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Gouty Arthritis

By CM Monteleone, Metabolic Analytics Practitioner and World Champion Sprinter

Where to begin? Whew what a topic! As a fan of red meat, I am often asked… what about gout? After all, if you do a simple google search on foods to avoid when you have gout, red meat and seafood, two of my favorite foods, are listed. However, the situation is much more complicated than this.

Gout was first identified in ancient Egypt. I’m going to pause right here to point out that fatty liver, often associated with gout, was also first identified in ancient Egypt. This time period saw the rise of grain agriculture-especially corn and wheat. Egyptians figured out how to fatten goose livers by way of feeding them excess grains and honey. Honey is high in fructose. The combination of grains and honey to produce fatty tissue on the liver produced a delicacy for them to eat: foie gras, but by also themselves eating the same foods, we saw the beginnings of degenerative and chronic disease in these Egyptians. It might be interesting to note that later, Romans discovered that adding wine to the formula fattened livers even more!

Gouty arthritis is in the category of metabolic diseases. That means: it is preventable through metabolics: diet and exercise. It is also in the category of arthritis, particularly of the rheumatoid kind. This means: it is also a bacterial problem.

The type of bacteria that are in our microbiome are produced because of the food we eat and the type of exercise we do. Both changes how these roughly 3 pounds of tiny, busy organisms dictate what vitamins and nutrients we have. That’s right! Gut bacteria MAKE vitamins like B vitamins AND eat nutrients. For example: the pathogenic (bad) bacteria called h.pylori, which is associated with ulcers and stomach cancers, EATS iron causing an iron deficiency in its host. The mycobiome, or fungus spores that live in us are also dependent on what we eat. Yeast, for instance, loves to eat sugar and simple starches. You can see that experiment yourself by simply adding a touch of honey to some warm water with a dry yeast packet. Balance of these microbacteria dictates so much.

What I have found with my clients with gout, is that through a mitigation of remedies to address bacteria, diet and exercise, the gout disappears.

1. Avoid ALL Alcohol: it is no coincidence that fatty liver tissue is also associated with alcohol consumption. There are hundreds of studies pointing to alcohol triggering the inflammation in the joints that is gout. While one or two studies suggest that wine might be ok due to the polyphenol (antioxidant plant compound) called resveratrol, there are many more that point to ALL alcohol being bad for gout. Remember: gout is related to the bacteria in our gut and that bacteria is greatly disturbed by alcohol. Again, several studies say that NO type of alcohol is ok. Not beer, not hard cocktails: none of it. If you have gout and you don’t want it anymore, no alcohol period. Thinking of switching to non-alcoholic beer? Well, studies show all beer, even beer without alcohol contributes to gout. That is due to grains (explained below).

2. Avoid sugar –especially fructose. Uric acid is a byproduct of fructose metabolism. Sugar feeds the pathogenic bacteria in the gut that create inflammatory cytokines and that settle in the joints, inflaming the uric acid crystals (we all have them, they are just not inflamed in all of us) and flare gout. While sweetened beverages are at the top of the list, any sugar is still associated with gout and a whole host of other metabolic ailments. Avoid high fructose including sugary beverages like soda, sports drinks, and some energy drinks. Also avoid excess fruit in the way of fruit juices and smoothies and high sugar dried fruits like dates. There is a whole article on orange juice increasing the incidence of gout. I personally find it shocking that we are teaching our young kids that fruit juice is good for them. It is not good for anyone in my opinion!

Start counting your grams of sugar- is it over 15g total? You have some work to do then!

3. Know that pharmaceutical remedies like Allopurinol will make flare ups worse when you stop taking it AND have side effects. It may temporarily alleviate the pain, but until you fix the root cause, you are just asking for increased doses as the years go by.

4. Genetics: while there is an association between genetics and gout, even as far back as the 18th century, these genes can be changed by environmental factors, or epigenetics. There is a particular association with glycolysis genes. This change is made through diet and exercise and these changes can then be passed on to your kin so that they have less of a chance of developing metabolic disease. Be a great parent even before you are a parent by being in great metabolic shape!

5. Avoid grains and increase protein. This sounds like it is counter to the western medicine advice since protein does tend to increase uric acid. However, gout is not the increase in purine intake, it is the renal and digestive UNDEREXCRETION of the purines. We actually produce 2/3 of our purine internally, and don’t get much of it from external sources like red meat. I even found one study from Taiwan indicating that red meat had no effect on gout flare ups. Why is your digestive system not excreting the purines? Your liver is responsible for this task. Since we already know that fatty liver is associated with gout, we know that this buildup of fatty tissue is interfering with the liver being able to do its job. Gout is another metabolic carbohydrate disease associated with insulin sensitivity. Remember, too, that grains turn to sucrose, glucose and fructose after they are broken down in our gut. That means no corn, wheat, oats or rice. None!

6. Fruits and Vegetables? Not so fast …Vitamin C supplementation can be helpful. Above, I pointed out that orange juice was found to be terrible for gout flares due to high sugar. However, fruits high in antioxidants but low in sugar such as cherries and blueberries are beneficial because of their antioxidants. As well, several studies point to supplementation of 500mg/day or higher of vitamin c helping to prevent gout. Peppers are very high in vitamin c and contain little sugar. Excess vegetables, however, can contain pesticides which are associated with poor liver health and gout/metabolic disease. They also increase the prevotella bacteria.

Resveratrol is a very effective polyphenol. It is an antioxidant plant compound found in the skins of blueberries. Even better than just eating blueberries, supplementation of resveratrol greatly decreased gout flare ups and has been shown to be beneficial to gut bacteria.

7. Electrolytes and nutrients . Addition of potassium, magnesium and zinc help control gout. Make sure zinc is properly balanced with copper (like ATP Synerzinc or red meat!). In addition iron (also found in red meat!) had a positive effect on stopping chronic gout.

8. Gut health is of great importance when attempting to mitigate a metabolic disease like gout. Grains and sugar rip the mucosal lining of the gut and create an inflammatory environment. Healing the gut with glutamine and glycine (Glutamed by ATP is my favorite) and eliminating these foods from the diet can be the biggest step in getting rid of gout. Avoid processed foods. I think it’s interesting that fat free dairy helped control gout. I believe this is due to a change in bacteria in the gut. Usually I am not a big fan of dairy because it can be very inflammatory, however including a fat free yogurt into daily diet for 3-6 months while also eliminating grains, sugars and alcohol can help transition an individual into a better environment to control gout. This is due to the bacteria Lactobacillus, found in fermented foods like pickles, kimchee and yogurt helping to take up space so that pathogenic bacteria don’t have as much room to thrive.

Better yet is the addition of probiotics. One probiotic after eating as well as 2 before bed have helped rebuild a strong gut bacteria balance. Some with gut conditions like SIBO cannot tolerate any fermented foods or probiotics so they should not incorporate those. Another protocol would be given.

Prevotella copri, the bacteria that comes from eating a vegan/vegetarian diet and a diet high in fiber is not only associated with gout but also rheumatoid arthritis in general. A specific study points to Prevotella intermedia and gout. Excess grains, sugar and fiber as well as endurance training changes the gut microbiota. The best way to get back in balance is to stick with high intensity training, a high protein,low carb, high good fat diet. High good fat means eliminating inflammatory omega-6 oils like soybean, corn, peanut and canola oil in favor of omega 3 fatty acids, (fish oil), avocado, coconut and olive oils.

It is also important to note here that NSAIDS like ibuprofen are terrible for your gut and should not be used as an anti-inflammatory.

9. Coffee and green or black tea contain phenolic compounds that may decrease flares of gout. As well since they are diuretic they help the excretion of uric acid. Caffeine was not shown to be a factor in this-it was strictly based on the beneficial plant antioxidants.

10. Berberine and Other Chinese medicines. Eastern medicine has a great way of getting to the bottom of what the ailment is, rather than just attempting to fix the pain. Berberine is a compound from the barks of trees that is shown to decrease blood sugar in the same way metformin does for diabetics. Berberine also kills pathogenic bacteria associated with metabolic disease. It must be started slowly and titrated up. Always work with a practitioner when dosing eastern medicines.

As well as berberine, there are dozens of TCM (Traditional Chinese Medicine) plants that can decrease gout flares. Among these are the seeds of yellow dragon fruit! A complete list is found in the references.

I hope this helps someone out there understand gout a little bit better. There is no negotiation within this list. That means, not a little alcohol sometimes, not a few grains here and there. That means NO sugar, grains or alcohol. That means adding anti-inflammatory elements like antioxidants and omega 3 fish oil. That means controlling blood sugar, getting exercise and asking yourself: What is most important to me? The answer should be: your health and happiness.

Gout References

Nutritional therapy https://pubmed.ncbi.nlm.nih.gov/27008448/

Non-Pharmacological approaches https://pubmed.ncbi.nlm.nih.gov/29272507/

Alcohol https://pubmed.ncbi.nlm.nih.gov/23881436/

Overview/Pesticides https://pubmed.ncbi.nlm.nih.gov/32774692/

Risk Factors/alcohol https://pubmed.ncbi.nlm.nih.gov/21285714/

Role of Alcohol https://pubmed.ncbi.nlm.nih.gov/33866874/

Alcohol triggers 24hr after https://pubmed.ncbi.nlm.nih.gov/16945617/

Dietary suggestions https://pubmed.ncbi.nlm.nih.gov/30202351/

Alcohol, gout and genes https://pubmed.ncbi.nlm.nih.gov/24532835/

Types of alcohol and gout: beer for men, liquor for women https://pubmed.ncbi.nlm.nih.gov/20525839/

Beer (with or without alcohol) in Fig 2 https://academic.oup.com/rheumatology/article/58/1/27/4934129