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Fructose Intake Associated With an Increased Risk for Gout

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Gout is a significant problem in New Zealand especially amongst the indigenous Maori population. This article explains there is a distinct link in studies between Fructose and increased uric acid and gout.

Gout is also connected with metabolic syndrome, sleep apnea, and taking statin medication. And interestingly besides treating these issues, coffee consumption has been shown to decrease gout. (links at end of article)

Fructose Intake Associated With an Increased Risk for Gout

“November 16, 2010 (Atlanta, Georgia) — Consuming sugar-sweetened sodas, orange juice, and fructose is associated with an increased risk for incident gout, according to new research findings from the Nurses’ Health Study.

Hyon K. Choi, MD, DrPH, from Boston University School of Medicine, Massachusetts, presented the findings here at the American College of Rheumatology 2010 Annual Meeting. The results were also published online November 10 in the Journal of the American Medical Association.

The main message, said Dr. Choi, is that “if your patient has hyperuricemia, or gout, and if they are consuming sugary beverages, particularly containing fructose (i.e., sugar, not artificial sweeteners), then I would recommend them stopping or at least reducing their intake,” Dr. Choi told Medscape Medical News.

Dr. Choi and colleagues analyzed data from the Nurses’ Health Study, an American prospective cohort study spanning 22 years, from 1984 to 2006. Women with no history of gout at baseline (n = 78,906) provided information about their intake of beverages and fructose by filling out validated food frequency questionnaires.

Over the course of the study, 778 incident cases of gout were reported. Compared with the consumption of less than 1 serving per month of sugar-sweetened soda, the consumption of 1 serving per day was associated with a 1.74-fold increased risk for gout, and the consumption of 2 or more servings per day was associated with a 2.39-fold increased risk (P < .001 for trend).

Consumption of orange juice was associated with a 1.41-fold and 2.42-fold increased risk for 1 and 2 servings per day, respectively (P = .02 for trend).

For 1 and 2 servings of sugar-sweetened soda, the absolute risk differences were 36 and 68 cases per 100,000 person-years, respectively; for 1 and 2 servings of orange juice, the absolute risk differences were 14 and 47 cases per 100,000 person-years, respectively.

The consumption of diet soft drinks was not associated with the risk for gout (P = .27 for trend).

Compared with the lowest quintile of fructose intake, the multivariate relative risk for gout in the top quintile was 1.62 (95% confidence interval, 1.20 – 2.19; P = .004 for trend), indicating a risk difference of 28 cases per 100,000 person-years.

According to Dr. Choi, the mechanism of fructose and its effect on the pathology of gout is well understood.

“Administration of fructose to human subjects results in a rapid increase in serum uric acid and increased purine synthesis,” he explained. “In addition, this effect is more pronounced in individuals with hyperuricemia or a history of gout.”

In the published paper, the authors point out that because “fructose intake is associated with increased serum insulin levels, insulin resistance, and increased adiposity, the overall negative health effect of fructose is expected to be larger in women with a history of gout, 70% of whom have metabolic syndrome.”

According to independent commentator George Bray, MD, from the Pennington Biomedical Research Center in Baton Rouge, Louisiana, this is another “nail in the coffin for the overuse of fructose-containing beverages.”

“In a previous report, gout in men was associated with a higher intake of fructose (either sugar or high-fructose corn syrup from beverages),” he told Medscape Medical News. “This paper extends this using the Nurses’ Health Study to show that the higher intake of fructose (soft drinks and juices) is associated with an increased risk of gout in women.”

Dr. Bray added that it would be a good idea to include the fructose content of foods and beverages on the label for the public’s information.

The study was not commercially funded. Dr. Choi reports receiving research grants and consulting fees from Takeda Pharmaceuticals North America. Dr. Bray has disclosed no relevant financial relationships.

JAMA. Published online November 10, 2010. Abstract

ACR 2010 Annual Meeting: Abstract L5. Presented November 10, 2010.”

Also read this study:
Soft Drinks, Fructose Consumption, and the Risk of Gout in Men: Prospective Cohort Study: Ranked “Changes Clinical Practice” by F1000

Hyon K. Choi; Gary Curhan

Where is fructose found?
It is mainly in fruit, high fructose corn syrup, agave syrup, and table sugar.

Here is a table of contents of fructose in fruit from The Paleo diet website.

Root vegetables are a good exchange for fruit as the type of sugar they digest to is glucose rather than fructose.

Statins and gout
A few months back I talked to a friend whose gout had flared using statin drugs prescribed to lower his cholesterol. I is listed as one of the 25 most common symptoms of Statins

This study too: Sleep Apnea as a Cause of Gout Flares

And coffee just might help: Drinking 4 or More Cups of Coffee a Day May Help Prevent Gout

And not to neglect treating metabolic syndrome which is linked with gout:
Hyperuricemia, Gout, and the Metabolic Syndrome
And the best way to treat metabolic syndrome – without doubt the paleolithic diet

5 COMMENTS

  1. I had my first gout attack about 10 years ago.
    At the beginning I was having attacks every 6 months. Then gradually I was getting them
    every 3 months, then every month and eventually every week.
    It started at my big toe and then it was moving sometimes in my knees,and generally all
    around my joints, in my feet.And the pain was agonising.
    I have tried all the cures you can imagine.I tried ACV, lemons, drinking a lot of water, but
    to no avail.I tried water fasting, juice fasting,baking soda, again without success.
    I almost gave up meat, limiting it to only once a week ,gave up alcohol completely,again
    no success.
    I was living on vegetables, lots and lots of fresh fruit, milk ,cheese beans and so on .My
    eating habits could not be healthier ,or so I thought.But my gout was worsening.
    Then I decided to increase the amount of fruit I was consuming, thinking that if some fruit
    is healthy, more fruit will be more healthy.Some days I was eating fruit only ,others over 10
    portions a day.
    And alas my gout instead of improving it became chronic.
    I was desperate I did not know what to do.
    And then one day accidentally I read an article about fructose,which is contained in fruit in
    large quantities.It said that it increases uric acid, in a matter of minutes.
    Fructose is also present in table sugar, and in HFCS, which is used in soft drinks.
    I put two and two together and realised what I was doing wrong.
    I stopped eating fruit and all other sugars, for a period of 3 weeks,and by magic I saw a
    dramatic improvement.Pain was gone, swelling was gone, I was fine.
    I re introduced fruit again in my diet but reducing them to 1 or 2 a day, and my gout completely
    disappeared.
    I do eat more meat now, and occasionally have an alcoholic drink, and thank God everything
    seems to be fine.
    Fructose was my enemy.

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