Fructose Causes Gout in Women

November 11, 2010

Fructose Causes Gout in Women 

 Competency:  SugarReference:  JAMA Online.  To be published Nov 27, 2010 

 Something funny has happened to American women over the last thirty years.  We have seen an epidemic of gout in women.  This article parses that out.  The incidence has gone from 16 cases per thousand to 46.  That’s a tripling .  Goodness.  And what did they find as the cause?   They compared data from the Nurses Health study looking at the consumption of sugared sodas and other sources of fructose.  

What they found was that women who drank one serving of sugared soda or less per month were some 74% less likely to get gout that those who drank one serving every day.   But those who drank two servings or more per day had a 240% increased risk of gout.  Same data with orange juice.    Two or more servings per day bump your risk of gout up 240%.  Orange juice, the sacred cow of breakfast!  Causes gout? What is gout?  It’s a painful arthritis, usually of the big toe.  It hurts a lot.  Folks describe being unable to put a sheet on their throbbing toe.    It will last for a couple of days, then fade away, if you don’t eat any more sugar, which you are likely not to do because you are in so much pain.   

We can help it medically by giving anti-inflammatory drugs or drugs that lower your uric acid.  We have also known for quite some time that there is a strong risk association with uric acid elevation, gout and coronary artery disease. How does that happen?   Here is the skinny.  We now know it down to the molecule.  When you drink fructose, your body can digest it only in your liver.  You absorb and digest glucose everywhere, but not fructose.  Our bodies were not designed to get a big boost of fructose all at once.  The fructose exhausts our liver cells, draining all their ATP, our energy molecule, into ADP, which then breaks down into uric acid.  

We do know from other research that a large “Big Gulp” of sugared soda, a supersized dose at a fast food place, will raise your uric acid some 2-3 points in just an hour.  Uric acid in your blood is what causes painful gout in your joints.  Along with that comes fatty liver because our livers don’t have any energy left over.  Your blood fats go up, your serum uric acid goes up, your liver fats go up.  Uric acid gobbles up nitric oxide.  Arteries get "endothelial dysfunction".   The LDLs start making deposits in your arteries.  The uric acid starts depositing in your joints, and we call that gout..   There it is. Now we have the evidence.  

Fructose causes gout. Gout is strongly associated with coronary artery disease because it comes along with all the LDLs in your blood.  What is so confounding is that fructose from any source can do it.  It doesn’t just have to be from sugared sodas.  Even orange juice will do it. 

 WWW. What will work for me?   Does that mean we should avoid fruit?  Well, if you are on a diet of only fruit, your LDLs will go up a bit, but because you have the fiber in whole fruits, the rate of absorption of fructose is much slower.  It’s the juice that concentrates the sugar and a liquid drink delivers the absorbable fructose rapidly to your stomach.   The simple formula for liquid calories is that the calories you drink are  the calories you store.  Now we also know that if those calories come from fructose you might get gout.  Stick with the whole fruit.

Column written by John E. Whitcomb, MD, Brookfield Longevity, Brookfield, WI. 262-784-5300