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)
“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.”
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