyone with similar genetics has had liver or kidney problems and act accordingly.

    People get obese because they like to eat and they don’t like to exercise. Period. Some people’s genetics may have a lower tolerance for not having a perfectly constructed diet and exercise program, but basically everyone who has ever been obese can attribute it to excess input and not enough output. As it is happening and after it happens, they get conditioned to this constant excess input. They try to diet, but they feel like they don’t have enough energy so the diet fails. They try to exercise, but they don’t like to exercise. The less work, but also less sustainable (and more risky) solution is to get the gastric bypass surgery or lapband or whatever done. This works for a few years, until their stomach stretches back out and they continue over eating (I’ve witnessed this). The more sustainable solution is to made a decision to eat less. A still better solution, but much more difficult, is to do some cardiovascular exercise. Go running or walking for 5 minutes 3 days for the first week and then step it up to 7 then to 10 and as high and far as you want to go. Then increase the intensity. Find some friends with similar goals and circumstances who want to do the same. You will see the most dramatic thing happen to your body. It is really quite amazing to experience.

    Also, I’m not a medical pro, don’t do anything I say. I could get you killed and I don’t have any money so you wouldn’t be able to sue me. Ask you doctor, etc. etc.

    1. It’s clear you have not read Taubes’ books, or you would not have written a length, metaphor-rich comment pushing the very ideas that he revealed were almost entirely false.

  6. Fascinating article. Also confirms my experiences. I’ve noticed that I get flare-ups around the holidays as I take in more cookies, candies, and other sweets. Definitely a connection. Now if only I would do something about that…

  7. All these guys are right..hormones play a major role as does caloric intake.. it’s a synergistic relationship..Western medical journals/books require black and white perspectives to be deemed worthy of publication/talk show conversation..hence we have a self-destructive relationship with food.

    Conflict and one-dimensionality sells, but it doesn’t make us any healthier.

  8. @James Hardy Fundamental to the modern idea of science is that ALL scientific truth is tentative. Especially things like the big bang and tectonic plate theory. We can’t yet carry out such big experiments which limits the kinds of testing we can do. Since we recently discovered that the expansion of the universe is speeding up, even the big bang gets some real questions.

    I love that the second half of the geologists were convinced that continents move in one meeting from a single graph of the captured magnetic field as the sea floor solidified at a spreading center. The graph from bores across the spreading center showed an exact mirror image. It was compelling.

    My current question is when we will give up on the theory that HIV = AIDS? Some just say that money beats truth or as Dylan put it, “Money doesn’t talk, it swears.” Still, the notion of cognitive dissonance was established at a gathering of people who believed the world would end at a particular time. When it didn’t some folks gave up their belief, but others did not. The scientist noted that higher intensity of prior acts based on the belief, i.e. investment in the idea, predicted higher likelihood of leaving the scene with their faith renewed. Lots of folks have invested much in the HIV theory.

  9. With all due respect, following the comments has made my brain hurt. Can you get gout in your brain? I hope not.

    I’ve given up believing there’s a perfect diet for every person and they’re all different. I don’t blame genetics at all, except to the degree that our genetics compel us to respond to bad foods in bad ways. Seriously though, can we stop with the eugenics-based blame game? I’m not fat because I failed to be a member of the Master Race. I’m fat for reasons I have yet to completely tease out. Thankfully I will be covered by health insurance at the beginning of next year and can go get labs done to confirm or rule out my suspicions.

    Based on my reading I think it’s a combination of the following:

    1. I’ve consumed way too much sugar in my life, chiefly in the form of sodas from late adolescence onward.

    2. Since I became an adult and left home I have been almost constantly sleep-deprived. This affects both hormone and neurotransmitter levels, which in turn affect metabolism.

    3. While I did not go out of my way to avoid saturated fat all those years, I also did not go out of my way to consume more, and until about five years ago I mostly ate margarine instead of butter.

    4. I used synthetic hormones in early adulthood, in the form of contraceptive pills.

    5. Aside from the sugar I’ve had a very carb-heavy diet, most of my carbs coming from grains. I don’t care who you are, human beings are not seed-eaters. And almost none of that grain was fermented properly. This makes a BIG difference.

    I saw the most damage done in the year or two after I had my second child. I attempted to go vegan and it made me fatter and crazier. I ate lots of whole-grain bread. I consumed lots of soy. Before you could say “look out fat@$$, your butt’s growing!”, I had aged a good five to ten years in appearance. In LESS THAN A YEAR’S TIME.

    My own data, in case anyone cares… there you go. Oh, and one more thing. All you people who are saying “nothing’s wrong with me or so-and-so, because I/they are fit and slender…” Quit it. Weight has nothing to do with physical fitness. NO. THING. I know a fat woman who runs marathons. I used to be a slender couch potato. If you are slender and you’re eating low-fat or vegetarian or vegan, I don’t care how much raw stuff you eat (and if it’s raw cruciferous, I hope you’re enjoying destroying your thyroid) or how many different colors you get onto your plate, you’re a ticking time bomb. Slender people who don’t eat right aren’t really slender, they’re pre-fat. Or pre-heart attack. Or pre-diabetic.

    I can look back at the mood swings and brain fog I was experiencing at 5’6″ and 130 pounds and know that’s where I was. OK, the heart attack hasn’t happened yet and I’m not yet diabetic. But I’ll be very, very surprised if my labs in January don’t show all the warning signs.

    I do think it’s a shame that slender people think they’re off the hook. It means they’ll neglect getting health insurance and they’ll neglect getting screenings. And then they’ll start peeing constantly and being ravenously thirsty and they’ll wonder why. They did all the right things, didn’t they–after all, they’re slender!

    Please, people… we need to do better than this. Meanwhile, you’re a primate. Primates are bug-eaters. Bugs are meat. Let it go already.

  10. Tim,

    this is very interesting. I’m a bartender by trade and occasionally see a customer that has complained of problems however, that is the rare exception and people love to complain in the bar. This makes me think again, we’re suffering for the industrial age diet.

    I’ve started experimenting with my diet quite a bit. I started noticing a slow gradual weight loss when I’d spend a late evening with one of my friends instead of going home. The difference? At home, I’d have a tendency to try to eat something unhealthy. At her house, I’d typically have a glass or two of wine, half an apple, and a few pieces of good quality cheese (I love Perrano). I think the apple was the main culprit there. As a result, I’ve been moving closer and closer to a mostly whole foods diet. I believe someone above described it as the “primal diet”. And my reasoning for this isn’t exactly what I’d describe as rocket science. Our bodies spent a couple of thousand years processing natural foods, not processed junk that was designed to addict us and make us fat so we’d consume more. I’ve noticed I feel a lot better after consuming natural whole foods (fruits, vegetables, lean meats, ect…). Something I have tried to do for years, particularly when I’m working out, is to make sure my potassium intake is greater than my sodium intake so as to keep the water in my muscle tissues.

    In addition, I hear lots of people hyping vegetarianism and veganism, which is odd to me, since if we were designed to be herbivores, our teeth wouldn’t be shaped like they are. They’d be shaped like a horses. Instead, we have the teeth of an omnivore and anyone who paid attention in science class in school, should be able to figure that out. To top it off, a lot of the vegetarian/vegan specialty foods have incredible levels of sodium. These are their substitute foods usually, veggie patties and faux cheeses are examples.

    Long story short, eat fresh fruits and vegetables, eat lean meat, stay active, and try to keep the foods organic as well.

  11. Great article, I’ve just been through a 2 month gout attack, the worst I’ve had and put it down the the fairly large quantities of Gatorade I was drinking beforehand. I started researching the link between fructose and gout last year when I had an attack after going on a fruit juice health kick. Now I’m fairly certain that it’s at least a big contributor, along with genetics and stuff that’s probably related to each person individually.

    @ Cameron Benz

    Meat eaters will often use the argument that we have VAGUELY canine shaped teeth to say we should be eating meat. Have you ever looked at a monkey or a gorillas teeth? They are far sharper than ours and are use for ripping plants. While I have nothing against people wanting to eat meat I do have a huge “beef” with cruelty in modern farming methods. If you’re happy eating animals that have been subjected to inhumane treatment go for it. My conscience won’t allow it, even if it means I have to work a bit harder to keep topped up with all the correct things.

  12. I got gout at 26 years old, I researched what caused it and got the same ‘ol purines type foods, alcohol…Doctor prescribed me 200mg of Allopurinol daily and I was angry at myself, asking how can this happen to me at such a young age? A few years later I bumped into Dr. Mercola on the web and read one of his articles about fructose particularly pop sodas which I had a tendency to drink a lot. I immediately changed my diet cut the pop and ate better and now I cut my prescription to 50mg of Allopurinol without my doctor’s consent which he said was for life and after almost a year no attacks of gout, now my final step is to eliminate Allopurinol completely and eat healthy, as well shock my doctor.

  13. Hi Tim and all,

    Regarding the increase of obesity in our societies my wife have an interesting hypothesis which we haven’t looked into. Her culprit is the introduction of light products which seems to correlate in time with the raise in obesity (not in anyway a fact checked hypothesis).

    I think that is an interesting idea, I’m personally having a problem believing that the problem comes from hormones and genetics alone.

    1. ‘Lite’ invariable refers to low fat. It is interesting to consider that if when you reduce the fat in a a processed food product it it likely to taste like cardboard. Hence the need to add sugar to make it palatable.

      Consider the comments around the 39th minute of the talk by Robert Lustig called Sugar: The bitter truth that can be seen on youtube.

      An example he uses are Snackwells Oreos which had 2g less of fat but 13 grams more of carbs (with 4 of these grams being sugar) than the regular version.

      The point he makes is the increase in fructose consumption has caused the obesity/diabetes epidemic.

  14. @ Meyer/Allen

    First, there is no such THING as a culture that doesn’t eat salt. ALL cultures eat salt. Salt is necessary for humans to live and function, and healthy humans can’t store (much)in their bodies. Prior to the discovery of salt deposits, most “processed” salt was created on the coasts, and traded inland, becoming progressively more valuable the further inland it traveled. Salted fish, shellfish, and seaweed also traded inland, and the very oldest settlements inland have seafood remains from salt water. “Salty” foods were more popular inland than on the coast, too, b/c less free salt is available inland.

    Second, studies show that most persons eat a very consistent amount of salt per day, that that amount does not vary much from day to day or year to year in a given person, and that the amount does not vary significantly based on availability, or from person to person, culture to culture, or even continent to continent. The amount of salt we eat appears to be biologically regulated.

    FINALLY, and this VERY IMPORTANT, the supposed connection between salt and high blood pressure is tenuous at best, and the old wives tale concerning that connection was fostered by poorly developed medical science early in the last century. What was noticed by medical science was that persons with high blood pressure tended to have high blood saline levels relative to other minerals in the blood, and it was assumed that excess salt was the cause/culprit, confirming folk lore. Further investigation was unfortunately not done.

    More recent studies with proper controls have shown that about 2/3 of persons show no reaction, about 1/6 show an increase in blood pressure, and about 1/6 show a DECREASE in blood pressure given increased salt (and vice versa w/salt restrictions). This is, approximately, random for a human trial.

    The current hypothesis is that real problem (or symptom) is an imbalance in blood potassium or magnesium, or possibly something else. Not excess salt. Salt just appeared as the culprit b/c scientists at the time didn’t know to look for an “imbalance,” and did not understand that “excessive” blood saline levesl would not correlate with salt use in diet; it is merely a symptom of some other problem. And the wive’s tale continues for the same reasons many others do–poor nutritional education.

  15. Andy,

    I wholeheartedly agree with you about many of the farming practices. I’ve gone to organic grass fed beef now that I’ve found a place to get it. Typical mas market beef is terrible in it’s treatment of the animals themselves. Hormones, antibiotics, improper feed, pens, etc…. are play a role. For a while, farmers have used antibiotics in the feed for the livestock to bulk animals up faster when they’re young and we’re now see the effect of that prolonged use of medication in the antibiotic-resistant strains of microbes such as staph that then mutate before being able to live in a human host.

    Now, this will be where we part ways in agreement. You point to the inhumane treatment of farmed animals as an act you can not condone consciously, but have you ever seen what happens to an animal when when a wild cat, wolf, or coyote gets to it? Do you consider that humane? I suppose you’ll chalk that up to nature. However, that’s really what our eating consists of. Which then brings us full circle back to the utter junk most of the modern American diet consists of.

    Also, I’m not pointing out the teeth saying we should only eat meat, but we should be eating meat and vegetables both. I did some research to and found that throughout the history of man, veganism and vegetarianism have been rare. The overwhelming history of societies of mankind has involved the consumption of meat.

    All that said, most Americans also eat TOO MUCH meat. i.e. “yeah I’ll have that 16oz. porterhouse slathered in butter, oh and can I get more butter and sour cream for my mashed potato?”.

    Cheers Andy!

  16. celery seed extract tablets

    I have had fantastic success with celery seed extract tablets for treating gout.

    If I forget, after a few days the gout really hurts. I take it, and no pain in one or two days.

    I found a reference to it in a natural health book – and then on the internet you’ll find explanations on how it reduces uric acid production, and removes it through its diuretic function. What a relief!

    I similarly found a rapid, almost instant cure for a bad back – after crippling disc pain – for another post perhaps.

  17. Well ain’t this somethin’.

    Two weeks ago I’d had it, so I went to see my doctor. The complaint is simple: I’m overweight, and every time I exercise I either pull something, or one of my feet goes offline and I spend the next two weeks limping around in horrible pain. I’m sick of it.

    I show him my foot, and he holds his hand above it. “It’s hot. It’s gout.” Great. He writes a script. Scripts are great and all, and I press him for the CAUSE, what do I need to change? He shrugs. “Some people just get it.”

    Great. I’m going to be on allopurinol for the rest of my life. I do not like this.

    But it works, the colchicine raises the pH of my body and I can walk the day after a workout. I’m back on program, exercising the way I know I should and not limping around as a result. My 40 mile bike ride on Saturday proved it. Ends justifying the means and all that.

    Paragraph 9 just about knocked me out of my chair. The breakdown of ATP increases the level of uric acid in my blood. I knew that, but to see it in print with references changes everything.

    The takeaway from this is the idea that I simply do not process fructose like other people. I’m not into long-term prophylactic treatments, I’m into taking care of root causes.

    I’ve run two marathons, and after the 2008 race I simply had to stop. Every run resulted in debilitating pain. Running on the foot anyway resulted in compensation injuries. I gained weight, so I ran harder, which resulted in more pain. The spiral has to stop.

    By posting this, Mr. Ferriss, you’ve helped me get to the core pathway of one of my most painful ongoing issues. Thank you.

  18. Hi Tim,

    I’m liking the education about Fructose and all but like so much of the other information about Gout and what to do about it and what causes it, there’s too much emphasis but on what we eat and drink.

    Personally, I have (had) gout worse than anyone I’ve ever met and the medications, eating right, not drinking, etc. never worked.

    Since the body produces uric acid (a natural antioxidant) and the body then attacks itself when it builds up too much, I call it an Autoimmune Disease.

    It was only when I started downing huge doses of high antioxidant (in the form of dark chocolate) did the attacks (2 per month on average) stop. (not just any chocolate, read up on the anti-inflammatory properties of raw cacao)

    What we eat and what we drink (including all the weird chemicals and pesticides and chlorine) certainly play into it all but that is because they are a good source of where we get our Free Radical Damage. So is the air we breathe, too much sun, charging too hard, (sports) stress, (hormones) and the list goes on.

    I’ve become so obsessed with it all, I’ve created a website about the whole experience. Good Luck!

  19. @patrea

    TWIMC, please email me at glen.fuller@verizon.net if you would like to discuss this further, as this is a tremendously important subject. And as usual, there’s more to this than meets the eye.

    Several years ago, at around age 25, I tried to enlist in the Air Force intending to pursue a career as a jet pilot. Everything during the physical was fine until a blood test revealed a high level of uric acid (goodbye flight school). I was on a weight gain powder supplement (MLO as I recall) at the time because I was weight training and trying to bulk up. I think there were even issues with my big toes.

    Then, a couple of years ago, I had problems associated with what I believed to be acidic pH (systemic-but no heartburn at all). Symptoms were–as best I can describe–pain all over AFTER eating or drinking anything leaning toward acidic pH. Had to cut out coffee (lots of different acids), eggs (arachadonic acid, etc.), even cherries! I can definitely say, common Celery helped a lot! Also, Cilantro, which by the way, I understand is liver tonic and a popular heavy metal detoxifier in Japan. Both will shift urine and saliva pH toward alkaline, and Cilantro will do it in a hurry. An alternative therapy for liver congestion was a benefit as well.

    Anyway, after a very uncomfortable episode caused by simple Marshmallow (the herb), blood and urine tests by an MD said everything was perfect. Nevertheless, I eliminated other things such as never drinking anything out of a plastic container, stopping the use of Teflon coated pans, etc.

    By far the worst reaction of all was caused by ingesting an over-the-counter product with the ingredients shown below. This information is from the label of a food acid neutralizer (and some report it relieves interstitial cystitis). Note the predominant ingredient in the list!

    My message–be careful, pay close attention and suspect everything, no matter how seemingly innocuous. Thankfully, all is now back to normal as far as I know, and the sensory effects have not returned.

    Nutritional Facts

    Each Serving Size provides:

    Nutritional Facts

    Each Serving Size 1/4 teaspoon provides:

    Ingredients Dosage % Daily Value

    Calcium as calcium glycerophosphate 130 15

    Phosphorus (mg) 100 10

    Percent Daily Values are based on a 2,000 calorie diet.

    *Daily Value not established.

    **Percent DV based on a 2,000 calorie diet.

  20. alcohol is deffo a cause

    i’ve been eating about 40gms a day of carbs overall for 7 years – all natural Primal whole foods based on meat and dairy, green and red veg, a few nuts and a bit of fruit…..

    i have been consuming almost no fructose for all that time – i now have gout.. why?

    because, up till recently, i drank a bottle of wine a day (20 years worth)

    M

    };¬(

    1. Markus,

      If you have a look at Robert Lustig’s “The Bitter Truth”, he demonstrates that consuming a certain quantity of fructose is chemically almost equivalent to consuming a similar quantity of ethanol. Has the same effect on the liver that is.

      (The difference is that fructose is not metabolised in the brain, so you don’t get the effects that alcohol usually has on the brain).

      This is likely to come to a shock to the innocent consume of fructose who may be teetotal.

      Looked at the other way though, it may come as a shock to the average consumer of wine (especially “healthy” red wine), that it has the same effect on his liver as fructose (which Lustig shows is a bad one).

      I say this as a (red) wine drinker myself, although not quite in such heroic quantities as a bottle a day (not over a long period, anyway).

      It has certainly made me think more carefully about future alcohol consumption.

      He also said quite clearly that alcohol was a carbohydrate, something which some low-carbers (I am one) deny.

  21. Gary Taubes is my hero, and Tim Ferris, are you the one who outlined the ENTIRE GCBC, which can be found online? What a service! And so wonderful to have this Gout chapter! Like others here, I treat anything by Taubes with the respect rightfully reserved for sacred writ. My husband and I went low carb high fat and hubby lost 25 lbs since March 21, 2010 and I lost 10. But it’s the ENERGY and loss of fatigue and brain fog that are the real pluses. And knowing we’ll be around to enjoy our grandchildren for a LONG time to come!

    (1) My husband and I join the crowd who would buy GCBC2 (i.e. GCBC before Gary’s editor made him cut it) and hope it gets published!

    (2) The Drs. Eades are great, so is Mark Sisson (Primal Blueprint) and Alan Watson (Cereal Killers — it has starting p. 120 a GREAT “Lipid Panel – Summary of coronary heart disease risk factors” which takes from Taubes’ research and that of others “goodies” – take it to your doctor and be sure and have your apo-B measured!).

    (3) Grass-fed beef & dairy. Weston A. Price is great; heard about eatwild dot com from Alan Watson’s “Cereal Killers” – it is a site where you can located grassfed beef & dairy no matter what state you live in; lists the farms, their hours, everything about them. I’m even going to try raw milk! But it’s for the cream (0 carbs 0 sugar) that I want it. Google tale of two calves – wow!

    (4) As for natural farming, check out Joel Salatin and Jerry Brunetti.

  22. Gout? We don’t need no stinking gout! Back when I was younger and trying to be virtuous, I made a good-faith effort to quit eating so much evil “red meat,” but after several recurrent gout attacks and associated drug treatment, I performed a little RLS’ Dr.J/Mr.H self-experimentation, and I discovered the problem: too much allegedly benign chicken, too many meals in a row. So I confessed my heresy and returned to a more balanced, standard mixed-carnivore diet, and now I’m gout free, Jerry, and I’m lovin’ it! But no, all seriousness aside, you can scoff at my statistically non-significant, personal anecdote if you like, it won’t hurt my feelings, but if the shoe fits–without the excruciating pain–I’m wearing it.

  23. My brother is a gout sufferer and I have conducted in depth research on the type of foods to eat and avoid for uric acid treatment. The foods to avoid are those with Purines. Period. Purines when digested makes more uric acid than a Gout sufferer can handle and this increases the likelihood of a gout flare up.

    1. That is certainly the Conventional Wisdom. And it’s wrong..

      I used to have gout, and at one time I was on 600mg of allopurinol to control it. But I was also on a low-fat diet. When I switched to a low-carb diet, I found that I could reduce my allopurinol to 100mg, and had no attacks for over a year. I also discovered that I could eat reasonable amounts of shrimp, nuts, and other purines with no attacks. I have since gone a little more towards the primal diet, in particular, I no longer eat *anything* that contains even a trace of high-fructose corn syrup (or has corn-anything even mentioned in the ingredients). And I have cut the allopurinol out completely.

      And while my memory of the exceedingly painful gout attacks has kept me from eating really large quantities of shellfish, I have found that the occasional meal of shellfish or other purine sources no longer triggers a gout attack.

      My conclusion: Gout is caused by high-carbohydrate diet. Period.

      That is at least as valid as your conclusion, since it is a study of n=1 (anecdote). BTW, I also used to be diabetic. If you check with any mainstream MD, you will ‘learn’ that neither of those conditions is curable, and must be controlled (with pills, progressing to injections in some cases) for the rest of your life. The truth is that gout and (type II) diabetes are similar to arsenic poisoning, in that to make them go away, you have only to quit eating the stuff that causes them. In the case of gout and diabetes, that something is sugar, and specifically fructose. HCFS seems to be an especially poisonous form of fructose. There may be other parts of the HFCS that share the blame, since I have found that I can also eat limited quantities of fresh fruit with no gout attacks.

      One of the problems with research on gout is that there are no recent meaningful studies. Aside from the fact that most of what passes for ‘research’ in nutrition would not get a passing grade in any science course that I taught, once allopurinol was discovered and shown to be effective (and *mostly* safe, with a few spectacular exceptions that resulted in death), and cheap, the researchers completely lost interest in researching the cause(s) of gout, and just settled on the conventional wisdom of 4 decades ago. The *only* studies I’ve seen in the last 30 years or so has been for additional “investigational medications” (most of which are more than an order of magnitude more expensive than allopurinol, and therefore more profitable) for those rare cases where the gout victim can’t tolerate allopurinol. There has been essentially no investigation into the underlying causes, because nobody is really interested in prevention.

      1. TxCHLInstructor – Thank you. You said it all and you said all so well – most of the old, out-dated, worn-out crap about what Gout is and what causes it makes me furious. It just makes for another billion dollar payoff for the pharmaceutical companies.

  24. well i can say for sure that i have been getting attacks of gout for nearly 30 year its been unbearable my joints are distorted from them..

    went to the best experts in Australia since i was 25 they all told me they could not find the cause.that i was doomed (they were right about that fro 30yrs).

    well I’ve been in the situation of multiply attacks all over my body for weeks at a time in terrible pain over the years.i went on to progout for full time and was still getting mild attacks then someone told me about fructose a year ago it took me 6month to get the courage to go off my progout and i stopped eating fruit altogether,i went six months feeling great

    Then i ate 2pce of fruit cake and got acute attack.

    it’s been a miracle to be free of this curse but need to very vigilante at all times on what i eat. Sugars can be deadly to people like me so i hope some one else can benefit from my experience God Bless

  25. Hi Tim,

    Gotta pick up your book! Did you tm the 3-hour body? 😉 (Something About Mary)

    March 2009 I weighed in at over 450 pounds @ 5’10” (Scale did not go higher, got a ERROR)

    I was coughing up blood(Gum disease I later found out) and I had gout. It started in my right shoulder and moved to above my elbow and feet. I was in pain.

    April 5th 2009 my best friend and life saver became a roadblock in my life. He did not let me continue my destructive ways. He put me on a higher protein, good carb diet. Like on the Biggest Loser/Transformation.com/Body4Life sites tout. I got down to 310 by 10-31-2009. I took the holidays off. On January 16th 2010 we started a program that was meant to save other biggins. I weighed 327 that cold day in January, 11 months ago. We are helping people like I was…

    I now weigh in at < 210 on my way to 175. I feel so much better, all my symptoms are gone.

    This is no diet, its my way of life. I love what I eat and look forward to working out everyday. Its not alway enjoyable but I know what it does for me.

    Tim, I looked at your plan and I can say other than the legumes, peas, and I do ingest some dairy to block what fat I am getting from lean meats and eggs.

    My day:

    Breakfast: 3 eggs and Cheese with Hot peppers

    2.5 hours later: Almonds 1 oz or EAS protein

    2.5 hours later: Lean Meat, unlimited good veggies

    2.5 hours later: EAS protein

    2.5 hours later: Lean Meat, unlimited good veggies

    2.5 hours later: Almonds 1 oz or EAS protein

    Repeat daily!

    Thanks Again Tim!

    Jim

  26. I have had gout for 20 years, am under the care of a hematologist, and consider myself an amateur expert on the subject. There are many dietary restrictions that can lower the frequency of gout attacks. This article focuses on sugar, which I assume is the focus of Tim’s next book.

    Unfortunately, the article uses glucose, fructose, sucrose, and high-fructose corn syrup interchangeably. In nutrition, the relevant differences are that glucose and fructose are naturally occurring simple sugars (good), while sucrose and high-fructose corn syrup are man-made complex sugars (bad). In addition, fructose is normally naturally ingested in the form of fruits and vegetables, which limits that amount of fructose that can be ingested at one time. The article seems to imply, then, that cutting out fruit and vegetables from the diet will deter gout attacks. I would disagree.

    Eliminating bad sugars is no doubt helpful to the diet, and very doable. I would not restrict good sugars found in fruits and vegetables from a healthy diet in order to restrict my sugar intake. Biologically, humans are evolutionary adapted to eating mostly fruits and vegetables with a small amount of meat. It is not until (biologically) recent times that humans have started to ingest carbohydrates and alcohol from agriculture, and very recent times ingesting processed sugar. If you want to restrict your diet for health reasons, start there.

    1. Thanks for the clarification Taylor, IMO it is really important to point that out. I figured out how to relieve my gout by getting more informed about how our cells work, what happens to them over time and how acidity builds up in different ways including uric acid.

      I don’t know how to explain it scientifically but what I understand is that sugars, especially the fake, processed ones, lead to a lot of acidic waste and it plays hell on our cells in general.

      If you or anyone else out there can shed more light on this, that would be great.

      Thanks

    2. Taylor: “Unfortunately, the article uses glucose, fructose, sucrose, and high-fructose corn syrup interchangeably. In nutrition, the relevant differences are that glucose and fructose are naturally occurring simple sugars (good), while sucrose and high-fructose corn syrup are man-made complex sugars (bad).”

      Actually that makes no difference whatsoever. All sugars must be broken down by our digestive enzymes into monosaccharides (glucose, fructose, galactose) before they can be absorbed through the intestine. So sucrose (50/50 sucrose/fructose) is equivalent to 55/45 HFCS as far as its impact on gout, and on just about everything else.

      Be careful in spreading false misinformation. It could potentially hurt someone.

      “Biologically, humans are evolutionary adapted to eating mostly fruits and vegetables with a small amount of meat.”

      Humans can’t extract meaningful amounts of calories out of vegetables, being unable to digest cellulose. Humans are evolutionarily adapted to eating mostly meat, with small amounts of fruit and vegetables to get us through difficult times.

      Calculate how many pounds of leafy greens and fruit would be required to make 2500 digestible calories. (Bananas and plantains don’t count, as they are Neolithic foods.) Then google “Expensive Tissue Hypothesis” for more info on how our digestive system processes these foods.

      JS

  27. Dr. Weil endorsing something isn’t exactly a ‘good’ sign. The guy swims in pseudoscience. I’ve read Good Calories, Bad Calories, and I think it is well researched and interesting, but Dr. Weil endorsing it actually makes me more skeptical of the book. The man is a bit of a scientific flake.

    1. I’ll second that. Dr. Weil is like a stopped clock (or Conventional Wisdom), as in only right if you happen to catch him at exactly the right time. For starters, take a look at a picture of the guy — he’s got NAFLD (pot gut). At least I *assume* it’s non-alcholic…

  28. Interesting subject. I’ve been a gout sufferer for the past 3-4 years and have had many very painful attacks. So bad at a couple points I couldn’t walk or stand. Ibuprofen took only the edge off.

    I’ve been in the process of restricting my diet now for the past year. First I gave up processed sugars, then processed foods (only eat whole grains), and now for the past 10 weeks have given up meats/dairy and been almost entirely vegan. I’m down about 12 lbs in 10 weeks, having already lost another 20 lbs. leading up to the switch to vegan.

    I had a gout attack yesterday, not a particularly bad one, but an attack nonetheless. Tracking all of what I’d eaten, I’m pretty sure I’ve tracked it down to the ‘juicer’ I bought myself for xmas and the 1.5 liters of fresh carrot / beetroot juice I drank in the past 2 days. Was the only real dietary difference or addition in the past weeks. Researching carrot juice led to fructose which led to this site…

    Not sure where this is leading me, but trying to gather relevant facts in order to make an informed decision. My plan has been to strip my diet down to a controlled minimum and slowly add various foods back in.

  29. Hi Tim,

    Just stumbled across this article today after I started listening to “Why we get fat and what to do about it”. I’ve always been a bit skeptical about this low carb stuff, but at the same time, I have felt like it’s the sandwiches I make to fill me up from time to time that seem to break my weight loss goals.

    I guess the penny has finally dropped! Here’s to a better health and lifestyle in 2011!

  30. tim,

    I saw you speak at Google the other day, that video in the beginning of your presentation was crazy!

    I read your book and the section about gout and your mother. As someone who has gout (through heredity) Does the slow-carb diet induce gout? I’ve been drinking a lot of water and nothing yet, but I’m concerned about all the foods I have purchased are on the “no-no” list.

    Anyone on here suffer from gout and trying out the diet?

    Thanks!

  31. Marvelous discussion – and huge fan of the 4-hr body – downloaded the Kindle v. and ate the whole thing in about 4-Kindle sessions….now to the point…

    The one thing which seems missing from the discussion of gout and sugars is that as a gout person (prior to the 4HrBod book ;-)) is that I am a workaholic and sometime prolific writer/researcher (in whatever catches my fancy) and work product productivity is related to gout!.

    To be more precise: At just prior to the onset of a major gout attack I feel a distinct buzz – and a real heady clarity to analysis, writing and so on.

    I’ve asked a few friends in the biotech world about this, to no outcome and so does anyone have any research links on the correlation between pre-onset gout (or serum puric acid levels) and intelligence, especially creativity?

    Just saying that from a user standpoint, there’s a clarity issue that’s woven in there and I suspect that serum uric acid levels which – a few other key nutirents – may form an ‘ultra high perormance cocktail’ which would comprise a combination of blood sugar levels, uric acid levels, etc, which would optimize the firing of neurons in el brain. Creativity, learning, and so forth is all about the firing and training of neuron paths, and thus, in addition to baroque music (and other Super Learning tools) is there a nutritional shortcut to be had here?

    Not to mention the potential payoff in meditation and other spiritual pursuits as well…

    Might help the learning process while shooting those instrument approaches, writing on deadline, dealing with client issues, and similar high stress kinds of activities.

    Just a thot… peace out….

    George

  32. I’m a “811” RAW Fruitarian who is almost 54. Gout runs in my family tree and I actually became a Fruit Centered Diet RAW Vegan to eliminate gout!

    All the noise about Fructose is just that NOISE. Yes, any kind of sugar extracted and denatured from it’s original plant is an abomination to the body’s intelligent ability to identify a useful food stuff.

    All the pompous noise about the need to eat the decaying carcasses of murdered animals is just NOISE too!

    I should share that I am also a BAREFOOT ULTRA MARATHON RUNNER who runs well over 100 miles per week over all kinds of surfaces.

    I am not protein defecient, B12 defecient, fat deficient, or any other nutrient deficient and thrive with 3-5% body fat at 160lbs and 28 BPM resting heart rate in the mornings. I take no supplements, pills, potions, or powders.

    I take a dump at least 3 times a day and pee 6-8 times a day and it’s always clear and when I poop there is no odor what so ever and I dont get gassy any more.

    Depending on how many hours I run in a day my caloric intake from Fruits, Greens and Veggies runs between 3500 and up to 10,000 for a 100+ miler in mountainous country.

    To learn more click on my blog link asscociated with my profile for this site.

    1. @Erskien,

      How long have you been a fruitarian? Any tooth issues? (I have heard of fruitarians losing teeth) Also, have you considered the possibility that the main reason you are so lean is solely due to the extreme amount of running you do?

      A question to anyone that can answer it: Is there any credible research that would indicate that humans share the physiological characteristics of frugivores?

  33. I am just starting to get over an extremely severe gout attack. I am 29, and I was diagnosed as having gout at 22. I am overweight and I am finally attempting to give 100% to becoming healthier. I recently picked up the 4 Hour Body and I am very excited to start using your tips and advice to become healthier. Over the past year I have eliminated almost all processed foods, refined sugars, and anything made in a vat from my diet. I have lost a little over 30 pounds since then, but I am not there yet.

    I have tried every medicine currently available to treat my attacks, and nothing has ever worked. Allopurinol, colchicine for acute symptoms, probenecid, indomethacin. Nothing.

    I have tried literally every natural gout cure I have come across, from apple cider vinegar, to baking soda in water, to montmorency cherries/concentrated cherry juice. The cherry juice was the best in terms of preventing attacks the longer I took it. The apple cider vinegar, as well as the baking soda work sometimes for reducing the inflammation, and I know a more alkaline body PH seems to have an affect on the symptoms, however this time the baking soda did not completely get rid of my symptoms. I have suffered from this disease for way too long, lost out on employment, romantic endeavors, and generally being happy due to this disease. I am at my wits end.

    I really want to start your program and I am going to try and stick to your dietary rules while cutting out some of the things which I know personally to trigger these horrible attacks, such as beans and red meat.

    My question is, for others who suffer from this disease, what protein sources can you successfully eat without bringing on attacks? I have reduced my diet to a handful of foods and I still suffer from these debilitating attacks. The protein sources in my diet generally consist of surimi, fresh fish, boneless chicken thighs, and occasionally tofu, but soy products seem to generally lead to attacks in short order. Any advice would be helpful because I have suffered from depression due to the never ending torturous pain. I am literally immobile during an attack and just trying to make it upstairs to the bathroom sometimes feels like an insurmountable effort.

    I feel that losing more weight in a sustainable fashion is the key. I want to cut out all sugars and carbs, and I want to cut out any food that seems to bring on the gout. Thank you for this blog post, and your book. I feel like I’ve had many Harajuku moments, but this last week took the cake. I will do my best to be successful for once.

    1. Chris,

      I’m a bit older than you (40+) and suffered with gout for many years. Just wanted to let you know that you’re on to the information here that has really helped me finally get rid of my gout. In addition read Gary Taubes books (GCBC and Why We Get Fat) and Robb Wolf’s The Paleo Solution.

      I spent over 2 years tracking all foods I ate, trying many different programs (including 60 days of vegetarian, 60 days of vegan, no-dairy, etc.). Some ways of eating had more success than others. Following Robb Wolf’s diet advice (very similar to Tim’s and in sync with Gary Taubes) finally made the difference. Stick to it religiously for 30-60 days and then you should be able to ‘cheat’ a bit with about any food and not have a gout attack.

      I eat red meats 5x per week, red wine regularly, and even have occasional cheat days with beer. I believe it was cutting the grains, fruits (especially fruit juice), and polyunsaturated fats that seemed to have the most affect for me. Haven’t needed the ‘black cherry juice’ (it would help me through severe gout attacks) in 6+ months. I used to need it very regularly.

      Cheers!

    2. i too get gout from soy.cereals,boxed or canned food are all no nos

      everything today in a box or can or bottle has soy added.

      its a curse

      i have been taking bromelain 2000gdu 2x a day

      tumeric 500 mg 3x day

      celery seed extract

      glucosamine sulfate

      quercetin 500 mg 2x a day

      seems to keep my attacks down.i dont get full blown attacks

      i am a red meat eater and do not get gout from that but if i eat a bowl cereal,wham

      its a rough disease hang tough.

      take colcrys when i really get a bad one

  34. Just wanted to add that hearing your interview on the Nerdist got me to purchase your book, and find this site. I remember reading about you via one of Seth Godin’s blogs a while back, but I just never followed up. I’m very glad I did this time. Thank you!

  35. I just started reading 4HB and found some problems I can’t find the answers to. I had gout attacks bad for the past 3 years. I’ve tried everything from drugs to diet and nothing seemed to work, until three months ago, when I read an article on beating gout. You take 64 oz of White Grape juice and add 1 package of Certo Fruit Pectin into it, shake and drink 8oz every morning. I have not had a gout attack since. Is there something in this or is it mum-bo-jumbo. You tell us no fruit juice. I don’t know what to do. It is really nice not having that excruciating pain.

    1. Never heard of that combo before.. I got through this latest attack with like 3 lbs of blueberries… back on allopurinol but I hate the way it makes me feel. Definitely still looking into more natural remedies. Thanks for the info, glad it worked for you Andy.

      1. Thanks Chris,

        I’m confused, Why should we not consume sucrose, for it induces gout, when we consume sucrose to relieve symptoms of gout.( Black Cherry Juice, Blueberries, Grape Juice with fruit pectin, etc..). What is the million dollar formula? You would think some scientific geek could break down these components and come up with a solution. What is the chemical break down in white grape juice with fruit pectin that seems to be working like a miracle remedy?

  36. Thank you Tim for posting this info.

    I am currently having a flair up of gout in my left heel. I went looking for my copy of Gary Taubes “Good Calories – Bad Calories” this morning and found almost no mention of gout. I was surprised because I thought he had mentioned the correlation between refined carbohydrate intake and reduced excretion of uric acid. (I may have seen him talking about it on Youtube) In any event this missing chapter has been very helpful. I plan to get back on my low-carb plan immediately!

  37. I’ve had uric acid kidney stones from time to time over the past 30+ years and what might be gout more recently. Both are due to the same root cause – excess uric acid.

    The first bout with stones was at age 19. I spent a few days in the hospital and the doctors couldn’t find the cause, so they sent in a psych who insisted that it was all in my head, possibly due to stress related to just having started college. By then, the excruciating pain had subsided. I went home fairly certain that this was not the answer.

    About 11 years later, I had identical pains and had the good fortune of seeing the passing stones and collected a sample as evidence. The Dr. prescribed short-term use of baking soda (sodium bicarbonate) tablets until the stones cleared and allopurinol for life. The urologist indicated that the lack of treatment over the intervening years had damaged at least one of the kidneys. Further bouts with the stones occur a few times a year, but rarely with anything like the pain of the first two incidents.

    The baking soda cleared the golf-ball-sized stones from the ultrasound within a few weeks. The Dr. explained that the uric acid precipitates solids when the blood or urine is generally acidic. The baking soda raises the blood and urine pH to a more alkaline level, allowing the stones (or gout crystals) to dissolve back into the blood or urine, or at least break up to the point where they can be passed. The allopurinol is supposed to reduce the production of the uric acid.

    The Dr. also referred me to a nutritionist. As you might imagine from earlier comments by others, she recommended a low protein, low-animal products, high-carb diet.

    After blowing up to over 300#, I eventually figured out that low/moderate carb eating was preferable. I lost most of the excess and managed to keep most of it off for the past 10 years. I still need to dump about 20 pounds, but I also find that low-carb seems to help with mental focus (consistent with what I’ve read on some variants of adult ADD).

    Though the baking soda tablets are available at the local pharm without a script, I’ve been using the supermarket powder in a glass of water, followed by lots of plain water over the next few days and repeats of the baking soda if needed. I check the blood pressure regularly and have yet to see any excursions beyond the healthy range. I also try to make sure that I’m replacing the other electrolytes that get flushed out with lots of water. The same treatment seems to help when painful and apparently gouty deposits start to appear in the joints of my fingers.

    I recently started using pH test tape. As expected, this tends to indicate excessive acidity (general acidity – They don’t indicate anything about uric acid levels.). Much of what I’ve read suggests that this correlates to a multitude of other common ills along the usual lines of metabolic syndrome.

    I’ll experiment a bit with some of the suggestions from comments above and elsewhere and see if I can come up with with a better way.

    I’m not a doctor and have no basis to suggest that any of this will benefit any of you, but perhaps some will find the information useful.

    1. What I thought were kidney stones turned out to be bladder stones (uric acid dihydrate, formed in the bladder, not the oxylate-based stones typically formed in the kidneys). Urine pH was 5, not the neutral 7 it should be. The nephologist prescribed calcium citrate capsules, which has solved that high-acid problem, so, no more bladder stones. Yes, pH paper will tell you the acidity of urine, but the digestive tract controls how much of the cure gets to the kidneys. Too much bicarb orally can mess up the acid balance in the stomach. Consider consulting a nephrologist (not a urologist).

  38. Tim

    I have to disagree with you this restricted view on gout it s not all that black with fruit and that s not the main cause of gout.

    Saying that fructose is always bad for gout may sound for many like a “don’t eat fruit at all if you have gout”. What a mistake!

    I have gout, and i builded my own menu that give me energy and protein i need, saying that, i m not taking ANY medicine and I m feeling good.

    I eat fruits every morning in resonable qty and no problem at all.

    First when you discover this illness you may think you are cursed, but after many crisis like you think hell is in you, i found it was a message from my body that i should change something in my eating. how come?

    I have decided :

    1 to get off medecine

    ,2 eat organic as much as possible (there s a connection between chemicals and gout which is 1000 tmes more dangerous!),

    3 no more sugar except honey.

    The curse became a blessing!

    I feel 200% in better health and energetic than before, i can work longer and better with much more pleasure than before my 1st gout crisis!

    Now i m drinking wine, eating meat and fish (protein) everyday in a reasonable way.

    What’s my trick ?

    Be extra careful about choosing the most organic wine, eat vegetables more, and drink bicarbonate waters.

    About fruits 2 things to add :

    Eat acid fruits: their acid is magical to change into basic.ie Lemons (ph 2.2).

    Moreover, the applecider (which is coming from fruit) is a must have, if you have any doubt about what you had for dinner, drink some water and put some apple cider in it… you will “feel” it, it’s magical!

    Take care

    C

  39. I love Coke products, always have. Now I have Type 2 diabetes and gout and all of the symptoms of acute fructose consumption. What puzzles me most right now is that my worst gout flares occur after consuming Coke Zero or diet coke. I had a terrible and immediate gout flare that lasted for days after drinking 3 – 12oz cans of Coke Zero. Then another time I had a fairly bad flare lasting for a week after drinking diet Coke from 2-litre bottle. Stumped.

  40. I’m currently experimenting with sugar-free eating as a method to eliminate gout and the need to take allopurinol. I watched the Dr. Robert Lustig lecture where he argued the point of fructose being toxic and listened very intently to the point that fructose ingestion increases uric acid production. I thought to myself: if I could eliminate a drug by cutting off the problem at the source, why not do it? After all, if I were diabetic and could avoid a lifetime of injections by changing my eating habits, I would do it. I’m 6 weeks in to the experiment and stopped taking allopurinol after the first week. After 4 weeks, I eliminated diet soda as well. I’m getting leaner, stronger, and faster. Best of all, no gout symptoms. I wish I would have done it years ago.

  41. Like many of your responders, I am confused by the high number of conflicting bits of information, opinions, and experiences regarding the cause(s) of gout and attempts to control it. Clearly, genetics play a major role in all aspects of the disease and attempts to control it, and the genetic variations in individuals make advice all but useless–certainly confusing–and perhaps harmful. I was ready to give up “white” food–potatoes, bread, crackers, etc.–until I read further through the responses and concluded that any extreme measures would be unnecessary. Moderation seems to be wiser than total abstinence, no matter what one ingests. As for gout, my one gout attack occurred in Brazil in my early 70s and a shot of cortisone took care of the pain. The pharmacist, also a gout sufferer, said that gout can be controlled somewhat with diet: no cauliflower, shell fish, beans, peas, or excessive intake of beer. I adopted this regimen and have not had a recurrence since, 2.5 years later. My brother has gout, so it runs in my family. If moderation, instead of total abstinence, achieves the same results, I am encouraged; indeed, since my attack, I have continued to drink one or two cans of beer daily and have occasionally eaten a few spoonfuls of pinto beans; I eat one or two meals of fish (tilapia, tuna, salmon, ruffy) weekly, all without any ill consequences so far. It may be of interest to note that my test in Brazil after the gout attack showed that my uric acid level was in the normal range. It seems that personal histories, even scientific research, are at best of little help in controlling gout attacks. The best one can do is moderate the intake of foods and drinks that show a strong likelihood of risk. As with my diet in general, I abstain completely from foods and drinks that are high-risk. I quit drinking carbonated drinks years ago, stopped eating red meats and shell fish, have quit eating cauliflower and peas, all because these foods are not high on my list of desired foods and so are easy to avoid. The items I very much enjoy, beer, wine, pinto beans, and so on, I simply moderate–and hope for the best.

  42. Like Damon above, I’m 5’10? and weigh 180 pounds, muscular and active, so BMI is also skewed for me. I’m 32 this year, and recently had my first attack that lasted 2 weeks.

    I consume both carbohydrates and meat (usually chicken), and occasionally beef at Japanese restaurants. I do not have a sweet tooth (seldom take fruits either) and do not take alcohol nor beer. I do not know what is causing gout for me.

    The doctors say my blood contains uric acid but they do not elaborate if it is high or low. I was given Colchicine (500mg) and told to avoid beans/tofu, seafood, fish, dried mushrooms, stews, meat, yeast extracts. I was advised to take more fruits. I tried going vegetarian, but it didn’t seem to help. So I’ve taken to having meat in small portions 3 x a week only. In fact I still have a mild pain in my left big toe, and it seems to be developing over on my right toe as well.

    I hate this because I can no longer go jogging or consume tofu and meat.

    1. Tan,

      Every blood test can tell you the exact level of acidity of your blood.

      I thought last year i couldn t do sport again, but really if you are careful with what you eat you will be able do to as much sport as you want.

      Of course if you take allopurinol all the time it should work, but as it has 2% blood cancer on the long term, i m taking it in minimum qty.

      The best medicine is knowing yourself, and check how your body reacts.

      Of course when you are younger it has better resistance to wine and alcohol etc… So you might think alcohol is doing not much, but it does, a lot.

      As i said above, especially if it s not organic wine, the chemicals are DANGEROUS for you and GOUT is reacting very quickly with those.

      I had one attack after a Japanese restaurant, i was mostly suspicious about the wine, the only one glass i had ….

      Now i m having wine (organic) red meat, vegetables and almost everything but no gout attack. And i don t take medicine at all. I m 45.

      The most important thing, don t move when you have an attack, why ?

      Because those crystals destroy the bones, on the long term it will become parmanent (not cool 🙁 )

      have a great day, and stay positive, you are discovering how your body is working now !

    2. @ JS Tan : Gout is a metabolic cause due to diet. People in the same family tend to eat the same food, which gets Gout called a Hereditary problem; really bad science. Gout is easily treated with standard treatments, however, adding Gymnema sylvestre to your diet, a pill every other day, you will have significant gout reduction results. (Also prevents diabetes – insulin resistance) Gymnema sylvestre has a derivative of deacylgymnemic acid, DAGA which is the 3-O-glucunonde of gymnemagenin; what this does is increase insulin usage, decrease harmful sugars and has an odd anti-inflammatory response that is better than Bayer Aspirin. OR, you could live with your Gout, be miserable, and think there is no ‘real’ cure.

      1. Thanks for the tip – will give it a shot. I don’t believe its hereditary either, cos no one in my family tree has had it. Am currently taking celery seed extract it it seems to prevent an outright flare – though there is still a dull ache to my left foot.

      2. Gymnema sylvestre sounds interesting. Since I no longer have gout (quit eating the stuff that causes gout), I might try it to see if the insulin response enhancement makes it easier to lose weight, similar to the way metformin does.

    3. To @JS Tan,

      I too am a gout sufferer, but I think your doctors may not be giving you proper guidance. I say this as one who is still recovering from a horribly bad hypersensitivity reaction to allopurinol after 15 months of taking it.

      The Colchicine you’re taking will only address the SYMPTOMS of gout (your pain and flare-ups) since it acts like a low-dose anti-inflammatory. It’s not the same as, but it is as if you were taking Motrin/Ibuprofin for the pain. The problem is that Cochicine doesn’t get to the ROOT CAUSE of your gout flare-ups.

      I have the same frustration since my doctors (multiples) want to treat the symptoms and can’t give me good advice on fixing the root cause of my gout attacks and high uric acid levels.

      Think of it as an onion: The Colchicine is the outer later and treats only the symptoms (pain). But the intermediate layer (I’ll stress intermediate) cause of the gout flare up is high uric acid, and you can lower that with drugs like allopurinol or probenecid, which doctors love to prescribe. I have been searching for the innermost layer of the onion, which would be root cause of high uric acid, and therefore a way to control it. This article certainly makes a strong case for the circumstantial evidence (but doesn’t give me the hard metabolic pathway info I desire), and another web site discusses the root metabolic pathways in more detail.

      The problem is the intermediate layer (allopurinol) is where my doctors (internal med, rheumatologists) stop. None of them could explain WHY my uric acid was high in the first place, nor how to lower it without meds. I’m healthy, exercise, nominal BMI, and don’t over-consume the traditionally “off-limit” low-purine foods.

      Low-protein diets didn’t work for me, as you may have discovered for yourself. One doctor said I was an “over-producer” of uric acid, so that I should avoid proteins if I wanted to avoid taking meds. You might want to find out for yourself whether you are over-producer, or an “under-excreter” of uric acid.

      The 1 year of low-protein/high complex carb diet made me gain weight, feel low-energy “ookey”, and did nothing for my gout attack frequency. It was a fail.

      Right now my course of action is dietary mod with augmentation by meds. My diet has become mostly like the Paleo diets except I do add some dairy and some whole-grain carbs (wonder what that diet is called?). And I take probenecid to get my uric acid levels way down. My rheumatologist tells me it can take up to a year for the uric acid crystals deposited in my joints to dissolve and be excreted.

      This article was right on-point, easy enough to read, I hope that the references are fact-checked enough to

  43. Great information and loved the book… I’ve had many people I knew completely stop sugar intake and not only dramatically lose weight but also report better joint flexibility and less swelling in their joints. Another note if you track the usage rate of high fructose corn syrup in our foods it is almost directly mimicked by the rate of diabetes in the states. Simply put we consume too many sugars…

  44. I’ve been eating a vegan diet for 24 years. Recently, after dental surgery, I was told to eat more protein for a week, so in seven days I ate 10 eggs. The result: gout! I’ve been treating it through diet: no more eggs, lots of cherries and strawberries. In three weeks my symptoms have been reduced by about 70%. So I’m consuming much more fructose than usual, and my symptoms are decreasing. Go figure!

  45. I had my first gout attack about 10 years ago.

    At the beginning I was having attacks every 6 months. Then gradually I was getting them

    every 3 months, then every month and eventually every week.

    It started at my big toe and then it was moving sometimes in my knees,and generally all

    around my joints, in my feet.And the pain was agonising.

    I have tried all the cures you can imagine.I tried ACV, lemons, drinking a lot of water, but

    to no avail.I tried water fasting, juice fasting,baking soda, again without success.

    I almost gave up meat, limiting it to only once a week ,gave up alcohol completely,again

    no success.

    I was living on vegetables, lots and lots of fresh fruit, milk ,cheese beans and so on .My

    eating habits could not be healthier ,or so I thought.But my gout was worsening.

    Then I decided to increase the amount of fruit I was consuming, thinking that if some fruit

    is healthy, more fruit will be more healthy.Some days I was eating fruit only ,others over 10

    portions a day.

    And alas my gout instead of improving it became chronic.

    I was desperate I did not know what to do.

    And then one day accidentally I read an article about fructose,which is contained in fruit in

    large quantities.It said that it increases uric acid, in a matter of minutes.

    Fructose is also present in table sugar, and in HFCS, which is used in soft drinks.

    I put two and two together and realised what I was doing wrong.

    I stopped eating fruit and all other sugars, for a period of 3 weeks,and by magic I saw a

    dramatic improvement.Pain was gone, swelling was gone, I was fine.

    I re introduced fruit again in my diet but reducing them to 1 or 2 a day, and my gout completely

    disappeared.

    I do eat more meat now, and occasionally have an alcoholic drink, and thank God everything

    seems to be fine.

    Fructose was my enemy.

    1. Hi I had suffered from gout attacks for over 15 years. I tried everything going and most have been listed above. I even boiled/steamed all my food no good..stopped eating red meat..no good..cut down on beer ..no good. Then I discovered a low carb diet in Atkins. I tried this to loose a bit of weight but didn’t correlate it to reducing gout. Basically Atkins strives to eliminate sugar and Fructose from your diet. When I went on Atkins I NEVER repeat NEVER had an attack of gout, only when I went off Atkins did I get repeat attacks. I have been trying to convince other suffers for years to cut out sugar in their diets. After years of gout attacks the low carb or what I like to call it the No Sugar Lifestyle I have completely eliminated gout from my life.

  46. I had a gout attack about 2 weeks ago, I’m 52 and it was my first. My father has had gout attacks in the past so heredity probably played a factor though I don’t think his attack was as bad as mine.

    I’ve been on a ketogenic diet for the past four months so I’m sure sugar or high carbs did not play a factor in my attack.

    From what I’ve seen online there doesn’t appear to be any good agreement on the lifestyle cause. What I mean by that is there’s no agreement on what to eat or what to avoid. Purines are cited by some but are ruled out by others with some saying purines from vegetables are okay (like mushrooms) but not from meats. Some sites (like Kaiser Permanente) say drinking coffee and carbonated beverages are good for gout prevention.

    From what I can deduce from my gout attack: I’ve lost about 35 pounds in a little over 4 months so the stress of that on my system may have played a factor, though I have lost that much weight in the past in a similar or shorter period of time with no gout. I added protein drinks to my diet to so I wouldn’t just have to add more meats, maybe the added protein was a factor? I was snacking on beef sticks which I’m guessing were made of all kinds of organ meats and such. My bloodwork also showed my electrolytes were off.

    I was put on Allopurinol and Prednisone for the gout and prescription of Potassium Chloride for the electrolyte imbalance. I couldn’t take pain killers like Ibuprofen due to the electrolyte imbalance so I had to tough out the excruciating pain for a few days before the other meds reduced inflammation and uric acid levels. I’ll probably supplement with lite salt later for the electrolytes.

    I never really stopped my keto diet but I’ve eaten less red meat the past two weeks and backed-off on losing weight quickly. I think the stress on the body probably wasn’t good. My big toe joint, where the attack occured, is about 90% recovered. I’ve had one beer in the past four months, the only alcohol, so that’s not a factor.

    1. @BAS I would consider a possible link between too much protein at that time being converted via gluconeogenesis into increase blood glucose. Postprandial glucose testing after eating different amounts and types of protein could help you tweak your ketogenic diet according to your physiology.

  47. I believe I have had mild attacks on and off for the past 6 years. Until recently, the attacks were really mild and to be honest, I believed I had pulled a muscle somehow. I am mid 30’s and drink (only at weekends) and eat fairly well and excercise on a regular basis.

    Following a rather unhealthy Christmas (stoppped excercising and drank heavily and ate rubbish foods including large amounts of sugar) in January this year, I had my first full blown attack which my Dr confirmed as suspected gout. Have to admit, he was fairly unhelpful and gave me base details of how to reduce the risk. The usual, lose weight, cut down on drinking, eat better blah. blah, blah. . .

    I did my own research and believed to have made a fairly good self diagnosis which attributed to a combination of factors which had occured over Christmas. One of these extra factors was getting sinusitis and having to take anti-biotics which in turn killed the naturally occuring bacteria. I had read that your gut is one of your main defenses against uric acid and figured this must have been the catalyst for the attack.

    However, I experienced a new attack this week. This time, the factors are different. I assisted another Dept at work 3 weeks ago and ended up being over tired and didn’t get to the gym. As I didn’t attend the gym, I found myself eating more biscuits/ chocolate etc while sitting on the sofa. My intake of sugary drinks increased also. After 3 weeks, I felt a twinge in my foot (my usual gouty location) and stopped instantly. I then had a can of Pepsi on Monday and bang, next day gout came on in full swing.

    This artiicale confirms what I have believed for a long time, my gout is caused by excess sugar consumption and lack of excercise. Big thanks to Tim Ferris for this article / blog as it near enough confirms my own theories. I think research should be started again to find a better long term solution to this horrific affliction as we need to FULLY determine what is the cause and best way to deal at first instance instead of self diagnosis.

  48. Your gout article rightfully refers to the work of Dr. Richard Johnson, who has moved from U. Fla to U. Col in Denver. His work clearly shows that dietary fructose is processed in the body to produce uric acid, and hence raises the level of uric acid in the blood.

    But there is more to the question of why the high concentration of serum uric acid precipitates as the crystals of monosodium urate (MSU) which cause gout. Consider that most gout attacks originate while the individual is sleeping. Why? The answer is sleep apnea, which is the frequent cessation of breathing for many seconds at a time during sleep. The resulting reduction of oxygen in the blood has three effects, each of which can make MSU precipitation more likely. The first is cell catabolism, in which ATP undergoes a chain of chemical transitions which culminates in the cellular generation of excess uric acid fed into the blood. The second is that the reduced oxygen in the blood makes the blood more acidic (lower pH) so it can hold less uric acid in solution. These two effects are transient, so blood tests taken after awakening misses their peaks. The third effect is long term. Over time the chronic intermittent reduction in oxygen causes gradual reduction of kidney function, so uric acid is removed from the blood more slowly.

    So fructose ingestion raises the uric acid baseline, but sleep apnea causes it to reach an abrupt tipping point which leads to gout. I’ve told hundreds of gout experts about this physiology, and the only one who already knew about it was Dr. Johnson. Unfortunately, he thought it was common knowledge.

    Dr. Johnson’s recent book The Fat Switch is written for general readership. It describes how fructose activates a biological switch in the body to cause it to store fat rather than burn fat. It is an excellent companion to The Four Hour Body.

    1. @Burton Abrams Very interesting. My mother suffers from gout and also sleep apnea. What effect would a CPAP machine have on all this? In my mothers case would her gout be far worse if you she was not receiving positive airway pressure and thus more air being delivered to her lungs and more oxygen being delivered to the bloodstream?

      1. Sky – My experience was that when I completely overcame my sleep apnea, my gout attacks ceased immediately and completely. If your Mom’s CPAP machine is properly adjusted for her, and if she always uses it whenever she sleeps, I expect that her gout attacks would be greatly mitigated. Unfortunately, many sleep physicians don’t recommend total adherence to CPAP usage. I think that is a big disservice to the patient.

        MSU crystals form quickly (minutes), but then dissolve very slowly (months). Most gout attacks last for about a week because the immune system places a protein sheath around the crystals so that they are no longer sensed by other immune system cells which activate the gout pain and inflammation. (A gout attack is initiated by the immune system chemically sensing the presence of these crystals, not by the physical fact that these crystals are needle shaped.) So a gout attack can be initiated if the sheath is ruptured, either chemically by an uricosic drug such as allopurinol or physically by undue stress on the affected joint. Sleep apnea may be the reason why the crystals are formed in the first place, but once formed they may initiate multiple gout attacks by these other means.

      2. Hi Burton,

        Your comment is well informative. I really enjoyed a lot. I got the full of knowledge about immune system. It’s amazing tips about health related well I want to know about how acne will be cured and give some knowledge about that for better natural health.

  49. Talk about timing. Today I was diagnosed with high uric acid and swelling in my ankle probably developing into gout. I have been prescribed allopurinol and colchicine. Yesterday fruit was a daily staple. Tomorrow it will not be.thanks so much!

    1. Ew, Colchicine…. Pretty toxic stuff. Gave me severe, explosive diarhea and nausea. My condition improved on a microdosage of Lithium Orotate (like 25 mg. Available online) combined with a macro dose of Vitamin C (1,000 mg+).

  50. Potassium deficiency is deeply involved in gout and high uric acid as an accentuating factor because uric acid is less soluble in acidic urine. Potassium bicarbonate supplements will reverse this. In view of the fact that this is not considered by current rheumatologists, it would be very valuable for you to bring it into your future writing. It is not only that potassium is not considered by physicians in regard to gout, many of them do not even believe that a potassium deficiency is likely. This even though many of them prescribe what are actually supplements, but prescribed under euphemistic terms such as salt substitutes, sodium free baking powder, ORT salts (oral rehydration therapy for diarrhea), polarizing solutions, GIK (glucose, insulin, potassium) salts, vegetables, or glucosamine. A deficiency is further defined out of existence by defining the blood serum content normal as 4.2 when the actual figure is 4.8. For gout, though, the chloride is not acceptable. But potassium bicarbonate powder dissolved in fruit juice or half teaspoon sprinkled on cereal will work very well. It may be obtained from businesses which add it to wine. If you supplement potassium, be very certain that vitamin B-1 is adequate, because otherwise heart disease can be triggered.

    1. Very interesting….given how crucial potassium is in general, and the new

      emphasis on low sodium, which knocks potassium out of balance and has its own issues.

      Wouldn’t just adding the juice of a couple of fresh lemons per day solve the acidity problem?

      Readers of this blog probably aren’t having fruit juice or cereal, by the way.

  51. Potassium deficiency is deeply involved in gout and high uric acid as an accentuating factor because uric acid is less soluble in acidic urine. Potassium bicarbonate supplements will reverse this. In view of the fact that this is not considered by current rheumatologists, it would be very valuable for you to bring it into your future writing. It is not only that potassium is not considered by physicians in regard to gout, many of them do not even believe that a potassium deficiency is likely. This even though many of them prescribe what are actually supplements, but prescribed under euphemistic terms such as salt substitutes, sodium free baking powder, ORT salts (oral rehydration therapy for diarrhea), polarizing solutions, GIK (glucose, insulin, potassium) salts, vegetables, or glucosamine. A deficiency is further defined out of existence by defining the blood serum content normal as 4.2 when the actual figure is 4.8. For gout, though, the chloride is not acceptable. But potassium bicarbonate powder dissolved in fruit juice or half teaspoon sprinkled on cereal will work very well. It may be obtained from businesses which add it to wine. You may see an article on this concept in http://www.webmedcentral.com/article_view/4217 . If you supplement potassium, be very certain that vitamin B-1 is adequate, because otherwise heart disease can be triggered (see http://charles_w.tripod.com/kandthiamin.html ).

    Sincerely, Charles Weber

  52. “everything today in a box or can or bottle has soy added.”

    Not sure about soy, but I have seen that gliadin (from wheat) is added to damned near everything in a box, can, or bag — even to potato chips and fish! That’s because it’s an appetite stimulant, which makes you want to eat (and buy) more. The food researchers discovered that in the mid-1970’s, when modern Frankenwheat started to become the dominant form of industrial food-like substance. (See Dr. Wm. Davis’ excellent book on that subject).

    Not coincidentally, gliadin is hidden behind several other names, and is not required to be on the nutrition label at all, thanks to the political power of the Monsanto company, who spends enormous amount of money “influencing” (corrupting) politicians.

    I used to have gout. My last attack was in 1999, the year I cut out all wheat from my diet, along with other grains, trans-fats, and sugar. Another side-effect from that change of diet in addition to freedom from gout was the loss of 100 lbs.

  53. Has anyone interested in this comment thread read Beating Gout: A Sufferer’s Guide to Living Pain Free? Was it helpful or would you deem it another run of the mill generic info product?

  54. beer used to give me gout bad.i stopped 12 yrs ago and attacks subsided.recently i went on bromeleian,cherry extract(tart),quercetin with c,celery seed extract,potassium citrate and in the beginning i wasgetting small attacks all over as the uric crystals were being dissolved.now after10 months or so,i am feeling better.i eat red meat at least 2-3 times week,pork,chicken.no probs.i really do think sweets,cakes and such give me attacks and make my arhtritis worse.its a horrible thing gout.but beer definitely is bad.

    1. Hi Mike,

      I am interested in what you said about bromeleain and cherry extract etc. In what manner do you include these into your daily life? Tablets/powders? And how do you know the crystals are dissolving?

      My diet is changing as we speak and steering clear of fructose is the new challenge.

      Any help would be awesome.

      Cheers,

      Ryan

    2. Try beer free of wheat or hops. I have had success drinking Sapporo and other Asian beers. Avoid IPA’s. Added sugar runs havoc on the system.

  55. also people SOY is a no no.everytime i eat anything with soy(boxed or frozen foods)i get gout and my jpoints ache for days.cereals,cookies,ice cream etc all made with soy.you cant eat anything in a box.

    i see websites that say soy is good for gout as well as fish oil(also made with soy) and i cant beleive it.vitamins also are made with soy,use only non soy.

    good luck

  56. 10 years suffered with G attacks now becoming more frequent. Last month had one in my ankle….I have very high levels of uric acid I maintain 600-625 without symptoms. What I noticed triggers it is not necessarily increasing the levels but rather any change either down or up. Now this article is interesting as I love my sweets from time to time but hours before my last attack which was my first ankle attack I ate 10-15 large marshmallows. My attack makes sense now as fructose intake was way up. I am quiet excited about this article as often I get dumfounded by the trigger as my diet is often very low in purine foods and yet the attacks come. Now I have a yet another possible piece of the puzzle to monitor. With hopes that I can pinpoint a dietary direction that can lead to life with less Gout.

    As a chronic sufferer what really helps is 1.5 liter of water every hour for 4 hours, seem to flush out the system. It seems to help as much as taking the medication. I have tested this quite often and alkali (7-9ph) water lowers the attacks symptoms as fast as medication Which is in line with reducing fructose levels and helping the elimination system. This make sense. I look forward to the results of monitoring my fructose levels.

  57. Potassium deficiency is deeply involved in gout and high uric acid as an accentuating factor because uric acid is less soluble in acidic urine. Potassium bicarbonate supplements will reverse this. In view of the fact that this is not considered by current rheumatologists, it would be very valuable for you to bring it into your future writing. It is not only that potassium is not considered by physicians in regard to gout, many of them do not even believe that a potassium deficiency is likely. This even though many of them prescribe what are actually supplements, but prescribed under euphemistic terms such as salt substitutes, sodium free baking powder, ORT salts (oral rehydration therapy for diarrhea), polarizing solutions, GIK (glucose, insulin, potassium) salts, vegetables, or glucosamine. A deficiency is further defined out of existence by defining the blood serum content normal as 4.2 when the actual figure is 4.8. For gout, though, the chloride is not acceptable. But potassium bicarbonate powder dissolved in fruit juice or half teaspoon sprinkled on cereal will work very well. It may be obtained from businesses which add it to wine. If you supplement potassium, be very certain that vitamin B-1 is adequate, because otherwise heart disease can be triggered (see

    Sincerely, Charles Weber

  58. The 4hour body diet requires the daily consumption of legumes. How does this influence people who get gout? Can they consume legumes daily or should it be replaced by something else? If so, could you please recommend alternatives?

  59. Its just TOO SIMPLE!!

    Modern crappy artificial diet is to blame.

    Eat more natural unprocessed foods, less repacked garbage and fast food and say good bye gout

    well Tim this is a great article by the way

    thanks for sharing this fact

    1. Not quite so simple, Ironthumb. In my case I’ve always been a fairly heavy drinker of beer and whisky until 5 years ago when I gave up alcohol completely. I also used to consume a lot of sucrose in my hot drinks, as well as sprinkling it on my cereals and putting it in my cooking. On top of all that I ate plenty of wheat in the form of bread.

      Since going LCHF 20 months ago, my intake of sugars has been cut right back to only the occasional piece of fruit or perhaps some berries mixed with cream. While I’ve always eaten copious amounts of red meat and fat, I would say that this has dropped slightly as a consequence of my LCHF lowered appetite. All of our food these days comes from the outer aisles of the supermarket – fresh vegetables, nuts, cream, cheese, eggs, beef, lamb, pork, chicken and fish. Now and then I eat chocolate which I’ve mixed myself from equal portions of dark 72% or greater chocolate and coconut oil.

      I’m 60 now and I’ve only ever had gout in the last 8 months – at least a year into my LCHF journey. One would think that I would have lessened my odds of getting it. I’ll perhaps do some research on the potassium angle that Charles Weber mentioned above and see if I can find an answer there. Unless you or anybody else has other ideas, of course.

      Cheers

      Gregg

  60. hi

    I have a couple of point to this. The analysis that gout increased in Africa and in England at a certain point in time is flawed in the sense that before these dates most of the people in the relevant areas had never seen a doctor. The “explosion” could come from the fact that it was the time when they first had medical treatment. Secondly being fat is a status symbol in many pacific islands on some they even stuff women full with food from childhood to make attractive brides, like geese.

    But most of all: I have never eaten candy or drank soft drinks and always had a diet low on meat. The last couple of years I have started to eat red meat and protein instead of carbohydrates (before I lived by the traditional diet, eat no fat but carbs,, never had a weight problem). Low and behold my kidneys are now damaged and my urine acid is too high. I have pains in my elbow, back (2 places) which is gout driven. This type of research above is the type of research when you are already sure you are right befor you start analyzing the material. The conclusions are flawed at best and completely interpreted to prove the authors point. Beware of this unprofessional marketers who sells you easy fixes in expensive books.

  61. Here’s my question:

    What does this have to do with people who have gout attacks when they consume meat or eggs?

    I have friend who only has gout issues if he eats proteins.

    I lost a lot of weight on a ketogenic diet, an he wanted to try it, but he said he cant because if he eats meat or eggs his gout literally makes him unable to walk.

    1. Meats, particularly shellfish and meat-based gravies/reduction sauces, e.g. osso buco, contain a high amount of purines. Anything over about 4 oz of meat at a meal is a trigger for some people. Look at a purine chart.

  62. HTK is, or was, a standard newspaper editing mark/note, from the copy-editing desk to the typesetting people, meaning Hed To Come. In hot-type days, the handwritten or typed text editing had been done, so the LInotype typesetting could begin, but the headine (hed) was not yet written. It was seldom used, so an HTK note was nearly unique per edition of the paper. Headline writing would be done after space for it was determined in the page-layout phase. When the galley proof came back from typesetting to the editor, with HTK instead of a headline word at the beginning of the type, the editor would write the first few words of the headline on the galley proof, so the compositors would know what headline to put with the HTK galley of type. TK is just an abbreviation of HTK.

  63. always i used to read smaller articles which as well clear their motive, and that is

    also happening with this article which I am reading here.

  64. Good article Tim! I’ m reading The Fat Switch right now and he provides mounds of studies saying that exact thing. I’m grateful you are covering health. Thanks so much.

  65. Please specify which diabetes to which you refer. It’s media coverage like this that results in T1 diabetics being treated unsympathetically by the public and even the medical community.

  66. Slight problem here, purines and pyrimadines are not components of protein they are the base building blocks of DNA. There is a reason why this chapter was left out – lots of mistakes! Makes me wonder now about the rest of his science!

  67. 4th paragraph by Gary is incorrect :

    “Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat”

    The fructose arguments are sound but that point is wrong. Amino acids are the building blocks of proteins, not purines. Purines are one of two types of building block of DNA (Adenine and Guanine). Although uric acid can be formed from the breakdown of protein in the main nitrogen from protein is captured as urea.

    Three points from this (1) food without many cells (and so without much DNA) like cheese can be protein-rich but have low purine content, and should not generate uric acid; (2) food sources with dense cells – working tissues like red meat and organs – have more DNA and higher levels of purines; (3) if your energy input is low (e.g fasting) then production of uric acid is likely to be from your own DAN – i.e. cell death as cells are sacrificed for energy.

    The consequences are still being debated

  68. This chapter is in “The Case Against Sugar” as a sub-chapter starting on p.238. That (1947) figure of 7% gout in India is very dubious. A recent study (2013) suggests it is 0.12%!

  69. Thank you for this article.

    I would have to say fruit sugar as well. I’ve been doing fruit, only sugar I consume. High fat , 1-2 Avos a day, vegan ( so no purines), nothing processed, active, hydrated, never have drank.

    Started intermittent fasting 20-24 hours a day with carbs under 30 grams a day. And my toes and fingers swollen and gout like. Miserable. The only culprit is fruit ( fructose) of past few years. I’d have a few apples, banana, tangelo.

    So did fruit sugar create high Uric acid levels and now that I’m IF and cutting, its flaring?

    I read somewhere that Ketones outcompete Uric acid when leaving body. How long will this take and what can I do?

    I’ll try ACV and see if that helps. Great responses everyone. I guess fructose Via fruit is not good either.

  70. Thank you! I learned so much that has helped me understand

    Gout and insulin resistance relationship.

    Your dates & info helped me set straight misinformation

    I have heard & read for over 20 yrs.

    Ketocure is helping me understand my problem h given me plans & hope to get well.

  71. My conclusions were the following.

    Conclusions:

    1. The standard medical advice, stop eating purine containing foods and drinking red wine, are not well supported by research. Purine foods have only a minor impact on uric acid and red wine is part of the larger alcohol problem.

    2. Sucrose and HFCS have a triple whammy effect on uric acid levels. They increase production, inhibit excretion through both lactic acid and insulin pathways.

    3. Alcohol is only a double whammy (increase production and lactic acid).

    4. Strenuous exercise can inhibit excretion of uric acid via the lactic acid pathway.

    5. Lack of sufficient water and nutrients can inhibit excretion of uric acid…(mygenericpharmacy)

  72. Sufro de gota desde hace mas de 30 años. Por experiencia sostengo que la gota se desencadena por factores como el ácido úrico alto acompañado de un incidente de estrés emocional, ayuno, esfuerzo físico extremo, inhalación de químicos, exceso de sol, lesiones en articulaciones, medicamentos como aspirina y consumo de alcohol. Este último (alcohol) no aumenta el ácido úrico sino que suelta los cristales del torrente sanguíneo que son los causantes de la gota. Mientras no ocurra el incidente que desencadena en gota, el ácido úrico alto en sangre pasa desapercibido como pasa en muchos otros que tienen al ácido úrico alto pero nunca sufren de gota.

  73. I used to be an acute Gout sufferer since I was 20, however 10 years ago when I was 57, I discovered what really caused it and now am Gout free.

    99% of people have got it wrong including the medical profession.

    The solution. DO NOT EAT ANY MEATS (other than one pan fried Salmon slice per week) OR GREENS, DO NOT DRINK ALCOHOL OR FIZZY DRINKS. EAT AS MUCH FRUIT AS YOU CAN, CARBS, and starches. Always eat cherries and zucchini which both reduce uric acid and one tablet per day of Probanacid (Procid). Plenty of exercise and water. Thats it, works great. I now move just like I did when a teenager.

    It annoys me regarding all the professional wives tales regarding gout, especially doctors, who nearly killed me 10 years ago through long term gout medication, which my body started rejecting requiring daily blood transfusions. All that is now behind me and fully controlled by diet.

    Rgds, Chris

    1. I am curious about you saying to cut out GREENS,,,,can you explain please?

      FIZZY DRINKS also got me. Do you mean carbonated? With or without Sugar…or just with Sugar?

      Lastly Zucchini…do you have a link for this?

  74. I loved reading the comments. So much great Info!

    What I got out of most posts is that Meats and Organ meats over a certain amount seems to create something to happen

    Also a biggie is Fructose. I am currently suffering with gout. It seemed to trigger with Moscow Mules and I had some home made Banana Bread and Some Honey from the Azores….which sent me literally spinning enough to have to lay down.

    I tend to believe that not sleeping right or long enough also has something to do with it

    Potassium is major as I know my Uric acid is high and My Potassium was low enough to worry my Dr.

    Both Citrate and Potassium Bicarbonate seem to help.

    Such a complicated disease with tentacles into so many other issues…Diabetes, Heart Disease, Hypertension

    For sure new research needs to be done with this

  75. “Conclusion: The risk of hyperuricemia and gout is positively correlated with the intake of red meat, seafoods, alcohol or fructose, and negatively with dairy products or soy foods. High-purine vegetables showed no association with hyperuricemia, but negative association with gout” (Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review, https://pubmed.ncbi.nlm.nih.gov/30485934/)

    “Conclusion: There is an adverse association of sugar-sweetened beverages and fruit juice intake with incident gout, which does not appear to extend to fruit intake” (Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies, https://pubmed.ncbi.nlm.nih.gov/31061018/)