Got Gout? It's Probably Not Caused By What You Think It Is
Read Gout: The Missing Chapter from Good Calories, Bad Calories, from fourhourworkweek.com -- posted with permission from author Gary Taubes (and a note that it hasn't been through the editing and the fact-checking of the rest of the book -- which probably means it's only five or six times more solid than the typical science book you read, instead of more.
The evidence that meat consumption causes gout? Um, well...
Because uric acid itself is a breakdown product of protein compounds known as purines - the building blocks of amino acids - and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels. A nearly vegetarian diet, for instance, is likely to drop serum uric acid levels by 10 to 15% percent compared to a typical American diet, but that's rarely sufficient to return high uric acid levels to normality, and there is little evidence that such diets reliably reduce the incidence of gouty attacks in those afflicted.(4) Thus, purine-free diets are no longer prescribed for the treatment of gout, as the gout specialist Irving Fox noted in 1984, "because of their ineffectiveness" and their "minor influence" on uric acid levels.(5) Moreover, the incident of gout in vegetarians, or mostly vegetarians, has always been significant and "much higher than is generally assumed." (One mid-century estimate, for instance, put the incidence of gout in India among "largely vegetarians and teetotalers" at 7%.)(6) Finally, there's the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.
The alternative hypothesis is suggested by the association between gout and the entire spectrum of diseases of civilization, and between hyperuricemia and the metabolic abnormalities of Syndrome X. In the past century, gout has manifested all of the now-familiar patterns, chronologically and geographically, of diseases of civilization, and so those diseases associated with western diets. European physicians in World War I, for instance, reported a reduced incidence of gout in countries undergoing food shortages.(8) In primitive populations eating traditional diets, gout was virtually unknown or at least went virtually unreported (with the conspicuous exception of Albert Schweitzer who says he saw it with surprising frequency.) The earliest documented cases reported in Asia and Africa were in the late 1940s.(9) And even in the 1960s, hospital records from Kenya and Uganda suggested an incidence of gout lower than one in a thousand among the native Africans. Nonetheless, by the late 1970s, uric acid levels in Africa were increasing with westernization and urbanization,(10) while the incidence of both hyperuricemia and gout among South Pacific islanders was reportedly sky-rocketing. By 1975, the New Zealand rheumatologist B.S. Rose, a colleague of Ian Prior's, was describing the native populations of the South Pacific as "one large gouty family."(11)
This post was inspired by my radio show with dietary researcher Dr. Jeff Volek, who touched on this as well.
The rest of Gary Taubes' Good Calories, Bad Calories. The more accessible (for people who don't read a lot of science) Why We Get Fat, also by Taubes.
Amy,
You truly are a step above everybody.
I thought of it nothing more than a casual question.
The reason the question was raised, way back in time the lame stream ran one of their prime time news magazines of several people getting ready for their high school reunions. One of the participants was doing an Atkins diet and developed gout.
I'm looking at doing a protein diet and don't want added complexities.
That you took the time to do the research impresses me. That tells me you do your best to never spew bullshit!!
Thank you very much!
Jim P. at July 3, 2012 11:26 PM
Amy Alkon
http://www.advicegoddess.com/archives/2012/07/04/got_gout_its_pr.html#comment-3252906">comment from Jim P.Thanks, Jim P. -- very sweet of you. That show with Volek spurred my interest in many areas -- this being one of them. (And frankly, Gary Taubes did all the very, very, very heavy lifting here. I just have interest and Google.)
Amy Alkon
at July 3, 2012 11:50 PM
One of my friends recently started to get gout. I showed him the Taubes article. He excluded sugar from his diet and is now gout free. You have to ask why the medical establishment gets beaten to the result by a science journalist.
Robbo at July 4, 2012 1:04 AM
Because if the medical establishment acctual cured issuse rather than medicate symptoms of those issuse they wouldnt make money.
I saw an add for some pill to 'cure' restless leg syndrom, or as people in my familly call it a nervous twitch
Issue, leg bouncing up and down occasionall while sitting or sleeping. Symptom, at worst charlie horse level of pain from muscle cramps.
Side effects include, mucsle cramps, fatigue, insomia, dry mouth, blod clots, rectal bleeding, loose stool, constipation, diarrea, incotance, blood in urine, water retention, dehydration, excessive sweating, liver failure, heart attack, stroke, and death.
lujlp at July 4, 2012 5:55 AM
Hi Amy,
You are getting such interesting people on your podcast. Thanks and keep up the good work.
I did a gout post a while back. I referenced information from Taubes, as well as people like Loren Cordain, Mark Sisson, Lustig, and Petro Dobromylskyj. Here are the conclusions I had
Conclusions:
1. The standard medical advice--stop eating purine containing foods and drinking red wine--are not well supported by research. Purine foods have only a minor impact on uric acid and red wine is part of the larger alcohol problem.
2. Sucrose and HFCS have a triple whammy effect on uric acid levels. They increase production, and inhibit excretion through both lactic acid and insulin pathways.
3. Alcohol is only a double whammy (increase production and lactic acid).
4. Strenuous exercise can inhibit excretion of uric acid via the lactic acid pathway.
5. Lack of sufficient water and nutrients can inhibit excretion of uric acid.
Here's my link.
http://www.emotionsforengineers.com/2009/09/causes-of-gout.html
Regards,
Tony
Tony K at July 4, 2012 6:39 AM
I already had gout when I went on Atkins about 10 years ago. I found that red meat plus low carb triggered gout attacks. Also, sausage which makes sense given the animal organs with purines in sausage.
In general, losing weight just makes a gout attack more likely for me. I was told by my doctor that uric acid is stored in fat. Makes sense to me. I take Allopurinol to control gout and it doesn't eliminate attacks but it does greatly reduce the frequency and severity.
Thanks for the info Amy.
Bill C at July 4, 2012 7:26 AM
@Bill C: Uric acid stored in fat? First time I've heard that. Oh, your doctor told you that.
Clue #1: The vast majority of MDs know less than nothing about nutrition or any related topic such as metabolism. Roughly speaking, MDs get all of the "information" they "know" on those subjects from pharma brochures, TV commercials, and junk-food snack-bar conversations with other MDs. I would carefully and thoroughly check any such pronouncement from an MD.
In general, if you have a broken bone or some other acute injury, an MD can usually handle that pretty well. OTOH, if you have a chronic disorder like gout (or diabetes, or IBS, or even high blood pressure), an MD is essentially clueless.
In reading through what passes for science in the field of nutrition, one thing I noticed was that once allopurinol was discovered, everybody in the field lost interest in studying the actual causes of gout (with a few exceptions ignored by the medical profession). Allopurinol is highly effective -- except for the unfortunate few folks that die from it.
I used to have gout. I don't any more, and I have been off allopurinol (and all other prescription drugs) for nearly two years. I simply quit eating the stuff that causes it. I still eat red meat, shellfish, and nuts, since those items have essentially no impact on gout one way or the other. I guess it's about time I wrote an article on my blog about that.
Losing weight will sometimes trigger an attack, but I suspect that is primarily due to things you *aren't* eating, as much as the things you are eating. And, unfortunately, once you have had an acute gout attack, you are likely to have them periodically. But I have lost over 120 lbs since my last gout attack, so the attacks are still preventable, at least for me, with diet and supplements.
One thing I have noticed about people who claim to follow an Atkins diet. Most of them know nothing about the Atkins diet because they either haven't actually read any of the books, or because they either did not understand or believe what they read. So when I hear somebody claim they are following THE Atkins diet, I usually start by asking them, "which version?" to see if they actually have a clue (there are at least 3 "versions," each of which are subtly different -- the latest book in the series, which was written after his death, has substantially more, and better, information). A very common problem with "Atkins" dieters is that they don't understand that butter is food, while margarine is not.
For the record, Atkins was a diet-guru-with-an-MD who discovered something that appears to work, and then assumed he had all of the answers to life, the universe, and everything. The only thing that distinguishes Atkins from quacks like Ornish and McDougall is that he got more of the answers right. Lots more. But not all of them. There has been some actual progress in the understanding of low-carb diet since Dr Atkins died (of a head injury). And one of Atkins early failings is that he did not distinguish between types of fat. That has since been corrected.
Howard at July 4, 2012 8:41 AM
Amy Alkon
http://www.advicegoddess.com/archives/2012/07/04/got_gout_its_pr.html#comment-3253283">comment from HowardBill, did you actually bother to go read the piece at the link? Here's more:
And Howard is exactly right about most MDs, including most shrinks. I finally truly lucked out in the shrink department -- great guy, and evidence-based. I send him thank you notes for this from time to time.
As for my internist, I consider her merely an avenue for getting tests I need and ignore her "wisdom" entirely because she is practicing based on hearsay, not evidence.
Amy Alkon
at July 4, 2012 9:02 AM
The Drinking Man's Diet
Steve Daniels at July 4, 2012 6:10 PM
A few years ago, while we were building our house, I started having gout attacks. I was puzzled by this because I'd never had gout before, there was no history of it in the family, and my diet had not changed. I followed the usual advice about diet, but to no effect.
Then, one afternoon while I was sanding some drywall joints, it occurred to me. Drywall compound is mostly calcium oxides and salts. And I was breathing in a lot of dust as I sanded. I got a good dust mask and started wearing it whenever I did anything with drywall. Presto, no more gout.
Cousin Dave at July 4, 2012 9:28 PM
Hi Amy,
You are getting such interesting people on your podcast. Thanks and keep up the good work.
I did a gout post a while back on emotions for engineers. I referenced information from Taubes, as well as people like Loren Cordain, Mark Sisson, Lustig, and Petro Dobromylskyj. Here are my conclusions:
Conclusions:
1. The standard medical advice--stop eating purine containing foods and drinking red wine--are not well supported by research. Purine foods have only a minor impact on uric acid and red wine is part of the larger alcohol problem.
2. Sucrose and HFCS have a triple whammy effect on uric acid levels. They increase production, and inhibit excretion through both lactic acid and insulin pathways.
3. Alcohol is only a double whammy (increase production and lactic acid).
4. Strenuous exercise can inhibit excretion of uric acid via the lactic acid pathway.
5. Lack of sufficient water and nutrients can inhibit excretion of uric acid.
http://www.emotionsforengineers.com/2009/09/causes-of-gout.html
Regards,
Tony
Tony K at July 5, 2012 7:03 AM
Darn it. I posted twice. A former boss of mine used to say, "Unskilled labor is a painful thing to watch," Sorry Amy. I hope your filters don't mark me as a spammer. Please feel free to "manage" the responses s you see fit.
Regards,
Tony
Tony K at July 5, 2012 7:08 AM
Darn it. I posted twice. A former boss of mine used to say, "Unskilled labor is a painful thing to watch," Sorry Amy. I hope your filters don't mark me as a purveyor of canned meat. Please feel free to "manage" the responses s you see fit.
Regards,
Tony
Tony K at July 5, 2012 7:09 AM
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