I’ve never experienced a gout attack, but if common graphical representations are to be believed, it feels like there are shards of broken glass embedded in your joints, or like someone’s holding a flamethrower on full blast and aiming it right at your big toe. For whatever reason, the big toe seems to be the joint that suffers the worst in gout, but the condition can manifest in other joints as well.
Conventional medicine holds that animal proteins and alcohol are major triggers for gout, so typical advice for those who suffer from gout is to reduce consumption of alcohol and animal protein—red meat and seafood, in particular.
Part of the rationale for these recommendations is that gout results from an abnormal accumulation in the blood of a compound called uric acid. At high blood concentrations, uric acid can crystallize and be deposited in the joints, and these uric acid crystals are responsible for the pain, swelling, and other fun stuff that comes along with gout. And a major source of uric acid is the metabolism of purines, which are nitrogen-containing compounds found in proteins (and other substances). Some foods are higher in purines than others, hence the recommendations to eliminate or reduce red meat and seafood in the diet. Beer is also high in purines, and other plant foods are sources of purines as well.
But uric acid is a normal compound in the body. It’s not solely a metabolic waste product; it performs important functions as well. So we don’t want to get rid of uric acid entirely, and we certainly don’t want to eliminate protein from our diets.
So if the body normally produces uric acid, what’s really the problem in gout? Does the body produce too much uric acid, or is the uric acid not cleared away properly?
If it’s the latter, and the problem isn’t with overproduction, but rather, with impaired clearance, how is uric acid cleared from the body, and what impairs this?
Well, to cut right to the chase, the kidneys filter excess uric acid out of the blood so it can be excreted in the urine. And what impairs the kidneys’ ability to do this? Insulin. Yes, dear readers, our old friend insulin strikes again. (I mentioned this insulin and gout connection way back in the insulin series.) Alcohol also reduces the kidneys’ ability to excrete uric acid, so there might be some truth to cutting back on alcohol if you have gout.
Mankind has been consuming animal proteins for a long time now, and gout is a relatively new disease. Well, “new” since about 300 years ago, which is when more accounts of it started being recorded. At that time, it occurred mainly among wealthy people—the people who could afford to eat rich meats and drink alcohol. But something else these “refined” individuals could afford that most common folk couldn’t, was sugar. Refined sugar. ;-)
Typical old-school representation of gout: a demon shooting fire at the toes.
Notice what appears to be a wealthy looking man eating what might be a meatball, and there’s alcohol on the table.
So what’s the real deal with gout? Is it caused by meat, or metabolic syndrome--that is, chronically elevated insulin?
Read all about it in my latest post for the KetoDiet Blog: Is Gout Caused by Red Meat or Metabolic Syndrome? I think you’ll find the details interesting, and what’s really fascinating is that a few studies have shown that diets that are higher in protein can actually reduce uric acid levels and frequency of gout attacks—provided that the diets are also lower in carbs. Nice, huh?
If you or someone you know suffers from gout, and you think you’ve been relegated to a life without steaks and red wine (perish the thought!), check out the post to learn why it’s not meat, but rather, chronically high insulin, that causes gout.
As a personal aside, I have a friend who suffers from gout, and he’s a vegetarian. No red meat, but lots of fruit, fruit juice, and grains. And fructose, via its effects on the liver, can be a huge contributor to hyperinsulinemia and gout.
If you’d like to learn more, Georgia Ede, MD, has a fabulous post that covers all of this as well—gout, meat, insulin, alcohol, and fructose, and it’s a highly recommended read: Got Gout but Love Meat?
Also, the must-read book, Good Calories, Bad Calories, by Gary Taubes, originally included a chapter on gout, but it didn’t make it into the version that got published. Fortunately, this “lost chapter” is available online and it’s another educational read on the connections between insulin, fructose, and gout: Gout: The Missing Chapter from Good Calories, Bad Calories
Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.
Two of my friends have had the gout.
They stopped consuming alcohol and got better.
And they both don't eat much meat. Lots of whole grains, legumes, non-fat dairy, some lean meat like turkey.
Thank you as always!ReplyDelete
Fructose overloads the fructokinase (an ATP depleting step) in the liver cell, depleting atp to adp and too much adp is broken down into the purine adenosine and so on to uric acid. So fructose links to gout convincingly. As I understand it , fructose does not have an insulin effect hence its "Great glycaemic index " pass.ReplyDelete
"Well, to cut right to the chase, the kidneys filter excess uric acid out of the blood so it can be excreted in the urine. And what impairs the kidneys’ ability to do this? Insulin."ReplyDelete
Let's be clear here - the study referenced said this happens where there is insulin *resistance*, not due to the secretion of insulin in general. Hence, a non-obese person with moderate carbohydrate consumption is not going to suffer from reduced uric acid and sodium excretion as a result of eating carbs. I know it's popular to bash insulin, but it's an accessory to a crime (overeating and poor diet), not the criminal!
YES!!! Towards the end my mother had some crippling attacks of gout. A friend linked me to thisReplyDelete
apparently dalmatians have a genetic inability to metabolise purines (and probably owners who feed them endive)
So we eliminated all the high purine foods and cut back on the moderate purine ones, to no avail.
The biggest culprit turned out to be rhubarb - which she ate loaded with sugar (I don't know if the oxalates were also a factor) but drastically cutting back on sugars and fruit seemed to help.
I realised that in the past I'd had a couple of gout attacks - strangely both in the top joint of my left thumb - one when I was dutifully eating an Ornish style high carb low fat vegan diet and the other when I was just eating "normal" low fat. Both misdiagnosed but in retrospect apart from the pain, swelling and reddening the crystals bursting through the skin from the joint should have been diagnostic. Just as with my mother I blame the sugar and "healthy" fruit.
Since going low carb/Paleo/keto not a one despite regularly scranning down liver
I started a ketogenic diet in March of this year. I now eat "carnivore", or essentially zero carb and only red meat, since June. My insulin, blood glucose, and all the other markers have been amazing. I feel better than I have ever felt, and all my tendonitis and allergies have disappeared (indicating virtually zero inflammation). I am not obese, and wasn't when I started this eating lifestyle. I have 10% body fat currently, and I am 47 years old. I am currently suffering from a pretty bad gout attack. I am wondering if there could be a genetic component to overproduction of uric acid as well. My father's side of the family has all suffered from gout. My first attack was 18 years ago, and have had them sporadically since. Additionally, I RARELY drink alcohol, but I did have 2 glasses of gin a few days ago. Wondering if this could be a trigger as well. Any thoughts?ReplyDelete
Alcohol: YES, this can/will be a factor in gout. Did you read the full article I linked to? I discussed alcohol in a bit more detail there, but yes, alcohol impairs the excretion of uric acid. As for a genetic component, I'm not sure if there is one, but it wouldn't surprise me if there were. Still, what would actually trigger a gout attack is not simply having the gene, but the introduction of an aggravating factor (such as alcohol or large amounts of fructose) that might impact what that gene does with regard to influence on uric acid metabolism.Delete
Turns out, what we know about gout is about men, not women. As usual.ReplyDelete
Women are more likely to experience it in their upper extremities, focused on the thumbs! Since I have angry thumbs which got better with a low carb diet, I added black cherry capsules for gout... and things got better.