Gout Pal Interactive

Thanks for bringing this one up, Dkr. You've reminded me that an article on fructose is long overdue.

The study that you refer to, was first published in the British Medical Journal (BMJ). When I first saw it, I took it at face value. If you search GoutPal for fructose, using the Gout Search box on the right, you will see that I have warned against excessive fructose on several pages.

However, after looking at some recent responses to the gout and fructose study, I am less sure.

There are strong indications that the science is flawed in this study. Soft drink additives and salt have been suggested as possible explanations for increases in gout that were not ruled out in the study. One respondent also claims that the increases are not significant, and are within the bounds of general population differences in the incidence of gout.

This all makes the view of fructose and gout very confusing.

I return to my standard advice of “Do what is right for you”

The study referred to is a statistical study. You are not a statistic.

A healthy, well balanced diet is important, and an excess of almost any nutrient might trigger gout in some individuals. Remember, we are dealing with a very complicated metabolic imbalance, where excesses or shortages in one aspect of diet can work in different ways to raise or lower uric acid.

The only true way to know how different things affect your gout, is to monitor your uric acid levels. Beware though, that in practice it can still be difficult to identify the exact cause of uric acid changes as there as so many variables (exercise level, hydration, food combinations, stress levels etc) that can affect your results.

Fruit has many good benefits and should be part of the diet.   Consume it in a form that requires that it be digested.   The goal should be to keep the level of fructose, where it is processed, to a low level.  

The problem with fruit sugar, fructose, is that it must be processed entirely in the liver using its resources, chief of which is the molecule ATP.   ATP is the energy source for everything the liver does.   The liver does plenty of other functions besides fructose processing.   It is central to the salvage/disposal process of existing purines and the creatiion of new purines from scratch.    These processes create uric acid.   The net result is that fructose does increase the serum uric acid levels.

The fructose can't be used directly by the tissues of the body.    It must be converted to glucose by the liver before cells can take it in and use the glucose for energy or alternatively be converted to fat (including fat in the liver).    This taxes the liver's resources so that other processes are interrupted.   The more fructose, the more overwhelmed and exhausted the liver becomes.  (Animal studies have shown that too high a percentage of fructose in the diet over time can cause all kinds of harm including liver cirrhosis.)

The design of our livers reflects the diet and lifestyle of earlier mankind.   Fruit was taken whole and only at certain seasons.   Since fruit was eaten whole, the fruit had to be digested before the fructose became available.    The fructose went to the liver as a manageable stream as it was digested.   The liver wasn't overwhelmed as it is today.   If there was any damage, the liver could recover over the winter months (the liver is one of the few organs that can regenerate).   Any fat build-up in the liver was used up during the winter when food was scarcer and calories had to be spent to keep up body temperature.

Advances in agriculture and food processing has made vast quantites of fructose available year round.   Fruits have gotten larger and sweeter.  Canning, freezing, bottling, and year-round importation make whole fruits available year-round.   Table sugar, which is half fructose, increased the flow of fructose to the liver.   Now there is high fructose corn syrup(HCFS) which makes the fructose available faster still.   The only way faster would be to intravenously feed it to the liver which is about what HCFS does.  

The point is that, if you suffer from gout, you need your liver to be fat-free and able to use its resources on the functions dealing with purines.   By all means, eat fruit but in some form requiring digestion.   If at possible, drink diet sodas and avoid drinks with a lot of sugar or HCFS.

Sorry for the rant - Brian