Gout
The disease of kings. Gout is caused by uric acid crystals depositing in joints, triggering intense inflammatory attacks. Once associated with rich diets and alcohol, we now understand fructose, insulin resistance, and kidney function play major roles. Acute attacks are among the most painful conditions known.
The Uric Acid Pathway
Why Uric Acid Rises
Overproduction
- Fructose: Metabolizes to uric acid
- High-purine foods: Organ meats, shellfish
- Cell turnover: Cancer, psoriasis
- Genetic: Some produce more
Under-Excretion
- Kidney dysfunction: Can't clear enough
- Insulin resistance: Blocks kidney excretion
- Dehydration: Concentrates uric acid
- Medications: Diuretics, aspirin
Attack Triggers
Alcohol
Beer worst (purines + alcohol). Increases production, decreases excretion.
Fructose/Sugar
Soda, fruit juice, high-fructose corn syrup. Rapidly raises uric acid.
Dehydration
Concentrates uric acid. Common trigger. Stay well hydrated.
Rich Foods
Red meat, shellfish, organ meats. Classic triggers. Moderation key.
Sudden Diet Changes
Fasting, crash diets can trigger. Cell breakdown releases purines.
Stress/Injury
Surgery, illness, trauma. Catabolism releases purines from cells.
Management Approaches
Eliminate Fructose
Cut soda, juice, high-fructose corn syrup. Major driver of modern gout.
Cherries
Tart cherry juice lowers uric acid. Studies show fewer attacks.
Hydration
2-3 liters daily. Helps kidneys excrete uric acid. Simple and effective.
Vitamin C
500-1500mg daily lowers uric acid. Increases kidney excretion.
Address Insulin Resistance
Low-carb diet, weight loss. Improves kidney uric acid clearance.
Limit Alcohol
Especially beer. Wine less problematic. Complete avoidance during attacks.