Gout is a type of arthritis that starts suddenly causes pain and swelling in joints. The pain (known as flares) can last for days or even weeks and then have periods of remission for weeks, months or years. Gout flares often begin in a single joint, typically in the big toe or a lower limb. [i]
Gout appeared in medical records very early in medical writing history - depicted as the fate of a life of affluence:
High levels of uric acid cause gout flares. Uric acid is a by-product of purine metabolism. Foods that have shown to produce high levels of purines are as follows; [ii]
Alcoholic beverages (all types)
Some fish, seafood including shellfish, anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock
Some meats, such as bacon, turkey, veal, venison and organ meats like liver
Meats, such as beef, chicken, duck, pork and ham
High intake of fructose increases serum urate levels [iii]
Vegetable purine-rich foods do not have any risk of increasing gout symptoms [iv]
* Lentils, mushrooms, legumes
* Dairy products.
* Olive oil
* Vitamin C increases renal excretion of uric acid and is used as a supplement during gout management
Gout results from uric acid in joints, which triggers the intracellular sensor (NLRP3) that signals danger and irritants resulting in an inflammatory response [v]
How do we balance the levels of uric acid in the system is by balancing the macronutrients?
The nutrients are fat, carbohydrate, protein and ketones.
Carbohydrate (glucose) mainly a fuel with very little going to structural functions (rebuilding damaged cells)
Fat is only a fuel source; ketones are both fuel and structural.
Protein is structural, with fuel being a last resort.
Gout is a product of a malfunctioning metabolic system. The body uses protein as a significant fuel source over glucose and fat—producing large quantities of Oxaloacetate, which combines with aspartate increasing uric acid.
High uric acid levels have been associated with other health conditions, including hypertension, type 2 Diabetes Mellitus, cardiovascular disease and fatty liver disease. But on the flip side, uric acid is a potent antioxidant and is found to be neuroprotective and an association between low levels and multiple sclerosis, Alzheimer's and Huntington's disease [vi]
By implementing a diet high in fat, moderate protein and low carbohydrate (glucose), we can put gout into remission, improve other health markers preventing the onset of chronic disease.
[i]Gout Symptoms, Causes & Diet Recommendations | NIAMS. (n.d.). Retrieved March 1, 2021, from https://www.niams.nih.gov/health-topics/gout [ii]Gout Symptoms, Causes & Diet Recommendations | NIAMS. (n.d.). Retrieved March 1, 2021, from https://www.niams.nih.gov/health-topics/gout [iii] Gustafsson, D., & Unwin, R. (2013). The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality. In BMC Nephrology (Vol. 14, Issue 1, p. 164). BioMed Central. https://doi.org/10.1186/1471-2369-14-164 [iv] Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective – A review. In Journal of Advanced Research (Vol. 8, Issue 5, pp. 495–511). Elsevier B.V. https://doi.org/10.1016/j.jare.2017.04.008 [v] Swanson, K. V., Deng, M., & Ting, J. P. Y. (2019). The NLRP3 inflammasome: molecular activation and regulation to therapeutics. In Nature Reviews Immunology (Vol. 19, Issue 8, pp. 477–489). Nature Publishing Group. https://doi.org/10.1038/s41577-019-0165-0 [vi] Gustafsson, D., & Unwin, R. (2013). The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality. In BMC Nephrology (Vol. 14, Issue 1, p. 164). BioMed Central. https://doi.org/10.1186/1471-2369-14-164