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Gout Dugout.Issue #071 Gout treatment needs improving | sugar and gout | colchicine can kill
September 29, 2015

Hello and Welcome to the September (Autumn/Fall) 2015, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read from that gives you useful ideas that may help with your gout.

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In the past few years there have been studies of how gout is treated by GP’s (PCP’s) in the U.K., U.S. Irish Republic (north Dublin area), New Zealand and Germany. All have concluded that it’s not good enough.

The latest one is from Australia. Here are some of the findings from 5 years worth of gout patients’ records.

• Allopurinol was prescribed to just 57%

• Only 55% of gout patients had their uric acid levels tested at any time over five years.

• Only 22.4% of patients over 5 years actually reached the target uric acid level of 6.0 mg/dL(360µmol/L; 0.36 mmol/L) - the level at which, generally, gout starts to clear. This is hardly surprising if they did not even get Allopurinol, or maybe not a strong enough dose.

And as you know, Allopurinol and uric acid testing are just very basic procedures in gout therapy, not advanced treatment.

What kinds of dietary and lifestyle advice they were given was not analysed, but I am not hopeful it was very sound if indeed they received much at all.

In New Zealand, where gout levels amongst the population are high, there is talk of uric acid being tested in pharmacies, which sounds like a good idea. In a New Zealand study only 34% of gout patients had uric acid testing.

In the Philippines, where the uric acid test is not expensive, (about US$2.50), a test is sometimes offered by pharmacies, usually as sales promotion. I have seen “get your free uric acid test here” if you etc.etc.

The lesson from all this is if you have, or think you have gout see a rheumatologist (or maybe a podiatrist) who knows much more about it than your local G.P (PCP). Or if that’s not possible, don’t be shy about seeing another G.P (PCP). And if so inclined, read widely about gout, so that you are aware of other treatments.


In the 1970’s and after, the late Dr. John Yudkin, Head of the Dept. of Nutrition at a University of London college, was an anti sugar campaigner, alongside co-campaigners such as Robert Atkins (The Atkins diet) and T.L. Cleave (The Saccharine Disease – he was referring to sugar not the artificial sweetener).

Yudkin’s book about sugar, Pure, White and Deadly (in the U.K), in the U.S called Sweet and Dangerous, was first published in 1972 and then again in 1986. It became a best seller – I remember owning a copy myself in those days. It was re-issued in 2012 under its Pure, White and Deadly title, propelled by the efforts of Dr. Robert Lustig, and I managed to re-read it a few weeks ago.

My curiosity was of course aroused when I came to a section on sugar and gout. After making some general well known remarks about gout, Yudkin went on to describe a gout and rheumatic disease study he conducted. It turned out the patients with rheumatoid arthritis ate the same amount of sugar as the control (normal) group. But the patients with gout ate much more sugar – 103 grams a day v 54 in the control (normal) group patients.

This would have been in the early 1970’s. Today, just about everywhere on the planet, sugar consumption is much higher. Remember sugar in its various forms gets everywhere. It is not just table sugar.

Excess sugar intake (and that probably includes fructose - fruit sugar - which is also half the composition of table sugar) is a cause of gout through the insulin resistance route. As regular readers know, excess carbohydrate intake (and sugar is a carbohydrate), is I think today’s leading cause of gout, not purines, genetics, or any of the other causes.

John Yudkin's book is available on, amazon,,, and

Dr.Lustig's video on YouTube about sugar has been viewed nearly 6 million times


As longer time readers know, just occasionally I digress from gout for one topic if there is momentous nutrition or health news that might have a bearing on gout diets people use.

There is but you may not have heard it. The days of “two eggs” or only 300 mg daily of cholesterol,for those who believed it, are over. In July it was announced that official U.S. dietary guidelines on dietary cholesterol are now that there will be no warnings and no limits. Many nutritionists, medical researchers and cardiologists have said for years that dietary cholesterol is not a problem. That is now to be official.

The Dietary Guidelines Advisory Committee says cholesterol is “not now considered a nutrient of concern for over consumption.”

The saturated fat, leads to high blood cholesterol, leads to atherosclerosis sequence has been widely believed since the 1970's. Atherosclerosis is the build up of deposited substances – one is cholesterol - in the inner lining of arteries. The mixture hardens to form plaque, one cause of a heart attack.

Expect low cholesterol foods sales to decline (at least in the U.S.). Expect those low/no cholesterol flashes, tags, slogans and signs on food packaging to disappear in the US.

Many countries went along with the US line back in the 1960’s - 1970's, when saturated fat and cholesterol were first demonized. We'll wait and watch to see whether other countries follow suit. I bet they do.

However, the report still encourages limitation of saturated fat and the intake of polyunsaturated fat. That is now controversial since saturated fat is making a come back, and many articulate concerns about polyunsaturated fat. One example of the sat fat comeback ? A 2014 meta analysis (a study of studies) of nearly 80 studies and over 500,000 people learnt that those who consume higher amounts of saturated fat have no more heart disease than those who consume less of it.

Do you want more detail about the guidelines ? Read this article


July brought the unhappy gout news that a woman in North East England had died after an over dose of colchicine. She was not a gout sufferer but her male partner was. There was a history of domestic brawling. For some reason she swallowed up to 44 of his colchicine tablets. She died 36-48 hours later. A verdict of accidental death was recorded. The coroner said the woman was not aware of the toxic effect of colchicine.

Moral of the story ? Remember that too much colchicine can kill. And keep your colchicine tablets away from others. Last year an Australian woman also died after a colchicine overdose.

How much colchicine should you take?

See our colchicine gout treatment page

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Tea, black or green, for treating gout? The case has been strengthened by two studies – one of black, one of green – which show tea reducing uric acid a bit, or inhibiting xanthine oxidase. Do not imagine a cup of tea will lower gout pain, or even clear up gout on its own. That’s not likely. Nevertheless tea is good for gout.

But any old cup of tea from a tea bag will not help. You have to choose certain types, according to the research, and you can read about it here, on this first of three pages about tea for gout.

Coriander (cilantro) is this issue's surprising topic, for which I have recently added a page on the website. The herb and spice has lowered uric acid in a study. Flash in the pan ? Possibly. More will be needed before it could be confirmed as a solid gout remedy. Read about coriander (cilantro) for gout here


Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase? Type that in the site search box.

There are currently around 240 pages, including all the back issues of this newsletter. It works. Use it!

Thanks for reading, all the best of health.

John Mepham BA (Econ)
Makati City,

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