Started having severe gout attacks in 2004. Doctors are particularly unaware about gout. Despite having extremely painful and long attacks (during one attack, spent more than a month in bed unable to walk), all the doctors I saw had no idea despite endless tests. Finally based on my own research I suggested gout and they were like "oh yes, I suppose it could be that".
Once diagnosed, doctors are quick to get you on daily drugs for the rest of your life. While these help, there's a price to be paid in liver damage from chronic medication.
I spent the next ~8 years bouncing from attack to attack despite the drugs, sometimes every few weeks, sometimes months would go by. Finally around 2012 I stumbled on the work of Robert Lustig (UCSF medicine professor) and particularly this talk (not about gout, but touches on it):
Fructose is processed by the body into: uric acid. Finally light bulb moment! I hardly ate any of the things traditionally associated with gout (red meat, shellfish) so couldn't modify my diet based on those. But fructose? Yes, turns out I was consuming way too much.
I drastically cut back on fructose, limiting myself to no more than 10g/day. I have been gout-free now for 7 years. I don't take any gout drugs anymore. Just avoid fructose at all cost.
Most fruit are nowhere near as healthy as most people expect they are. They have been selectively bred over many hundreds of years to be far larger, sweeter and more devoid of micronutrients than they were hundreds of years ago. The amount of sugar (especially fructose) in fruits like apples, oranges and bananas is shockingly high, and can cause or exacerbate conditions such as obesity, fatty liver, type 2 diabetes, gout and other metabolic or inflammatory diseases.
Replacing some fruit with vegetables instead, and choosing less sweet fruit like various berries or melons may be a good idea for most people.
Obese people avoiding fruit is one of the biggest eye roll on offer. I had a fat roommate who measured out the raw almonds he ate because they were calorie dense the same day he’d eat two whole pizzas for dinner.
Meanwhile, almonds and bananas aren’t the things making people fat. Looking at my own fat friends, some tasty fruit is the only fiber they even get.
And vegetables aren’t even on the menu of most fat people I’ve lived with. Don’t discourage the only healthy habits people do have.
Look at the the actual diet of an obese / fatty liver / type2 person and you’ll see how silly this advice is. It ain’t the fruit.
My own anecdote is that my dad was diabetic and he definitely didn't understand how much sugar was in fruit. He did ok controlling his blood sugar, but he considered fruit to be "healthy" and so ate about as much of it as he wanted, which regularly caused blood sugar spikes.
And I know it's not the same thing, but the number of times our small kids get offered juice as a "healthy" option when it's got almost as much sugar as soda... I think it's a real phenomena that certain things have a reputation for being much healthier than they are and it causes problems.
Sadly, as said elsewhere in the thread, many (but not all!) modern fruit varieties have been selected for sugar content.
However, some fruits and vegetables are particularly important for their fiber content even if you can't get rid of the fructose.
Things like inulin or resistant starch are very important to avoid having too many Bacteroides and too few Bifidobacterium, which is one of the big differences in westernized human guts vs more traditional ones.
It wasn't "advice". It's a true statement: Most fruit isn't as healthy as people think it is.
If you've got someone eating an unhealthy diet, but sticking some token fruit in, then that means that even their token nods towards good diet aren't as good as they think, and they should be made aware of that.
This thread isn't about being fat, it was about gout.
I've never been fat but had plenty of gout attacks. Back when I was getting my worst gout attacks I was in the best shape of my life but the problem was I was consuming too much fructose. From a combination of drinking fruit juices (a single glass can have more than my limit of 10g/day!) and not paying enough attention to sugar content of regular foods. When I finally started adding it all up I was easily reaching 100g of fructose per day.
> From a combination of drinking fruit juices and [other stuff] ...
Yes! Juices and smoothies are bad for you. Eat fruit in solid form only, to make your digestive system work harder (as designed), and slow down your rate of calorie ingestion.
It's getting harder and harder to find fruit that hasn't been bred to maximised sugar content, though.
My grandfather was getting obese and had a risk of getting diabetes.
I always assumed he ate healthy food, since he always made an effort for it.
When his medic reviewed all his food choices... the issue was actually fruit, in particular various kind of oranges, my grandpa just loves oranges and will eat them often, several per day.
The difference between fruit juice and actual fruit is massive. Volume for starters it’s far easier to overconsume juice than whole fruits. Then there’s the matter of the rough fibrous matter being strained out and the glycaemic index ... (EDIT not to mention the various adulterations for shelf life and added sugar and stuff)
Most national dietary guidelines encourage eating fruits and vegetables, with an emphasis on the vegetables. The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar.
> The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar.
I think a more precise way to say this is:
Due to the water and fiber in fruit, they tend to be more satiating than eating something like a chocolate bar on a calorie normalized basis.
Fructose is almost always absorbed; fructose malabsorption causes SIBO. Fiber reduces the glycemic index and makes fruit more satiating. Glucose aids the absorption of fructose preventing SIBO.
But in the case of fruit w.r.t. gout, the missing variable here is that while fructose increases the production of uric acid, potassium promotes the excretion of uric acid [1], and fruits are generally an excellent source of potassium while soft drinks contain little to none. The net effect of fruit on gout risk seems to be inconclusive [2] but it's clear that fruits are much less concerning than foods with added fructose. Since a significant fraction of Westerners do not consume enough potassium [3], and potassium is key to preventing hypertension and stroke [4,5], it is bad advice to suggest reducing fruit consumption for most people, unless you're already eating like Steve Jobs.
>> That’s a very simplistic way of looking at things which isn’t supported by medical science.
I agree with you on this one but from what I've heard, it is likely that fruit juices and smoothies are not fruits either. If that is correct, the message can get very muddied.
>> Specifically glucose, fructose, sucrose, are worth treating differently for the purposes of diet management.
Now we need to not only treat different sugars differently, we also need to treat the delivery methods differently as well. At some point, the message just becomes too complicated.
> from what I've heard, it is likely that fruit juices and smoothies are not fruits either. If that is correct, the message can get very muddied.
Not really. The original comment in this chain talked about processed foods vs unprocessed. Fruit juices are fairly obviously processed so this rule works for them too.
It is simplistic, but for most people it is probably a great start.
When people talk about sugar like this they are talking about fructose. Bringing glucose into it confuses people since it is scientifically sugar, but not what people mean when they talk about eating sugar, which is just eating sweets, soda, juice, etc.
> Fructose is the monosaccharide and is the problem
Glucose is also a monosaccharide.
"sugar" (table sugar, maple syrup, etc) are mainly sucrose, which is one part fructose and one part glucose (joined together, into a disaccharide)
I agree that fructose is the troublesome part of this pair. But when people say "sugar", they aren't referring to fructose, they're referring to sucrose.
It is in the context of dieting advice “instead of a chocolate bar, eat an apple” (still about 20 grams of sugar/100 kcal, but about half that of the chocolate bar)
The other difference is that while chocolate bar makes you more active if you was low on sugar, you are still quite empty, hungry and looking for more to eat shortly after you ate that.
If you eat apples, you hit limit soon. Apples also do not work all that much if you actually need quick energy when doing something straining. It does not have that "immediately feel better" effect (which motivates you eat more and more).
The fiber will impact the absorption rate and insulin spike, but in the end you’ll have consumed the same amount of sugar. For calorie-counting purposes, or say, avoiding gout due to fructose intake, there will be no difference.
Why wouldn't the absorption rate have an impact? Seems like it could slow down absorption enough for your kidneys to filter out byproducts that can lead to gout. Interested to learn if you know something different.
The most common and pervasive misconceptions about nutrition use the extremely simplistic view of it, believing that in the end all matters is that you end up with N grams of say sugar.
The effects on the body of consuming an apple versus the equivalent two table spoons of raw sugar are not even remotely similar.
The problem is that there’s no study demonstrating what was stated. Consuming a fructose concentrate will not have the same outcome as consuming the same amount of fructose through fruits.
There isn’t a study that shows the outcomes are equivalent . I have no idea where OP got his conclusion that fruits are an issue.
Yes, keeping an eye on glycemic index or FODMAP for people with metabolic disease works but I can’t find studies showing that you can eat so much fruit to get diabetic or gout.
> Studies also have shown that high-fiber foods may have other heart-health benefits, such as reducing blood pressure and inflammation.
Helps control blood sugar levels. In people with diabetes, fiber — particularly soluble fiber — can slow the absorption of sugar and help improve blood sugar levels.
The amount of sugar (especially fructose) in fruits like apples, oranges and bananas is shockingly high, and can cause or exacerbate conditions such as obesity, fatty liver, type 2 diabetes, gout and other metabolic or inflammatory diseases.
If you want some idea of how bad it is: monkeys get diabetes from bananas now
I have yet to meet someone who is obese and his calorie intake is primary from fruits.
Edit: I just did napkin calculation. Sedentary 170cm high male weighting 66kg would need to eat 20 apples a day to keep his weight. Or 3600 grams per day. The shocking high sugar content still means nearly uneatable quantity of apples just to get enough calories for rather small office worker who does no sport.
Juice is not apple, that is competely different argument. 20 apples is quite a lot and dude I picked is small - I intentionally made him smaller then average.
I am 100% confident that pearl clutching over need to replace fruit by vegetables else people will be obese is really not even close to why people get fat.
I have yet to meet someone who is obese and his calorie intake is primary from fruits.
I see people drinking smoothies thinking they are the healthy choice not realising a smoothie has more sugar in than a Coke. They are not even a good post-surf recovery drink for the surfers who invented them and gave them the infantile name!
I would assume we talk about fresh apples. If you process it in such a heavy way it is something completely different. You can also eat a lot more dried apples then fresh ones. Or you can drink a lot more apple juice then eat apples.
> The amount of sugar (especially fructose) in fruits like apples, oranges and bananas is shockingly high, and can cause or exacerbate conditions such as obesity, fatty liver, type 2 diabetes, gout and other metabolic or inflammatory diseases.
While vegetables are often superior to fruit for the reasons you indicate, if your diet contains neither then you could still consider fruit a 'step down' from the ever-popular refined carb snacks. Most fruit contains enough fiber to help you feel more satiated than a refined carb snack would.
I avoid fructose, from any and all sources. Yes, it does mean limiting fruits but I eat them in moderation within my self-imposed 10g/day limit. I sometimes go up to 25g/day but only on special occasions no more than once a month or so.
Here's one list of fructose content per type of fruit. I mostly stick to the ones with least fructose:
Since you mention IBS in the context of fructose, are you aware of the the phenomena of fructose malabsorption? My wife has this combination of issues at times, strongly related to eating or drinking of apples or apple juice and other similarly high fructose fruits and extracts like agave.
The worst offender is fruit juice. It is practically soda with some vitamin C.
Suppose I'm from a country that does not have fruits. How do you convince me to start eating them from a health perspective? Fibre is in vegetables and I'm not too keen on increasing sugar intake for no reason.
Fruit juice removes all of the fructose from the fiber your body has to scrounge through to absorb the sugar.
The overall quantity of sugar may be roughly equivalent, but the glass of juice is going to hit your blood stream almost as fast as a can of coke. Probably as fast since a typical bottle of fruit juice is running about 20 calories more than a soda.
Also PSA: Watch out for apple juice in your 100% fruit juice. It is at this point a very old industry trick to use apple juice that's concentrated, increasing the sugar content drastically. If you got a press and juiced your own apples, it would taste like flavored water to you compared to the 'worst' case in bottled juices.
Tart cherries (sometimes called Montmorency cherries) are pretty much miraculous gout treatments. I regularly take varying amounts as a prophylactic (I pour the concentrate into other drinks), but back when I was getting acute attacks I could knock them out in an hour if I drank say half a cup of the concentrate. (again, not straight: it's too tart by itself!) There is a local grocery store that carries this concentrate in the refrigerated section, but even the hot-on-the-shelf jugs at GNC seem to work.
> doctors are quick to get you on daily drugs for the rest of your life.
When all you really need is an 8oz glass of tart cherry juice per day [0]. If you have "trigger" foods [1], then those still need to be avoided, but the cherry juice will allow you to enjoy a normal, non-excessive diet of pretty much everything else.
[0] Sweet cherry juice works too, but you need a lot more of it, to the point where it would be excessive and unhealthy.
[1] By trigger foods, I mean those that will cause a gout attack regardless of how much is consumed. For me, it's spinach - as little as one leaf will make my toe sore for a couple of days. Most people never learn their trigger foods, so consider yourself lucky if you know yours.
I've had some success with tart cherry juice (Montmorency) as well.
I had my first gout attack in my mid-40s - I'm pretty fit and not noticeably overweight (lots of cycling) and got a foot pain that I thought was a small broken bone or some-such. My GP had one look and realised it was gout (red inflammation is a giveaway). Anyway, I just took Ibuprofen and lots of liquid for a few days and it went away.
I've had a few minor bouts of it that seem to be brought on by either eating asparagus or mackerel or not drinking enough water, so I tried the cherry juice for a while which seemed to work. After a year or so of that, I thought I'd just try drinking more water instead - that works most of the time though I did have a minor gout episode just last week.
I had my first gout attack on August 14th 2018 at just 24, following a night filled with liquor and red meat. Though I’ve gone through periods of continuous activity, it’s safe to say I lead a somewhat sedentary life. Today, at 26, I have been free of major gout symptoms since my first attack 2 years ago. Though I occasionally get mild inflammation in my gout-prone foot if I stray too far from my diet, I’ve been effectively symptom free since immediately course-correcting my diet following my diagnosis. My new diet is mostly plant based, though some fish and occasionally chicken seems to be safe from causing any symptoms. I’ve even been able to pick up running again.
My long term outlook however remains uncertain, and I will likely be doing semi-annual hematology profiles for the foreseeable future (my rheumatologist wants to have long term data on uric acid levels.)
I hope this serves as some relief for anyone who has been recently diagnosed and is looking for positive reassurance about the changes they’re considering for themselves. YMMV.
I had mine at about the same age or maybe a little younger - my foot was so swollen, and so sensitive that doctors couldn't believe it was anything other than a break, sprain or some other gross damage. When the X-Ray came back clear, and a blood test showed high Uric Acid they were stunned.
Still, I had no further symptoms for several years. Then I had another, then it became a yearly thing and now I'm on Allopurinol permanently.
My doctors insist that I cut down my drinking (I don't drink), my consumption of red meat (some, but not much) and a variety of other things which mostly don't apply to me.
It's in the family history - everyone on the male side of my family going back generations has had it. A great-something grandfather had attacks so bad that anyone even walking near his bed was threatened with a grisly end. I can certainly sympathise.
Trying to walk with a gouty foot is painful enough, but it's made worse by how inconsiderate so many people are - so many people will walk into you, people on bikes, skateboards, one-wheels, etc ride directly towards you. Which makes you brace, slightly in the event they don't swerve-away, which triggers another burst of pain from the bracing.
An uncle who has to use a walking stick at times complains of the same problem of appearing to be invisible to people on the streets, and of people brushing past and knocking against the walking stick.
> My doctors insist that I cut down my drinking (I don't drink), my consumption of red meat (some, but not much) and a variety of other things which mostly don't apply to me.
See my other post in this topic. Try cutting way down on fructose.
Wow! Until I read the last sentence, I was going to suggest using a walking stick as a visual way of signalling to others that you have some sort of disability and can’t just quickly move out of their way. As a (mostly) healthy and regular pedestrian, I come across the groups you mention – and those who walk with their eyes glued to their phone, expecting others to move out of their way. I really would’ve thought that they’d show more consideration to older people or others, such as your uncle, who are obviously less sprightly. :(
I love going for walks and every now and again, I have to remind myself that I’m lucky to be able to do so and shouldn’t take it for granted. Best wishes to you and others who don’t have the same luxury.
> I come across the groups you mention – and those who walk with their eyes glued to their phone, expecting others to move out of their way
The folks who don't move or alter their path for the elderly and those with crutches or walking sticks are all over the spectrum.
But it's not just phone users, people will look up, see an older person, and then look down or away and not alter their path at all.
Bags and strollers are frequently used as battering rams. Some of those big trendy bags have extremely sharp corners, as well as metal clasps and other items that also cut and/or bruise.
Groups of people expect that others will get out of their way - members of the group directly in your path will look up, and then back to the rest of their group.
Couples are particularly bad at this - yes, you're together, you're clearly deeply in love, but that doesn't grant you the right to occupy the centre of the footpath and force everyone else to go around.
I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. In a few years you will probably start having more frequent attacks. Lossing weight is little more effective. Keeping your uric acid well below 6.0 mg/dL is when the process starts very very slowly reversing.
Fortunately there is a better understanding of the dissease and more new therapies in the pipeline.
> Dedicated gout research, going on quietly in the background of other breathtaking advances in rheumatology, is now paying off. This comes at a time when the number of patients affected by gout continues to rise, mainly due to an epidemic of obesity. An effort to improve lifestyle choices as a society and better management of the disease by clinicians should have a positive impact on gout incidence and outcome in our lifetimes.
> Importantly, prophylaxis may prevent the acute inflammatory response to crystals, but will not alter crystal deposition and ongoing joint damage, so the patient may well be unaware of progressive tophi formation and destruction of cartilage and bone. Therefore, prophylaxis should only be employed with effective ULT.
> Treatment is lifelong with a dose sufficient to maintain the serum urate below 6.8 mg/dl (404 μmol/l), preferably below 6.0 mg/dl (357 μmol/l). Anything short of this does not reverse the process, but merely slows the rate at which crystal deposition continues. The lower the serum urate achieved, the faster tophaceous deposits will resolve [1]
> I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout.
We all might get gout for different reasons but the generalization of "with dietary changes alone it is not possible to stop progression of gout" is not true. I have completely stopped my gout attacks by cutting way back on fructose.
Given the frankly enormous variances in medicine, saying that it is entirely impossible that their situation has improved in the way described just because you can't see it seems a little small-minded. Such strong claims are something that might have been acceptable and expected thirty years ago, but not now.
Allopurinol works for most people (but sadly not everyone), my gout kept me in bed for a month of agony, but once I was able to start allopurinol my uric acid levels have dropped and been managed for over a decade without issue, or gross dietary changes.
That doesn't seem quite right. If your diet consists only of things that do not metabolize into uric acid, how can you experience gout? It might require a very strict diet, but surely this is possible?
It's not just direct metabolism of stuff in the diet. Your body indirectly makes stuff that is then metabolized into uric acid (e.g. your DNA). Could be making too much, could not be excreting enough.
"Many factors contribute to hyperuricemia, including genetics, insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, use of diuretics (e.g. thiazides, loop diuretics), and excessive consumption of alcoholic beverages. Of these, alcohol consumption is the most important."
"Causes of hyperuricemia can be classified into three functional types: increased production of uric acid, decreased excretion of uric acid, and mixed type. Causes of increased production include high levels of purine in the diet and increased purine metabolism. Causes of decreased excretion include kidney disease, certain drugs, and competition for excretion between uric acid and other molecules. Mixed causes include high levels of alcohol and/or fructose in the diet, and starvation."
Purines and pyrimidines make up the two groups of nitrogenous bases, including the two groups of nucleotide bases. Two of the four deoxyribonucleotides (deoxyadenosine and deoxyguanosine) and two of the four ribonucleotides (adenosine, or AMP, and guanosine, or GMP), the respective building blocks of DNA and RNA, are purines.
I don't believe the current scientific consensus has meat consumption as a risk factor for gout. I read a paper recently that specifically mentioned that simple sugars (glucose, fructose, sucrose) and purine. Purine is present in quantity in certain organ meats, but not meats that most people eat frequently, and you're more likely to get it from legumes.
A quick search on the internet shows the opposite. Most popular legumes don't have high levels of purines despite having high protein levels.
Also "higher total dietary protein intake from mainly poultry and fish/shellfish was associated with an increased risk of gout, while dietary intake of soy and nonsoy legumes was associated with a reduced risk of gout."
There are a lot of people who saying the same thing. There are a lot of papers on the fact that beans and nuts increase changes of gout.
Edit: I will just add, it seems to be the last half century of nutrition "science" has largely been wrong. I hope more people keep exploring things for themselves instead of getting our top down advice from the experts.
> There are a lot of papers on the fact that beans and nuts increase chances of gout.
I can't find any, link?
Sounds like there are vegetables which are high in purines, which are suspected to be related to gout. But studies consistently show that those vegetables do not have an effect, whereas meat, fish etc do.
(Also I suspect the downvotes are because the comment claimed that this was the "prevailing opinion", which it is not)
All opinions on a forum are "alternative opinions". We can't tell if somebody is a scientist here, or whether they're talking shit or not, or whether the consensus (like in many cases) are old wives tales (like "fat is bad for you").
Even peer reviewed papers are "alternative opinions".
Unless it has been peer reviewed in several papers, repeated, empirically proven, and got into textbooks, I wouldn't consider anything a "solid scientific truth".
Agreed. I take new, exciting findings with a hefty dollop of salt. I’m prepared to wait for replication of findings and/or a meta-analysis of a large body of work before taking medical or health-based research too seriously.
I'm not concerned what scientists think about meat. This is not a theoretical problem for me and cutting out red meat has kept my uric acid levels nominal.
> Some scientists point to the dramatic rise in rates of obesity — from 13.4 percent of adults in 1980 to 42.4 percent in 2017-18, again per the NHANES — since excess weight depresses kidney efficiency, and to the likely not unrelated introduction, in 1967, of high-fructose corn syrup, which can cause the body to produce higher levels of uric acid, and its wholesale embrace in the early 1980s by the American food industry and then the world. Once gout was confined largely to Western civilization (with some outliers, like the Mongol ruler Kublai Khan); now its ravages are global.
High fructose corn syrup seems to me the strongest contender for "single biggest cause" – it ties in nicely with the obesity epidemic, and the two surely snowball together. That doesn't mean that other factors (the same as 18th century's) can't bring gout on, like a comment elsewhere here reports, but I just cannot believe that high fructose corn syrup's ubiquitous stance in our food isn't met with some pernicious and hard-to-trace effects on our health.
I shy away from blaming high-fructose corn syrup as some sort of subtle poison. A gram of HFCS is anywhere from 42–55% fructose, which is the same as what you’d get from an apple.
But I think there may be something to the dose of HFCS.
Fructose has to be metabolized in the liver, and there’s an upper bound of how much it can break down at once. (I believe 50 grams.) Which, if you’re eating fruit, is fine; the fiber slows down digestion, and also you’re probably not eating like 6 apples at once.
But oh man, look at an energy drink, or a sugary coffee drink. I am from Midwestern white trash stock, and during my obese younger years, I would frequently drink a 44oz Big Gulp of Mountain Dew. That’s a shotgun blast of fructose, and my gut instinct (hah) says that there’s a dose-response curve going on here.
That is wrong. Fructose metabolism specifically differs from other types of sugars, by requiring a particular enzyme, which means it can only be broken down in the liver.
Unlike glucose, which is directly metabolized widely in the body, fructose is almost entirely metabolized in the liver in humans, where it is directed toward replenishment of liver glycogen and triglyceride synthesis. Under one percent of ingested fructose is directly converted to plasma triglyceride.
No you misread my comment. I never said fructose is indistinguishable from glucose. I said sucrose is almost indistinguishable from high fructose corn syrup.
Sucrose is 50% fructose 50% glucose and most high fructose corn syrup is 55% fructose 45% glucose. They are almost identical.
That is not true. Natural sugar (e.g. sugar cane) is 50% fructose. HFCS is by definition a compound sugar with more than 50% of fructose. How much higher, depends on the manufacturer.
HCFS-42 is high fructose corn syrup with 42% fructose. So you don't need greater than 50% fructose. And the most common high fructose corn syrup is hcfs 55% which is very close to sugar.
The scientific consensus is pretty much there won't be any significant changes to your health if you replace sugar with HCFS or vice versa.
Gout isn't caused by what you eat, it's an underlying problem with your kidneys/liver/body and an inability to extract uric acid. It can be exasterbated by drinking beer, dehydration, red meat etc.
Saying it's caused by what you eat is a bit like saying peanuts cause peanut allergies, or eating gluten causes coeliacs. You already have the condition, the things you eat makes it worse.
I've been suffering with it since I've been a teenager.
Gout is caused by excessive levels of uric acid, which is an end-product of purine metabolism. You can get uric acid via two pathophysiologic mechanisms: under-excretion of uric acid, or over-production.
Under-excretion is by far and away the most common cause of gout (think ~90% of cases). Causes for this include things like chronic kidney disease or an inborne/hereditary problem (like you mentioned), but can also be caused by extrinsic factors such as some medications (common ones include cyclosporine, most diuretics, a few of the TB drugs) as well as more general problems (alcohol decreases UA excretion by itself, dehydration can contribute)
Over-production is a whole other kettle of fish. This is most commonly secondary to some problem of increased cell turnover (think leukaemia, lymphoma, haemolytic anaemia etc.), Again alcohol and obesity can contribute.
You'll note alcohol was in both groups. Alcohol excess (especailly beer) can lead to gout without any other contributing factor. Excess alcohol + excess red meat is an especially bad combo which can lead to gout without any other contributing health issues.
So, gout can certainly be caused by what you eat. It's not the ONLY cause of gout, though.
>Excess alcohol + excess red meat is an especially bad combo
My buddy was a beer drinker and had an almost 100% beef diet, on his bi-yearly checkup they found out that the uric acid levels were too high. He switched to turkey/chicken meat and wine, got rid of the occasional brawn (as in meat jelly), and he is pretty much okay now.
Not to disagree but can you define nebulous terms like excess and put those in context for us who may not be professionals with underlying knowledge of quantity of what acceptable levels and excess are.
Anecdotally, I drink a lot of beer but only twice a week. The rest of the week I may very well be a monk. Not a drop. Does the quantity I consume on weekends count as excess? On what scale or timeline?
Not OP, but his description lines up with my experience. Short answer is, probably imo. Long answer is, every person is different, and if you don't have gout, you may never get it.
In my case, I had what I thought was a persistent toe sprain for years and only later realized it was gout. I'm sure alcohol contributed, as did dehydration, poor running form, the keto diet I was on, and sudden weight loss.
>Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Red meat (especially rare-medium) for me is a no. I can feel the low-level gouty effects for days after in my left foot, and I have to back off the beer to compensate.
Red meats contain a lot of purines, which often metabolize into uric acid. They are on the list of products whose consumption gout sufferers should minimize.
You can temporarily increase your uric acid levels by eating purine rich food/drink beer etc. But if your body is excreting it, as it should be - the levels won't remain high enough to build up crystals.
It takes years of persistent high levels, it's always caused by your body. But you can reduce attacks by changing diet, loosing weight or taking medication.
If your body was functioning properly it wouldn't matter how terrible your diet was.
Bad analogy, but you can run your car without an oil change for a damn long time. The eventual breakdown isn't just an innate action taken by your car.
Diabetes can also cause damage to the kidneys in turn causing the inability to extract uric acid, and nowadays this is the leading cause, not a genetic issue anymore. That might not apply to you personally, but to most people it does.
While true, I can't edit my kidneys/liver/body yet, so for now I need to edit diet. My experience: Keto eliminated my gout flareups (eliminating fructose/beer, but gorging on beef), and Vegan has done the same (eliminate meat, add back in some fruits, still not much beer). The standard American diet is a pox...
How is something diet aggravated but not diet related? Seems like all these people who claim there's no _meaningful_ correlation here are just setting goalposts in a way where they don't feel compelled to change their diets.
> Seems like all these people who claim there's no _meaningful_ correlation here are just setting goalposts in a way where they don't feel compelled to change their diets.
Bingo. People would rather find anything to blame but themselves. Change is also hard. People can change; most wont. You see it far too often in "fat acceptance" and "healthy at every size" communities.
And I certainly changed my diet over the past 10 years, and my gut bacteria has become more diverse and presumably more healthy as a result. I've verified this through various stool tests and 3rd party microbiome trackers over the years (uBiome, Thryve)
I don't want to get into pseudoscience or offer anyone advice, but I can tell you that my experience with increasing specific bacteria that increase butyric acid within the gut has seemed to work for me. In theory, one could do this by eating butyrate promoting foods such as almonds, apples, barley, kiwifruit, and more, or take a bifidobacteria-enhancing fiber such as GOS.
Something that I learned recently that blew my mind was that gout is caused primarily from consuming DNA.
How? Gout is caused by a buildup of uric acid, which is created in the body as a byproduct of breaking down purines. Purines are essentially broken down pieces of DNA.
This makes sense when you discover that beer can cause or worsen gout, because of the large amount of yeast present, but other fermented beverages such as wine do not.
Obviously there are other factors that go into gout, and other causes too, but the primary cause is eating DNA!
Apart from the non-organic portion of liquids, doesn't just about everything you consumer consist of organic cells filled with DNA? Plants, animals, it's all DNA
The parent said it was caused by consuming DNA. All DNA is broken down during digestion.
That is not a useful generalization if it's actually a small sliver of broken down DNA that causes the issue. It's like saying "all food-borne illness is caused by eating DNA." It may be literally correct, but is general to the point of adding no value in understanding the specific cause of the problem.
There is this common fallacy when dealing with chemistry that compounds with close structures (or substructures) are the same or have related effects. You can find benzene rings as a substructure of some amino acids all over your proteins doesn't mean eating protein will poison you with benzene...
Sometimes just as little as a change in the spatial configuration of a compound (cis/trans isomers for example) or the addition of a carbon can dramatically change the effect of a molecule on a living body...
Gout is a metabolic disorder period. Excessive sugar in barley syrups from alcohol, and soda pop, and even excessive amount of starch in diet lead to metabolic purine synthesis. The metabolites produce purines in the process of storing away all this sugar, additionally causing inflation in the body the more your BMI is excessive. loose weight and the flair ups reduce, the numbers might not change. Been dealing with gout since I was 28, but had symptoms since around 23. Also have super flat feet making things worse. I take 300mg of allopurinol every day.
I had my first gout attack a couple years ago several weeks into a keto diet (had done keto before with no issues). I found https://www.virtahealth.com/blog/keto-adapted which shows a graph of uric acid spiking as you begin the diet and returning back to baseline after several weeks, which was something I didn't know before, but I was still confused because it was already at several weeks.
To make a long story short I discovered the next year that the culprit was pistachios. So long as I don't eat too many of them while dieting, my foot is fine.
I watch/read a lot of history and I am always curious, if you traveled back in time how would you treat gout? Without medications to manage uric acid what would you do for Ben Franklin, DaVinci, Michelangelo or Charlemagne? Have them lose weight? Stay away from foods X, Y, and Z but eat more of A/B/C? Does exercise help/hurt? Are there any herbs etc that we know today would lower uric acid which you could find with your vast Future Knowledge?
Both Franklin and Da Vinci were well-known and documented tea-totalling vegetarians. The kind you avoid inviting to parties because they won't stop proselytizing it.
Turns out genetic metabolic problems have always been around and modern simple "life hacks" like a fad diet product or an exercise product aren't always the cure.
Or, they were able to manage this horrible condition, and lead extremely successful and productive lives, despite the lack of modern medicine, because of their personal experimentation and resulting lifestyle changes.
Or, yeah, maybe they were just dumb lifehacking sheep.
Some people believe that cherry juice can negate the effects but by far Prednisone works at relieving the pain, almost to the point of seeming like a magic pill.
Unfortunately it is a short lasting treatment as after a few times it quickly becomes less effective and it has side effects such as mood swings.
But take a 50mg pill when you can't walk and an hour later you're dancing.
So I guess if I was a time traveler I would probably try something like making an alcohol based serum from pigs adrenal glands?
A close friend of mine suffered from gout since 2012 and it got aggravated since last two years. He also was severely obese with a BMI around 37. Last year his SGPT and SGOT levels really spiked up drastically and doctor suggested it was the beginning of Fibrosis and asked him to reduce weight.
He started intermittent fasting 18:6 and religious intake of ~3 litres (250 ml per kg). He reduced 20 kgs in last 8 months.
He is totally off allopurinol and the gout seems to have vanished. His uric acid levels and the SGPT SGOT levels are back normal.
Somewhat similarly, I suffered 4-8 attacks per year from the age of 24 to 49. Colchicine was my friend.
But at 49 I quit drinking, lost almost 50 lbs over a year period, and almost completely stopped having gout attacks.
Interestingly, I still get occasional attacks (once or twice a year at most), and they are all almost totally associated either with dehydration (to which I seem somewhat prone) or stress; particularly the stress of flying for 4+ hours on a business-related trip. I board the plane feeling fine, and step off with that little tinge in my left-big-toe joint.
I think the jury is still out on what the the 100% correct treatment of gout or many of the modern life style related sickness. But many can be cured by reversing what one eat to what people ate 100 years ago or 20.000 years ago. 100 years would mean no processed food, vegetable oils and a lot less sugar. 20.000 years would also remove all type of wheat and corns.
Here is a guy who cured gout with the carnivore diet. https://meatrx.com/category/success-stories/gout/
Huh? Olive oil was known to at least the Greeks and Romans, and some disputed citation on Wikipedia even says that olives were harvested even 8.000 years BC.
Diets are more universal now. In many locations, in the recent past, frying would have been done with lard rather than vegetable oil. One can make lard from pigs that one raises in the backyard. I don't even know what a canola plant looks like, and olive trees tend not to like climates that freeze for months at a time.
On mobile so I won’t be looking up a source. Was listening to a pod cast from a a cardiac specialist whose position was that higher salt intake is not as important for heart and artery health as long as you have balanced exercise and hydration. His point was that excessive carbohydrates lead to inflammation which leads to plaque build up which leads to heart disease. But salt can be ok.
There might also be evidence that as with so many other things, different people require different amounts.
My partner consistently shows low sodium in their blood work, yet eats way more salt than I do (my blood results are normal) and craves saltier things. They will put salt on already-salted foods that I consider too salty already.
How much is 'different people' and how much is different actions? Is eating salt a 1:1 direct cause of high sodium or is it relative to hydration, exercise, and other factors?
I'm quite certain it's relative. Hydration and exercise are huge factors. I'm not sure how common it is now, but construction workers in hot climates were often given straight salt tablets to swallow in the past-- with as much water & exercise as they get, it's actually necessary to prevent Hyponatremia. They're probably more into energy drinks these days.
Anyway, the person I was thinking of also seems to take in less fluids and get less exercise than I do on average, further compounding the difference for us in particular. That's part of why I mentioned our case, it's more extreme the closer you look.
I have been suffering from gout for the last 4 years or so (36 y/o now) with roughly 1 attack per year, prominently in the right big toe. There is a history of gout in my family. More recently I've had the odd time where I have mild symptoms - pain in foot rather than toe and still able to limp around without too much issue. I have wanted to avoid taking allopurinol daily and have done a lot of research to find more natural / dietary solutions without really finding any silver bullet. Interesting things i have come across:
1. There is at least one study showing Lemon Juice it can lower uric acid levels in humans[1] seemingly by lowering PH of urine.
2. Tart cherry juice is mentioned a lot as a cure. There are a quite a few studies[2]. Make sure and get the tart cherry (Montmorency) juice, you can get it in a concentrated syrup. My uncle says he has not had an attack since he started drinking a generic supermarket tart juice every day. I have never had an attack whilst taking cherry juice but i haven't been taking it consistently.
3. Interesting article linking fructose and gout which matched my intuition a lot more than the link with meat - https://tim.blog/2009/10/05/gout/
4. Hot bath with epsom salts seems to temporarily ease symptoms.
I personally haven't noticed a correlation between eating meat / fish and gout attacks. I have gone from eating meat twice a day to about once a week now and there has been no noticeable change in the gout.
> 2. Tart cherry juice is mentioned a lot as a cure. There are a quite a few studies[2]. Make sure and get the tart cherry (Montmorency) juice, you can get it in a concentrated syrup. My uncle says he has not had an attack since he started drinking a generic supermarket tart juice every day. I have never had an attack whilst taking cherry juice but i haven't been taking it consistently.
Tart Cherry Extract capsules are another option. Gout pain relief within hours. (Note, there is a drowsy/melatonin side effect with big doses)
Creams with high concentrations of menthol and methyl salicylate seem to help. Also applied to the ankle and knee (along with massage) to help stimulate circulation away from the big toe.
To fight my gout and to limit the portions of gout drug I quit smoking in 2009 and stopped drinking alcohol for about 5 years. Now I take drug occasionally and don't eat meat every day (its like once few months, maybe I could call my self vegetarian). Another good practice to lower acids that induce gout is exercises, and drinking water is ok, like 3 liters a 100kg person or so. Same good is limiting coffee and tea. Really just settle in place where there is drinking water strait from the tap, that helps to limit littering with plastic bottles
Got gout the first time when I as 23 - at around 185 pounds and very fit. I was cutting down for summer, and had switched over to a very high-protein diet. The first time, I thought I had broke my toe, or gotten an infection - it was absolutely horrible.
I get it roughly 2-3-4 times a year now, and it is always after the following pattern:
- Not drinking enough water
- Eating too much chicken
- Drinking too much beer
Often in combination. Luckily, that makes my gout incredibly predictable - and I have found meds which work. As soon as I take meds fast enough during the onset, I'm fine.
If it's steroids, I'd recommend getting off of them as soon as you can. Making those diet changes more permanent will help. If you can't or won't do that, getting on regular allo is probably better than treating regular attacks.
I have a similar story and have treated through diet successfully. Haven't taken steroids in almost 2 years.
I have suspicions that my wrist pain was because of gout. My doctor only seemed to care whether or not I've ever had a full-on attack, but I think it's plausible that there could be negative effects short of that. My wrist pain went away when I modified my diet, which I was advised to do anyway.
I'm sure I made other changes to my life during that period of time so I can't say for certain that it wasn't some other change that caused the pain to go away. I also know that wrist pain can go away on its own without any intervention. I wanted to leave this comment here in case it helps others; I would have been very grateful if simply modifying my diet would have helped me as I tried many things during that period of time.
I'd also be interested in getting feedback from those more knowledgeable as I don't have much of a medical background. I did find a study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101606/ which may support what I'm saying, but I might be completely wrong.
I've been getting attacks for about 20 years. First time it happened I woke up in agony one morning, went to the hospital and they were convinced I'd broken it. Spent a few years on Allopurinol during which I only ever had an attack if I was dehydrated from illness, then they stopped my allopurinol because of a recurrent kidney infection. Earlier this year they tried putting me back on allopurinol and I had the longest, most painful attack I've ever had lasting over two months and didn't stop until I stopped taking the allopurinol. I've now been told the only thing I can do is take colchicine when it kicks off.
However it cannot be taken during an acute episode of gout or it will worsen it. Ie it is a preventative not a treatment.
I’m presuming you went to your family doctor rather than the emergency room so your gout flare (relatively speaking, not necessarily from your perspective) probably wasn’t so bad which is why they gave an NSAID and sent you on your way. Ideally they should have told you that if you get more flares and dietary/lifestyle modification don’t help then you should take a long term preventative
Pain can be horrible at night but get relatively better in the morning. It took me a few visits to realize my doctors didn't realize that saying it was an 8 at night didn't make it clear that I was being rocked with waves of stabbing pain, where I couldn't sleep all night, and literally couldn't move my foot, even if I tried to pick it up with both hands. But because I was coherent and calm the next morning, an 8 must have seemed like a moderate amount of pain!
Anyway, the right place to go is rheumatologist. Urgent care or ER in the meantime, but insist that you get steroids or at least colchicine if you need pain relief.
Gout is a very misunderstood disease. I wouldn't be surprised if your PCP didn't treat it appropriately. And they may not have understood your pain level. See my other comment on a peer post.
It's considered dangerous over longer periods than 15 days (banned in some places in Europe, allowed in others and in the US), but mesulid, for 2-3 days, has been the sure-fire way to get rid of gout symptoms...
Yes, which isn't to say that only free content should be posted, but tagging it paywalled would at least let people know "Yeah, I can't rtfm, so I won't bother"
https://www.drugs.com/mtm/febuxostat.html febuxostat is a wonder drug that has saved my toes for so many years now. This is after i had a pain in my heel. a couple of days i ignored it unill i felt as if there was a stone inside the heel. plantar fasciitis was the diagnosis. taking the medication purely on a reccomendation and it worked. was supposed to get a surgery instead
Once diagnosed, doctors are quick to get you on daily drugs for the rest of your life. While these help, there's a price to be paid in liver damage from chronic medication.
I spent the next ~8 years bouncing from attack to attack despite the drugs, sometimes every few weeks, sometimes months would go by. Finally around 2012 I stumbled on the work of Robert Lustig (UCSF medicine professor) and particularly this talk (not about gout, but touches on it):
https://www.youtube.com/watch?v=dBnniua6-oM
Fructose is processed by the body into: uric acid. Finally light bulb moment! I hardly ate any of the things traditionally associated with gout (red meat, shellfish) so couldn't modify my diet based on those. But fructose? Yes, turns out I was consuming way too much.
I drastically cut back on fructose, limiting myself to no more than 10g/day. I have been gout-free now for 7 years. I don't take any gout drugs anymore. Just avoid fructose at all cost.