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The Gout Dugout.Issue #042. Does fructose cause gout? | my gout story | will Ilaris be approved?
June 16, 2011
Hello and Welcome to the June 2011 edition of the Gout Dugout newsletter, the free gout newsletter. Only ten minutes to read, and it gives you ideas about gout you might find usable.
I'll start with a piece about fructose and gout.
DOES FRUCTOSE CAUSE GOUT?
Although there are over 165 pages currently on the website, there are still three possible causes of gout that are only mentioned in passing - kidney impairment, fructose and sleep apnea. This aching hole demands to be filled and it's on my to do list. But today I'll present the debate about fructose and gout in the Gout Dugout.
If you have never heard of this possible cause of gout before, you may be very surprised because fructose is the main sugar in most fruit, and fruit juices. After all, fruit is put on such a nutrition pedestal by governments, medical science and nutritionists. Five a day (Britain) or Strive for Five (America) or Reach For It (Canada) and all that. But what is seriously proposed, and it has been since the 1960's, is that fructose, which also constitutes half of table sugar, (sucrose)- and it's in high fructose corn syrup - is a cause of gout.
I can hear you groaning, "not another dietary restriction - not another factor to remember before something goes in my mouth." Yes, you do need to know where fructose is found, but as I'll explain later on, there is a simple solution.
Why haven't you probably heard of this from your over worked local GP (PCP)? Possibly because it hasn't yet been proven, although some of the evidence is substantial and the theory has multi study support and some heavyweight backers. To name three -the online health newsletter writer Dr.Joseph Mercola, the author of The Sugar Fix Dr. Richard Johnson, and the science journalist Gary Taubes.
Taubes wrote a fascinating draft chapter on gout that didn't make it into his excellent book "Good calories, Bad calories: Challenging the conventional wisdom on diet, weight control and disease."
These three write compellingly
about fructose causing gout. But I have read so far one academically respectable study - and it has to be said it was a research study done by employees of a major food commodity producer whose products include high fructose corn syrup - which argued that other fructose and uric acid studies of various types do NOT show that fructose causes high uric acid (hyperuricaemia).(1)
Table sugar consists of 50% fructose and 50% glucose. Some believe sugar can cause gout in more than one way. Fructose does it by raising uric acid directly and by inhibiting uric acid excretion; glucose does it when excessive carbohydrate intake (carbohydrates get broken down to glucose) leads to insulin resistance, higher insulin levels, the consequent inhibition of uric acid excretion and so finally a uric acid level rise in the blood. You know what can happen next.
So, as they would say in Singapore, what to do lah?
As I said above I am not sure the fructose proof is as clear cut as the proof about insulin resistance. But what should a gout sufferer do about this? Suppose fructose does raise uric acid?
I would suggest your action guide is not.....
"He who hesitates is lost"
"Look before you leap"
And mine is.....
"When in doubt.... avoid."
In other words, pay attention to fructose and restrict your intake.
We can't afford to wait for the years which will be necessary, to prove this fructose and uric acid connection one way or the other. After all it has been an item for 50 years already.
In the meantime, eating fructose for 10 years or more might raise your uric acid level, or keep it at gout provoking levels. Gout is too troublesome to take risks that can be avoided.
IMO, high fructose corn syrup (HFCS) - check the labels it's everywhere including colas and other soft drinks - should be completely avoided. So should table sugar, but what about fruit? Does fructose in fruit (and 100% fruit juices) have to be avoided completely? Actually no. I would say fruit is another matter. We all know it's largely healthy.
According to Dr. Mercola, 25 grams of fructose daily is safe. This amount won't raise your uric acid, but he thinks you would be wiser to limit your fructose to 15 grams from fruit and 10 grams from all the other sources. And if you have gout perhaps less, say 10 grams daily from fruit. How much fruit is that? And which ones? Fruits' sweetness is not the same. High fructose fruits include very sweet ones of course. eg. mangos and grapes.
There's no fructose, or an insignificant amount, in many vegetables, meat, dairy and fish. It's found in some root vegetables e.g. carrots. Here is a list of the amount of fructose in popular fruit to help you understand which and how much fruit you can eat. (Scroll down to the list). And whilst you're there, you might read what Dr. Joseph Mercola says, and watch the Dr.Richard Johnson video. You may have to put your email address into a box to gain access.
What's the simple solution?
I'm sure the five servings a day of fruit and veg is correct - one slice of dietary advice that governments have got right. (In some countries it's more than five). And five-a-day can be comfortably fitted into all the gout diets that best-gout-remedies.com currently thinks can help with gout - Zone, Atkins, a low calorie diet, a low purine diet, Paleo, Holford Low-GL, and the Acid-Alkaline diet.
You could experiment. Eat more fructose and test your uric acid level, or reduce fructose and test your uric acid level. If you do this, make sure your doctor is involved and also checks your uric acid.
If 15 grams of fructose a day from fruit is your fructose budget, you can still eat sufficient fruit, including sweet and sour cherries, strawberries, blueberries and other berries. Make sure your other sources of fructose - table sugar, HFCS, honey, agave, molasses (treacle), colas and other sugar or HFCS sweetened soft drinks, and fruit juices - don't exceed another 10 grams daily. Oh, and celery too. It has just 0.51 grams of fructose per 100 grams of raw celery.
A gout solution from a fructose cause?
I have recently received a well written story from a gout sufferer whose gout attack almost disappeared when she gave up fruit and all sugars. I hope to say more about this later.
There'll be much more about fructose and gout when the fructose pages go live on the website. I'll mention it in this newsletter.
Ilaris (trade/brand name), which has the extraordinary, almost unpronounceable generic name of canakinumab, comes under the gout spotlight on June 21. An Arthritis Advisory Committee (AAC) of the US FDA has been convened at an hotel in Maryland to examine its merits and safety. The committee will probably vote on whether Ilaris should be approved, and if so, for whom.
But if it votes for approval, that doesn't mean the FDA will approve it, merely that another hurdle has been crossed. The AAC committee voted overwhelmingly for Krystexxa's approval in June 2009 but a few weeks later the FDA decided against, until it was satisfied with its manufacturing and labeling. (However, a year later the FDA did approve it). Ilaris is the first of a number of new gout drugs, currently at various development stages. Ilaris's developers, Novartis, have also filed for approval in EU countries, Canada and Switzerland.
Arcalyst is a somewhat similar drug to Ilaris, but this one hasn't yet reached approval stage. Neither Ilaris nor Arcalyst get uric acid down and out. And they work completely differently to existing gout drugs. Ilaris works by inhibiting IL1-b (interleukin -1(b) to reduce the pain of gout attacks. Arcalyst (generic: rilonacept) works by inhibiting IL-1 (interleukin-1). Both are inflammatory cytokines, released by a gout flare. One day these drugs may replace colchicine. And talking of colchicine.....
Death from an overdose of colchicine isn't common but it happens. Earlier this month three elderly people in Australia were hospitalised after high dose colchicine. Sadly one died. A low dose has been found in a study to be just as effective. How much is a low dose? To treat gout attacks the U.S. FDA recommends 1.2mg followed by 0.6mg one hour later. That is enough for a day - a total of 1.8mg daily. To prevent gout attacks (prophylaxis) the recommendation is 0.6 mg once or twice a day in patients older than 16. Maximum: 1.2 mg daily.
MY GOUT STORY
This isn't my gout story (I only have excessive uric acid) but the page title of a new page on best-gout-remedies.com with which I am particularly pleased.....because it reports site visitors' personal experiences with gout.
You may be one of those who prefer to read and learn about gout though the experiences of other sufferers, and if that's so, this page is definitely for you. (New contributions will be added as they arrive). And already it seems to be popular. Visitors to the site are spending more time reading this page, than they do reading the average page.
So far there are three detailed contributions here. Two are from gout professionals - long-time sufferers who found a gout cure from diet and discovered what caused their gout. One even managed to get rid of a tophi toe with dietary measures. The third is from someone who reminds us that if you have gout-in-the-family you have to be very careful to avoid your first attack.
In the case of the two gout pros, both came eventually to learn what foods they could and couldn't eat. And it came as no surprise to me that both the professionals did not point the finger at only high or medium purine foods and beverages, but also at sugar and high carb processed foods.
In other words what has probably caused, or contributed to the cause of their gout, has been insulin resistance, not excessive purines or other causes such as kidney impairment, transplant drugs, and maybe fructose. Both M.H., and the visitor from Massachusetts, have strategies that monitor sugar and processed foods as well as purines. Can gout have two or more causes? You bet.
Confused by all the different foods people mention as gout-risky? One reason why they do mention so many that should be avoided is because gout can have different causes.
The third contributor graphically describes his initial shock and feelings from learning he
had gout, the mistakes he made, and how he has achieved some success so far with cherry extract.
"The narrative of John Smith" is the title of Sir Arthur Conan Doyle's (the author of the Sherlock Holmes stories) first novel, which has never been published. Until now that is, because its manuscript's caretakers, the British Library, plan to publish it in November this year. It is not however a finished book - it ends around chapter 6. Neither is it a Sherlock Holmes story.
The reason I'm writing about it here is that it is the story of a man who is confined to a room because of his gout. Will it be of interest to us? It is apparently a record of John Smith's musing (pondering) about life and of conversations with his visitors. So maybe not.
On the other hand, because of Conan Doyle's tremendous eye for detail, John Smith might have some useful tips for dealing with gout, and we might learn how he dealt with gout attacks, at a time (1880's/1890's) when gout in the West was even more common, and notorious, than now. And a time when uric acid was much better known than it is today.
So I'll obtain a copy and review it in December or January 2012.
In next month's issue, among other items, the gout sufferers' diet, parsley for gout, and what the AAC decided about Ilaris.
John Mepham BA.(Econ).
799, Infantry Street,
(1) Sun et al: Lack of association between dietary fructose and hyperuricemia risk in adults. Nutrition & Metabolism 2010 7:16.
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.
NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor, or other health care professional, before implementing any treatment.
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