Download Too Many Carbohydrates Cause Gout For centuries, gout has been

Too Many Carbohydrates Cause Gout
For centuries, gout has been associated with obesity and overindulgence in alcohol. As I have
discussed before, obesity is linked to development of insulin resistance which also causes elevated
triglycerides, high blood pressure, diabetes, stroke, chronic kidney disease and heart attacks and
elevated uric acid levels. The greater the degree of obesity, the more likely a person seems to be
predisposed to develop gout.
Elevated insulin levels (hyperinsulinemia) are one of the hallmark signs of insulin resistance and have
been shown to reduce the kidney’s ability to excrete uric acid as well as sodium (table salt) in
humans. The reduction of uric acid excretion by the kidney leads to an increase of uric acid in blood
stream.
Interestingly, uric acid levels seem to elevate before the onset of medical complications associated
with insulin resistance (elevated triglycerides, high blood pressure, diabetes, stroke, chronic kidney
disease and heart attacks). This is a tantilizing clue that at a basic level, uric acid may somehow fuel
the complications of insulin resistance.
But as I discussed before in this blog, the increasing weight that leads to insulin resistance (and gout)
is probably a surrogate marker for the true driving force of this disorder, carbohydrates. Weight
often reflects the amount of carbohydrates consumed by an individual. The more an individual
weighs, the more carbohydrates they tend to consume and visa versa.
Fructose and Gout
Fructose, an increasing common form of carbohydrate in our food supply has been shown to directly
elevate uric acid in humans. Likewise, increasing or decreasing dietary fructose in a rat’s diet leads
to a subsequent increase and decrease in the blood pressure, triglycerides and insulin levels
respectively.
Because of this and other accumulating evidence, many scientists believe that gout is the direct
consequence of excessive carbohydrate intake (fructose or otherwise) in our diet.
Reduction Gout Attacks By Reducing Carbohydrate Intake
If increased carbohydrate intake leads to more insulin resistance and insulin resistance seems to
cause elevated uric acid levels and gout in patients, then does a reduction in carbohydrates seem to
improve the outcome of gout? A recent study seems to suggest yes and remarkably so.
A recently performed study was conducted to evaluate the impact of a low-carbohydrate on the
level of serum uric acid and the frequency of gout attacks. The study included 13 non-diabetic men
who had experienced an average of 2 gouty attacks per individual over the 16 weeks preceding the
diet study.
The subjects reduced their carbohydrate intake to approximately 160 grams per day. The average
American male consumes between 300-350 grams of carbohydrates per day.
After 16 weeks, none of the patients had a single flair of their gout! Remember, each study subject
had about 2 episodes of gout attacks in the 16 weeks before the study. Additionally, the subjects
lost an average of 17 lbs as well ashad improvements of their triglyceride and cholesterol levels.
The reduction in uric acid with this mild level of carbohydrate restriction was almost 2 mg/dl. This is
better that reduction seen with severe protein (low purine) diets and as good as standard
medication therapy without the risks of side effects and expense of copays.
What Should My Goal Be For Carbohydrate Reduction?
Although the study mentioned above had subjects only reduce their carbohydrate intake to 160
grams per day, I recommend reducing the carbohydrates even further to help prevent or reverse the
development of heart disease, diabetes and high blood pressure.
Studies have shown that reducing your daily intake of carbohydrates (sugars and starches) to 100125 grams/day will lead to a consistent and steady reduction in blood sugar, cholesterol,
triglycerides, blood pressure and uric acid levels in the vast majority of individuals.
Try to eliminate most of your carbohydrate from the least psychologically important meals of the
day. For many of us, it’s breakfast and lunch. Don’t waste your carbohydrate “allowance” on fast
food, sodas or a donut at breakfast.
Focus instead on eating more proteins and fats at these times and saving your carbohydrate
allowance when you eat with family or friends. There is no metabolic importance to eating
carbohydrates at dinner, it’s only a psychological trick that I have found has helped me as well as
many of my patients.
By saving your carbohydrate allowance for this meal, the reduction in carbohydrates won’t seem so
intrusive and difficult. You’ll still be able to enjoy some of your carbohydrate comfort foods and not
feel as if cutting back on carbs is such a sacrifice.