The Main Culprit Behind Gout: Fructose and Alcohol

Gout is a form of inflammatory arthritis caused by high levels of uric acid in the blood. Uric acid is produced when the body breaks down substances called purines. Purines are found in many foods, but there are two main culprits that drive up uric acid production and increase the risk of gout: fructose (sugar) and alcohol.

Fructose Metabolism Leads to Excess Uric Acid

Fructose is a simple sugar found in many foods and beverages including fruit, fruit juice, soda, candy, desserts, and products containing added sugar. Not all sugars are equal when it comes to gout risk. Sucrose, lactose, and maltose do not appear to increase uric acid levels like fructose does.

Fructose is metabolized differently than other sugars. It is absorbed directly by the liver, while glucose first goes to the bloodstream. In the liver, fructose is broken down into various byproducts, including uric acid. The more fructose consumed, the more uric acid the liver produces.

High fructose intake has been shown to increase uric acid levels and gout risk for several reasons:

• Fructose increases oxidative stress and inflammation in the body more than glucose. Chronic inflammation damages tissues and impairs normal metabolic functions.
• Fructose causes insulin resistance, leptin resistance, and fat accumulation in the liver. This leads to metabolic syndrome, diabetes, and other issues that are often seen with gout.
• Fructose metabolism inhibits nitric oxide production and causes high blood pressure, another condition associated with gout.
• The byproducts of fructose metabolism prevent the mitochondria from properly utilizing pyruvic acid. This forces the liver to turn excess calories into fat.

The Sugar Addiction Cycle

The chronic inflammation and metabolic dysfunction caused by excessive fructose intake leads to intense food cravings, especially for sugary foods. This creates a vicious cycle of sugar addiction. The more sugar someone consumes, the more uric acid is produced and the higher the risk for developing gout.

It’s no coincidence that gout often occurs alongside other conditions like diabetes, high blood pressure, high triglycerides, and metabolic syndrome. These are all related to insulin resistance and mitochondrial dysfunction, which are driven largely by excess fructose consumption.

These cravings are very difficult to ignore due to the effects of sugar on the brain’s reward pathways. The taste of sugar lights up the nucleus accumbens, releasing dopamine and creating a surge of pleasure and desire for more. This makes sugar highly habit forming and addictive.

Over time, it takes more and more sugar consumption to stimulate the same degree of dopamine release and pleasurable high. This demonstrates the development of tolerance, a hallmark of addiction. The inevitable result is higher and higher sugar intake.

Alcohol Also Raises Uric Acid

Like fructose, alcohol intake increases uric acid levels and gout risk. Beer especially can raise uric acid because it contains purines that get broken down into uric acid.

Like fructose, alcohol intake increases uric acid levels and gout risk. Beer especially can raise uric acid because it contains purines that get broken down into uric acid.

Alcohol also reduces the kidneys’ ability to excrete uric acid in a couple ways. First, it directly impairs kidney function, reducing their ability to filter out waste products like uric acid. It basically inhibits the kidneys from doing their job of removing excess uric acid from the blood.

Second, alcohol metabolism creates byproducts that are toxic to kidney cells and damage kidney tissue over time. This compounding damage to the kidneys again reduces their capacity to properly excrete uric acid.

The combination of increased production of uric acid (from breaking down purines in beer) along with decreased excretion of uric acid (from kidney impairment) is a double whammy. This causes uric acid levels to substantially build up.

Even moderate alcohol consumption can interfere with proper uric acid excretion. And the more heavily someone drinks, the worse the kidney damage becomes. People who drink regularly and heavily are especially prone to gout attacks.

For those already dealing with high uric acid levels or gout, alcohol should be avoided completely. At a minimum, moderation is key. Consuming more than 1-2 servings of alcohol per day, and especially binge drinking, will make gout worse and more frequent. The impact that even a single night of heavy drinking can have on uric acid levels and gout risk should not be underestimated.

Avoiding Gout in the Modern World

In the past, gout was mostly seen among royalty and the upper class who consumed lots of rich foods and alcohol. But with the cheap availability of added sugars today, the average person eats far more fructose than is healthy.

The recommended limit for added sugar is only 25 grams per day. But most Americans consume three times that amount on average. With fructose hidden in so many foods, it takes effort to minimize intake. But doing so can go a long way toward preventing gout and related metabolic conditions.

Along with limiting sugar and alcohol, eating a diet low in purine-rich foods can also help lower uric acid levels. Foods particularly high in purines include organ meats, seafood, and red meat. But avoiding sugar and alcohol is most crucial.

Testing Uric Acid Levels

Blood tests can measure uric acid levels. Values above 5.5 mg/dL often indicate mitochondrial dysfunction and insulin resistance. Other markers like fasting insulin and triglycerides can also reveal insulin resistance issues.

The higher your uric acid level, the more likely you are to develop gout at some point. By cutting back on dietary fructose and alcohol and keeping uric acid levels in the healthy range, you can prevent painful gout attacks and reduce risk for many other chronic diseases. A healthy lifestyle goes a long way.