You wake up one morning with your toe in terrible pain and soon realize you may be suffering from a gout attack, a painful type of inflammatory arthritis that generally attacks the big toe. You may not realize you are not alone since gout has been a medical issue since 400 BC when Hippocrates, a well-known physician, attempted to describe and treat gout.
You call your doctor and he tells you to go on a low purine diet but over the course of a few months and several more gout attacks you realize there may be more to the story.
Research is now linking high uric acid levels to intake of fructose. Since gout is associated with high uric acid levels can this be an important connection?
Really? Can fructose really be related to increasing incidence of gout?
Research shows more than a few studies make this connection.
High fructose corn syrup (HFCS) was introduced in the early 70’s, as sugar was an expensive sweetener. Although it is only slightly different chemically than sugar it is now used as a sweetener in most foods thereby dramatically increasing fructose consumption in the US.
What are other main sources of fructose?
Agave has been touted as healthy sweetener but it contains almost double the fructose of HFCS. In addition, although we think of fruit as healthy if eaten in large quantities it can contribute to high fructose consumption. Fruit juice is also a significant source of fructose.
In fact, for those with insulin resistance and metabolic syndrome (which is highly correlated with gout) consuming more than 25 grams of fructose can dramatically increase uric acid levels above the normal level of 4.0.
So what is the take home message?
- Read all labels and avoid products with HFCS, Agave or fructose.
- Avoid all juices and limit your intake of fruit, especially those that contain large amounts of fructose (see this list for amounts).
- Make sure to consume a balanced diet with adequate protein, limited carbohydrates mostly from veggies and salad to assist with lowering insulin resistance. Other recommendations can be found here.
If you have frequent gout attacks this is one nutrient you may have ignored which needing addressing. In this case, the result of fructose from all fructose-containing foods may not be so sweet.