This page on fructose and gout was last reviewed, or updated, on 4 March 2015.
THIS IS THE FIRST OF THREE PAGES ABOUT FRUCTOSE AND ITS ASSOCIATION WITH GOUT. THERE ARE LINKS TO THE SECOND AND THIRD AT THE BOTTOM OF THIS ARTICLE.
WHAT IS FRUCTOSE AND WHERE IS IT FOUND?
Fructose, (aka levulose) a carbohydrate, is a leading sugar (sugars are also carbohydrate) in fruit and fruit juice and is the pre-dominant sugar in some fruit. It also forms half of a molecule of white table sugar (sucrose).The other half of the sucrose molecule is glucose. (Brown sugar is mainly sucrose, so it has almost a 50/50 glucose-fructose split).
Glucose and fructose are conjoined in sugar, but fructose is metabolized differently to glucose (mainly in the liver).
Fructose seems an unlikely candidate for a cause of gout. It is not one of the causes of gout in the public mind. The public thinks of alcohol and purines, but experienced gout sufferers often come to suspect a sugar, and then avoid sugars. Sugar can also lead to gout via the insulin resistance route.
Other sources of fructose
If you monitor your fructose intake you’ll need to have an understanding of its amounts in foods and beverages.
Fructose is also found in veggies, especially root vegetables such as carrots, but in most vegetables it isn’t likely there is enough to be a significant source.
Honey is a large source. It is about 41% fructose in the USDA National Nutrient database, 41 grams of fructose per 100 grams of honey, or 8 - 9 grams of fructose per tablespoon. If your fructose budget is 25 grams a day, just a tablespoon is 30% of your daily fructose budget. If it’s 50 grams a day that’s 16-18% of your budget. More further on.
Fruit juice contains fructose – and it may be added, check the labels. Fruit juice usually contains more fructose than the fruit it’s associated with.
Scroll down the fructose article to the fructose table. And whilst you’re there, you could read what Dr. Joseph Mercola says about fructose, and view the video of his fructose and uric acid discussion with Dr.Richard Johnson. You may have to type your email address into a box to gain entry.
There are comprehensive tables of the amount of fructose in vegetables, fruit, fruit juices, alcoholic and other beverages, bread and grains, salad dressings, cereals, sweeteners and desserts, even fast foods in The Sugar Fix.(6)
You can view the amount of fructose in many, (not all) foods and beverages at the USDA National Nutrient Database, which you can download free from this page on best-gout-remedies.com
Or click here to use it online, courtesy of the U.S. Department of Agriculture.
FRUCTOSE AND GOUT
The idea that fructose might be one of the causes of gout is not particularly new but it still seems to be relatively unknown outside the worlds of medical and nutritional research. Way back in the 1960’s, in the same decade that high fructose corn syrup (HFCS - aka isoglucose, maize syrup, glucose-fructose syrup), was first developed, there were studies suggesting that fructose and gout were at least strongly associated.
And some concluded fructose raised the uric acid level. In the past few years yet more studies of different types have said the same. Moreover if you already have gout, your uric acid is more responsive to fructose consumption than if you do not.(3)
How might fructose cause gout?
Those who think fructose is among the causes of gout, think they know the mechanisms by which it does raise uric acid (UA) directly. i.e. not because it causes another medical condition which leads to raised uric acid. One of these direct and complicated mechanisms is that fructose accelerates the ATP (adenosine triphosphate) molecule breakdown in cells to purines and uric acid. (Adenosine is a form of the purine adenine. ATP is the energy powerhouse in cells).
A second direct mechanism is that it stimulates the production of purines. Thirdly, if the liver has to deal with too much fructose, higher uric acid is the result. And fourthly lactic acid is produced by the metabolism of fructose and it inhibits uric acid (UA) excretion by the kidneys.
Research in favour (favor)
Three types of research support the fructose causes gout proposal.
First, there are the studies showing if you feed or infuse rats and humans with fructose, uric acid (UA) rises. (8) (9) (10). I am quoting three here but there are others. It has been shown that if you feed a high fructose diet, UA rises in humans.
Second, large population studies (epidemiologic studies) showed those who consumed more sugar sweetened soft drinks, all of which contain forms of fructose – compared to people who don’t drink these – have a higher risk of high uric acid or of gout. The risk rose as more was consumed. (1) (4). These conclusions from the population studies are supported by another finding from at least one of these studies. That is, diet sodas that don’t have fructose or sugar (half fructose) as sweeteners, don’t carry a risk of gout.
And third, studies such as the landmark Intermediary Metabolism of Fructose in 1993 (3) – it quoted a mammoth 138 fructose and other sugars' studies – explained how fructose does it.
However, you probably haven’t heard of fructose and gout from your local GP (PCP). Possibly it’s because, as I’ll explain, the studies don’t agree, although some of the evidence is substantial. The theory also has some well known supporters.
For example, the online health newsletter writer Dr.Joseph Mercola; and Dr. Richard Johnson, who has argued that fructose causes higher uric acid in his 2008 book The Sugar Fix: The high-fructose fall out that’s making you fat and sick (6). (Available in paperback; search online bookstores). It describes a low fructose diet, and this chapter also includes low fructose menus.
Another who has reported on the fructose and gout saga is the science journalist Gary Taubes, who wrote a fascinating draft chapter on gout, including fructose and gout, that didn’t make it into his book "Good calories, Bad calories. Fats,Carbs, and the Controversial Science of Diet and Health."
You’ll be reading about gout for a few minutes before you arrive at his fructose and gout commentary.
Despite all this work on fructose and gout for 45 years, this isn’t an open and shut case.
For every fructose feeding or infusion study that says fructose raises uric acid, (UA) there’s another, at least, of the same type that says, no it doesn’t (11) (12). Two are quoted here but there are others. Another study concluded a fructose infusion made UA rise, but a fructose rich diet did not, both in serum (blood) and urine (7).
Then there was a population study which didn’t indicate fructose raised the risk of high uric acid (hyperuricemia). In this case an investigation into NHANES data (The National Health and Nutrition Examination Survey 1999 – 2004). i.e. whether over time a large population had a higher risk of high uric acid levels because they consumed more fructose.(2)
You can read or download (pdf) this study here. To download best, when the page arrives, click on the pdf link at the right under "Viewing Options."
A one time gout sufferer, now clear of gout for three years, explains how he came to learn that fructose causes his gout, after many remedies failed. See "How I cured my gout."
Go to our second page about gout and fructose, where I explain how you might deal with the gout and fructose dilemma.
Go to our third page about gout and fructose - read what our visitors say.
Study references for the first page about fructose and gout
(1) Jee Wong J. Choi, Earl S. Ford, Xiang Gao, and Hyon K.Choi Sugar-Sweetened Soft Drinks, Diet Soft Drinks, and Serum Uric Acid Level: The Third National Health and Nutrition Examination Survey. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 1, January 15, 2008, pp 109–116
(2) Sun et al: Lack of association between dietary fructose and hyperuricemia risk in adults. Nutrition & Metabolism 2010. 7:16.
(3) Mayes, Peter.A. Intermediary metabolism of fructose.American Journal of Clinical Nutrition 1993 Nov; 58 (Supp): 754S-765S
(4) Hyon K.Choi, Gary Curhan . Soft drinks, fructose consumption and the risk of gout in men. British Medical Journal. 2008 February 9; 336(7639):309
(5) Hyon K.Choi, Walter Willet, Gary Curhan. Fructose-rich beverages and risk of gout in women. Journal of the American Medical Association. 2010 Nov 24;304(20):2270-8
(6) Richard Johnson MD (with Timothy Gower and Elizabeth Gollub PhD, RD), The Sugar Fix:The high-fructose fall out that’s making you fat and sick.The Pocket books division of Simon & Schuster Inc., New York 2008.
(7) Abstract. Robert G.Narins, Jerome S.Weisbergh, Allen R. Meyers Effects of carbohydrates on uric acid metabolism.Metabolism 1974; May; 23 (5):455-65.
(8) Perheentupa J.,Raivio K.Fructose-Induced Hyperuricaemia. The Lancet 1967 2:528-531.
(9) Stirpe F, Della Corte E, Bonetti E, Abbondanza A, Abbati A, De Stefano F. Fructose- induced hyperuricaemia. The Lancet 1970;2:1310-1.
(10) Sheldon Reiser, Andrea S.Powell, Daniel J.Scholfield, Pankaja Panda, Kathleeen C. Ellwood, John S.Canary. Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose corn starch. American Journal of Clinical Nutrition 1989;49: 832-9.
(11) Abstract. Curreri P.W., Pruitt B.A.Jr., Absence of fructose-induced hyperuricaemia in men. The Lancet 1970 Vol. 1 pp. 839
(12) Phyllis A. Crapo RD, and Orville G.Kolterman MD, The metabolic effects of 2-week fructose feeding in normal subjects. The American Journal of Clinical Nutrition April 1984 pages 525-534.