Ever had gout or known someone that did? Ever heard the line about excess purines being the cause? Consider this:
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.
http://www.fourhourworkweek.com/blog/2009/10/05/gout/
That's right - eating foods with less purine content does not help with gout. How can that be true, you may wonder. The answer is that eating foods lower in purine content does not reduce the intake of purines enough to matter; even vegetarians can have relatively high rates of gout. What matters is why your body stops clearing the purine fueled uric acid, which, at high blood concentrations, results in accumulation of destructive crystals in (most commonly) the joints.
About that, Taubes comments:
... 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 other words, there's really no reason to think that gout is "caused" by anything other than what causes all of the clusters of diseases known as the diseases of civilization. In fact, the treatment that works best for gout is carbohydrate restriction, generally, with particular attention paid to fructose consumption.
Uric acid is cleared from the body via the kidney, but with the metabolic derrangement that results from high carbohydrate diets, the kidney becomes overloaded and uric acid clearance becomes secondary.
... a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)
Second, fructose directly raises uric acid levels.
Third, fructose, which is broken down in the liver in a manner similar to that of alcohol, can over task the liver and contribute to accelerated insulin resistance, which exacerbates all of the symptoms of metabolic syndrome.
In other words, just like statins and blood pressure medications treat symptoms of metabolic syndrome, but don't cure it, gout medications treat the symptoms of gout but don't deal with the cause.
I recommend you read the article linked above, but for treatment, all you need do is eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar or wheat as you pursue vigorous health vice relief of symptoms.
I'll include more on why fructose consumption should be moderate in following posts.
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.
http://www.fourhourworkweek.com/blog/2009/10/05/gout/
That's right - eating foods with less purine content does not help with gout. How can that be true, you may wonder. The answer is that eating foods lower in purine content does not reduce the intake of purines enough to matter; even vegetarians can have relatively high rates of gout. What matters is why your body stops clearing the purine fueled uric acid, which, at high blood concentrations, results in accumulation of destructive crystals in (most commonly) the joints.
About that, Taubes comments:
... 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 other words, there's really no reason to think that gout is "caused" by anything other than what causes all of the clusters of diseases known as the diseases of civilization. In fact, the treatment that works best for gout is carbohydrate restriction, generally, with particular attention paid to fructose consumption.
Uric acid is cleared from the body via the kidney, but with the metabolic derrangement that results from high carbohydrate diets, the kidney becomes overloaded and uric acid clearance becomes secondary.
... a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)
Second, fructose directly raises uric acid levels.
Third, fructose, which is broken down in the liver in a manner similar to that of alcohol, can over task the liver and contribute to accelerated insulin resistance, which exacerbates all of the symptoms of metabolic syndrome.
In other words, just like statins and blood pressure medications treat symptoms of metabolic syndrome, but don't cure it, gout medications treat the symptoms of gout but don't deal with the cause.
I recommend you read the article linked above, but for treatment, all you need do is eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar or wheat as you pursue vigorous health vice relief of symptoms.
I'll include more on why fructose consumption should be moderate in following posts.
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