By Dr. Mercola
Rates of gout have skyrocketed in the UK, rising 64 percent between 1997 and 2012.1 That equates to about a four percent rise every year, and this painful condition now affects one in 40 people!
Unfortunately, many of the media outlets that picked up this story have been focusing on the researchers' finding that access to medication was a problem, and rates of people using uric-acid-lowering medications remained "suboptimal."
If you struggle with gout, as increasing numbers of people do, the message to take home is that you don't need to take drugs to deal with this potentially excruciating condition.
You can address the underlying cause of excess uric acid formation through all natural means, and very effectively at that. Gout is, after all, primarily a lifestyle-related disease.
The Symptoms of Gout Are Related to Excess Uric Acid
Uric acid is a normal waste product found in your blood. High levels of uric acid are associated with gout, which is a type of painful arthritis and inflammation, and about half the time, targets the base of the big toe.
It has been known for some time that people with high blood pressure, overweight, and people with kidney disease often have high uric acid levels as well.
Uric acid functions both as an antioxidant and as a pro-oxidant once inside your cells. So, if you lower uric acid too much, you lose its antioxidant benefits. But if your uric acid levels are too high, it tends to increase to harmful levels inside your cells as well, where it acts as a pro-oxidant.
When the metabolic processes that control the amount of uric acid in your blood fail to do their job effectively, gout occurs. The stiffness and swelling are a result of excess uric acid-forming crystals in your joints, and the pain associated with this condition is caused by your body's inflammatory response to the crystals.
The symptoms associated with gout can be excruciating. In fact, gout is described as one of the most painful forms of arthritis. Most often, gout attacks the big toe first, with sufferers often describing it as being burned by a flame or skewered with a hot poker.
Gout symptoms usually go away within three to 10 days, and the next attack may not occur for months, or even years, if at all. However, oftentimes, gout becomes a lifelong problem, with attacks occurring with increasing frequency and severity. In time, this can permanently damage your joints and surrounding areas, especially if you don't take steps to help reduce your uric acid levels.
Why Drugs Are Not the Long-Term Solution for Gout
Conventional approaches to the treatment of gout typically involve the use of drugs like:
- Allopurinol, which works by reducing the amount of uric acid made by the body
- Colchicine, which blocks the inflammation caused by uric acid crystals
- Non-steroidal anti-inflammatory drugs (NSAIDs)
These drugs may work in the short term, but they also may have very dangerous, long-term side effects. Because gout is frequently a lifelong condition, you may end up staying on these drugs for very long periods of time, which can wreak havoc with your health.
Any time we're talking about reducing inflammation, please remember that your diet is your number one priority. This is especially true with gout, as it's known that meats and purine-rich foods can raise uric acid. Even more importantly, however, is the fact that one of the most potent ways to raise uric acid is by consuming large amounts of fructose!
If You Have Gout, Carefully Limit Your Fructose
Uric acid is a byproduct of fructose metabolism. In fact, fructose typically generates uric acid within minutes of ingestion. I became fully aware of the dramatic and devastating impact fructose has on your uric acid levels when I interviewed Dr. Richard Johnson on this topic. You can watch that interview above.
Dr. Johnson's research focuses on how fructose -- which is among the top sources of calories in the US diet – causes obesity, diabetes, and a number of other common diseases, including:
- High blood pressure
- High cholesterol and high triglycerides
- Kidney disease and fatty liver disease
- Heart disease
As it turns out, a major component of all of these diseases is elevated uric acid, and more recent research shows that fructose is the ONLY type of sugar that will raise your uric acid levels!
Fructose is distinctly different from other sugars as it's metabolized through very specific pathways that differ from those of glucose, for example, and it is through this distinct metabolic action that uric acid is generated. According to Dr. Johnson's research, uric acid appears to take on a lead role in creating health problems when it reaches levels in your body of 5.5 mg per dl or higher.
At this level, uric acid is associated with an increased risk for developing high blood pressure, as well as diabetes, obesity, and kidney disease. The ideal range for uric acid lies between 3 to 5.5 mg per dl. The connection between fructose consumption and increased uric acid is so reliable that a uric acid level taken from your blood can actually be used as a marker for fructose toxicity. I now recommend that a uric acid level be a routine part of your blood screening.
Interestingly and not commonly noted, low-carb diets that move one towards a nutritional ketosis can also cause a high uric acid level. It is unclear if uric acid elevation from this route can cause the same damage as that from a high fructose intake. This actually occurred to me and after discussing it with Dr. Johnson I have concluded that it is harmless in this scenario.
Research Connects Fructose-Rich Beverages to Gout
If you're still not convinced that fructose could be increasing your risk of gout, consider a JAMA study from 2010.2 The analysis showed that women who drank more than two cans of soda per day were more than twice as likely to develop gout, compared with women who rarely drank soda. Drinking 12 ounces or more of orange juice daily had the roughly the same effect. Additionally, as reported by CNN:3
"Women who had just one soda or 6-ounce glass of OJ per day were at 74 percent and 41 percent greater risk, respectively, compared with women who rarely drank either. The culprit appears to be fructose, says the lead author of the study, Dr. Hyon Choi, M.D., a professor of medicine at Boston University School of Medicine."
A similar study on men also revealed that men who drank two or more sugary soft drinks a day had an 85 percent higher risk of gout than those who drank less than one a month.4 The risk significantly increased among men who drank five to six servings of sugary soft drinks a week. Fruit juice and fructose-rich fruits such as oranges and apples also increased the risk.
As a general health rule, I recommend limiting your total fructose consumption to about 25 grams per day on average, and that includes fructose from fruit. However, if you have insulin resistance, heart disease, cancer, high blood pressure, or elevated uric acid levels, you may want to cut it down to 15 grams or less.
For those who are particularly sensitive to fructose, Dr. Johnson has developed a program to help people optimize their uric acid levels, and the key step in this program is complete elimination of fructose, until your levels are within the ideal range of 3-5.5 mg/dl. The chart below is excerpted from Dr. Johnson's book, The Sugar Fix, which contains more details on the fructose content of common foods. You can use it to help you cut back in your diet:
Top Lifestyle Changes for Fighting and Preventing Gout
Limiting fructose in your diet is one of the most important parts of managing and preventing gout attacks, and you can find a simple guide for doing so using my nutrition plan. You'll want to be sure to cut out soda, fruit drinks, and other sweetened beverages, as these types of drinks are a primary source of excessive fructose. Instead, drink plenty of pure water, as the fluids will help to remove uric acid from your body. Other top tips include:
• Limit Alcohol Consumption, Especially Beer: Gout is more likely if you drink too much alcohol but beer in particular may be problematic. It turns out that the yeast and all that's used to make beer work together to make beer another powerful uric acid trigger. While this concept is still new, pilot studies support Dr. Johnson's findings, so beer consumption is also something to definitely consider when you're watching your weight and trying to improve your health.
• Eat Tart Cherries in Moderation: Cherries contain powerful compounds like anthocyanins and bioflavonoids, which are known to fight inflammation and may help lower your uric acid levels.5 If you eat cherries for their therapeutic value, 10 sweet cherries or 1 cup of sour cherries contain about 4 grams of fructose, so be sure to take that into account for your total daily fructose consumption.
• Eat More Potassium-Rich Foods: Potassium deficiency is sometimes seen in people with gout, and potassium citrate preparations, which are known to alkalize your urine, may help your body to excrete uric acid.10 A proper balance of potassium both inside and outside your cells is crucial for your body to function properly, but if you eat a highly processed diet (the same type often associated with gout), you may not be getting enough. Potassium is widely available in fruits and vegetables, but I've included some of the most beneficial sources below. If you want to supplement, consider using potassium bicarbonate, which is probably the best potassium source to use as a supplement. I personally use it every night in my dental irrigator.
✓ Swiss chard (960 mg of potassium per 1 cup)
✓ Avocado (874 mg per cup)
✓ Spinach (838 mg per cup)
✓ Crimini mushrooms (635 mg in 5 ounces)
✓ Broccoli (505 mg per cup)
✓ Brussels sprouts (494 mg per cup)
✓ Celery (344 mg per cup)
✓ Romaine lettuce (324 mg per 2 cups)