Gout

Overview

Gout is a painful condition and many women have even claimed it is more painful than child birth. The most often quoted reason for someone suffering with gout is that, quite simply, the person has high levels of uric acid. As a qualified phlebotomist I've seen possibly over 1,000 patient blood test lab results and some people have high levels of uric acid but have no gout. Whereas some patients who have terrible gout problems had normal uric acid levels. So it can not be that simple.

Joint fluid from gout and non-gout sufferers will have some uric acid crystals in there. If it was uric acid, or more precisely urate crystals, that CAUSED gout surely all patients with urate crystals in their joints would suffer from gout but they don't.

References for later perusal

Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study

Urate crystals in asymptomatic metatarsophalangeal joints

Common advice is to avoid high purine foods because purines break down to uric acid but purines are made endogenously by the body. In fact to a level many times higher than you possibly manage to consume in your diet. If purines are so bad for human health why does the body make so much? The body breakdown of ATP creates some purine, even DNA breakdown will result in some purines.

Even the proximal convoluted tubules of the kidney excretes purines but then reabsorbs over 50 percent of it. Why would it do that if it were harmful? Seems like the body wants to hold onto uric acid.

Regulation of uric acid metabolism and excretion

Uric Acid Lowers With Protein Consumption

If you remove protein from your diet you will be increasing other macros. So you'll either need to consume more fat or additional carbohydrates. Incidence of gout is associated with higher levels of insulin, or more precisely insulin resistance. One study that looked at different diets found the Atkins diet, high in protein, actually lowered serum uric acid compared to low-fat diets and high carb diets.

High-Protein Diet (Atkins Diet) and Uric Acid Response

The 16 patients on the high protein Atkins style diet saw that over a 6th month period gout flare ups reduced and they had other additional benefits, such as an improved lipid profile. There were 74 people in the study in total with a mean age of 51 and a BMI of 31. The high protein group also lost weight and saw lower levels of fasting insulin.

The authors of the study said

"Conclusion: Our findings suggest that the Atkins diet (i.e., a high protein diet without calorie restriction) can reduce SUA levels despite substantial purine loading. This effect may be more pronounced and clinically meaningful among those with hyperuricemia or obesity. Comparative effectiveness research with other proven CV-metabolic diets would help determine the optimal dietary approach to lower SUA levels."

Summary

The studies suggest that despite a non-calorie restricted high purine loading diet (eating lots of protein) serum uric acid levels did not rise.

Possible Causes Of Gout?

It seems that high insulin levels may be one of the things in play.

The kidneys have the job of recycling uric acid and sodium, they are genetically programmed to do this. High insulin leads to water retention which in turn results in dysregulation of sodium and uric acid levels.

Uric acid is required as an antioxidant. So you do need the right amount. On a meat heavy diet you do get another antioxidant to assist uric acid perform the antioxidant role. This is from vitamin C, which you can obtain from organ meats and even muscle meat. Vitamin C is another antioxidant and if your GLUT 4 transporters are in good shape you'll take in enough vitamin C. If you take vitamin C as a supplement you may overload the system and the body will see it at a toxic level and try to excrete it by generating oxalate.

Quick studies for other issues you may have heard about.

Fructose is an issue not purines.

https://pubmed.ncbi.nlm.nih.gov/27697882/

Fruit can contribute to gout

https://pubmed.ncbi.nlm.nih.gov/31004140/

Alcohol can contribute to gout

https://pubmed.ncbi.nlm.nih.gov/8976122/

Strangely coffee seems to be protective in some people

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/

The main study quoted:

The study results had significant statistical difference and the 'p value' suggests there's a one in one-thousand chance of being wrong