What is Gout?
Gout is a common form of arthritis that has been recognized for centuries. Patients often will complain of experiencing recurrent episodes of pain and inflammation in a joint, particularly the large toe and usually lasts for 1-2 weeks. It is often associated with obesity and excessive alcohol consumption.
The incidence of gout seems to be increasing along with the incidence of obesity and diabetes in the U.S. Although men are affected more often than women, many women suffer from gout as well.
Pain and Inflammation
The pain of gout is due to an inflammatory reaction triggered by a buildup of uric acid in the joint. Uric acid (otherwise known as urate) is a normal waste product of protein metabolism. When concentrations of uric acid build up in the blood stream, they seep into the fluid of our joints and can trigger a painful inflammatory reaction. Why the reaction often occurs first in the joint of the large toe is generally unknown. It can also occur in the ankle initially and less commonly the knee.
The conventional approach to the treatment of gout is to provide medications that either reduce inflammation during an acute episode of pain or lower the level of uric acid in the blood. Both approaches help reduce the pain and frequency of attacks but neither addresses the underlying cause of gout.
Too Many Carbohydrates Cause Gout
For centuries, gout has been associated with obesity and overindulgence in alcohol. As I have discussed before, obesity is linked to development of insulin resistance which also causes elevated triglycerides, high blood pressure, diabetes, stroke, chronic kidney disease and heart attacks and elevated uric acid levels. The greater the degree of obesity, the more likely a person seems to be predisposed to develop gout.
Elevated insulin levels (hyperinsulinemia) are one of the hallmark signs of insulin resistance and have been shown to reduce the kidney’s ability to excrete uric acid as well as sodium (table salt) in humans. The reduction of uric acid excretion by the kidney leads to an increase of uric acid in blood stream.
Interestingly, uric acid levels seem to elevate before the onset of medical complications associated with insulin resistance (elevated triglycerides, high blood pressure, diabetes, stroke, chronic kidney disease and heart attacks). This is a tantilizing clue that at a basic level, uric acid may somehow fuel the complications of insulin resistance.
But as I discussed before in this blog, the increasing weight that leads to insulin resistance (and gout) is probably a surrogate marker for the true driving force of this disorder, carbohydrates. Weight often reflects the amount of carbohydrates consumed by an individual. The more an individual weighs, the more carbohydrates they tend to consume and visa versa.
Fructose and Gout
Fructose, an increasing common form of carbohydrate in our food supply has been shown to directly elevate uric acid in humans. Likewise, increasing or decreasing dietary fructose in a rat’s diet leads to a subsequent increase and decrease in the blood pressure, triglycerides and insulin levels respectively.
Because of this and other accumulating evidence, many scientists believe that gout is the direct consequence of excessive carbohydrate intake (fructose or otherwise) in our diet.
Reduction Gout Attacks By Reducing Carbohydrate Intake
If increased carbohydrate intake leads to more insulin resistance and insulin resistance seems to cause elevated uric acid levels and gout in patients, then does a reduction in carbohydrates seem to improve the outcome of gout? A recent study seems to suggest yes and remarkably so.
A recently performed study was conducted to evaluate the impact of a low-carbohydrate on the level of serum uric acid and the frequency of gout attacks. The study included 13 non-diabetic men who had experienced an average of 2 gouty attacks per individual over the 16 weeks preceding the diet study.
The subjects reduced their carbohydrate intake to approximately 160 grams per day. The average American male consumes between 300-350 grams of carbohydrates per day.
After 16 weeks, none of the patients had a single flair of their gout! Remember, each study subject had about 2 episodes of gout attacks in the 16 weeks before the study. Additionally, the subjects lost an average of 17 lbs as well ashad improvements of their triglyceride and cholesterol levels.
The reduction in uric acid with this mild level of carbohydrate restriction was almost 2 mg/dl. This is better that reduction seen with severe protein (low purine) diets and as good as standard medication therapy without the risks of side effects and expense of copays.
What Should My Goal Be For Carbohydrate Reduction?
Although the study mentioned above had subjects only reduce their carbohydrate intake to 160 grams per day, I recommend reducing the carbohydrates even further to help prevent or reverse the development of heart disease, diabetes and high blood pressure.
Studies have shown that reducing your daily intake of carbohydrates (sugars and starches) to 100-125 grams/day will lead to a consistent and steady reduction in blood sugar, cholesterol, triglycerides, blood pressure and uric acid levels in the vast majority of individuals.
Try to eliminate most of your carbohydrate from the least psychologically important meals of the day. For many of us, it’s breakfast and lunch. Don’t waste your carbohydrate “allowance” on fast food, sodas or a donut at breakfast.
Focus instead on eating more proteins and fats at these times and saving your carbohydrate allowance when you eat with family or friends. There is no metabolic importance to eating carbohydrates at dinner, it’s only a psychological trick that I have found has helped me as well as many of my patients.
By saving your carbohydrate allowance for this meal, the reduction in carbohydrates won’t seem so intrusive and difficult. You’ll still be able to enjoy some of your carbohydrate comfort foods and not feel as if cutting back on carbs is such a sacrifice.