Gout
Gout is a very painful disorder where excessive levels of uric acid in the blood stream become deposited in joints. The uric acid crystals cause significant inflammation and, in long-standing cases, joint damage. Perhaps even more importantly, high uric acid levels are thought to be associated with the development of metabolic syndrome, a collection of metabolic disorders that predispose to heart disease and diabetes. Indications of metabolic syndrome include:
• Elevated fasting blood sugar
• High blood pressure
• Low HDL cholesterol with high triglycerides
• Excessive waist area body fat
• Elevated uric acid
While gout itself is painful and unpleasant, it may be part of a more dangerous, broader problem of metabolism.
Gout is thought to result from a combination of inherited factors and diet imbalances. The inherited traits involve the tendency to over-produce uric acid or to have difficulty in removing it from the bloodstream to the urine. Some individuals may have both traits. However, even in those with a predisposition to gout, the episodes are usually triggered by dietary imbalance. The most commonly known dietary factors are purines which are protein molecules in meats, especially organ meats such as liver.
Purines are broken down into zanthine which is then converted to uric acid. Other dietary factors, however, sharply increase zanthine production and thus uric acid production. The most prolific generator of zanthine is the dietary sugar fructose which has progressively increased in the US diet over the past 3 decades. Over the past 100 years, dietary fructose consumption has increased from about 1 pound to about 90 pounds per person yearly.
Fructose comes primarily from forms of sugar derived from corn such as “high fructose corn syrup” which may be up to 90% fructose. Interestingly, excessive fructose also causes a pronounced increase in triglyceride production by the liver increasing blood triglyceride levels. It is likely that high fructose consumption is the link between gout and metabolic syndrome.
The practical approach to managing gout is to appreciate that those who suffer from it have a genetically mediated inability to handle higher amounts of uric acid. The solution is then to focus on the dietary factors that put the impaired uric acid handling mechanism under stress. This is a combination of several factors including high purine intake, but perhaps more so high sugar and particularly fructose intake. A nutritional analysis is able to examine these factors allowing the design of a corrective nutritional program. While “fixing” one dietary factor will often yield inconsistent results, a more comprehensive nutritional program that balances the unique combination of factors that drive the high uric acid production in each individual typically brings much more dramatic control.