April 20, 2011

The surprising cause of gout - and why your doctor won't tell you about it

Gout has made an incredible comeback in the last 10 years. It used to be that this "disease of kings" was barely known. When I mentioned gout to a patient, they would look at me like I was speaking a foreign language. But today, there are commercials on TV about gout. So what is gout, and how do you get rid of it?

Gout is a highly painful and often disabling condition. It hits when uric acid crystals form in your joints. This creates an intense immune reaction. Your white blood cells rush to the area to try to wipe out the "foreign" crystals. In so doing, it can cause a lot of damage to your joints. Uric acid crystals also can accumulate in your kidneys creating stones.

If you have gout, your doctor likely has told you to cut way back on meat and foods containing a particular chemical class called purines. Normal metabolism converts purines into uric acid. But in gout, the process accelerates. But these foods aren't all you have to worry about.

Two recent studies now link the fructose in common beverages to gout in women. The large ongoing Nurses' Health Study has found that one serving of fructose-laden soft drinks or other beverages daily increases gout risk by 74%. Two or more servings per day increases risk by 239%. Diet soft drinks did not increase the risk. But they have other problems.

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A second study confirmed the association between sugar (fructose) laden soft drinks and higher uric acid levels in both men and women.

If you have high uric acid, don't wait for your doctor to tell you to clean up your diet. He likely will never think of it. Foods rich in purines include sardines, most animal protein, spinach, beer, anchovies, organ meat, legumes, mushrooms, asparagus, and cauliflower. The average person won't have a problem with these items. However, if you have gout, it's best to avoid them. Please add sweetened processed "foods" to this list of uric acid inducing foods. Avoid these as well, particularly soft drinks.

Ref: JAMA. 2010 Nov 24;304(20):2270-8. Epub 2010 Nov 10; Arthritis Rheum. 2008 Jan 15;59(1):109-16.

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