Diets for Gout: Could the Same Underlying Problem Cause Both Gout and Obesity?
Why do diets for gout work? Perhaps better put: why, when you reduce your weight, do you simultaneously reduce your risk for gout?
This simple question has fascinating implications. Obesity and gout associate. In other words, if you're at risk for one, you're at risk for the other. The Caloric Balance Hypothesis says nothing about why obesity might predispose to gout. After all, if calories "count," and excess calories make us fat, how do excess calories simultaneously cause/make us at risk for gout?
The Lipophilia Hypothesis says that overabundance of insulin and blood sugar drives obesity. And this underlying carbohydrate/hyperinsulinemia disease (for lack of a better name) drives not only obesity but also a staggering variety of other diseases, including gout.
Okay, so we have two predictions. Caloric Balance tells us nothing about why gout and obesity associate. Lipophilia says they're related because high carb living causes both conditions; thus diets for gout should be low carb.
So what does the evidence seem to say?
1. Unfortunately for us, science journalist Gary Taubes excised his chapter on gout from Good Calories Bad Calories to keep the book (relatively) trim. The good news is that online sources allow us to read some of his writing on the subject.
This excellent blog entry quotes Taubes discussing the work of Gerald Reaven, who describes how hyperinsulinemia could be the root cause for gout:
"These observations would suggest that anything that raised insulin levels would in turn raise uric acid levels and might cause gout, which would implicate any high carbohydrate diet with sufficient calories."
Taubes also discusses the role of fructose and simple sugar in the etiology of gout. His comprehensive discussion (replete with citations) should convince most skeptics that the "gout-carbohydrate" argument has serious heft.
2. This article, "Ask the doctor about treating gout," debunks the idea that a high protein diet causes gout and instead offers:
"Excessive carbohydrate consumption, particularly of refined flour and sugar, foods that in previous times were solely the domain of the wealthy, can also raise the uric acid levels and precipitate gout. This fact also explains the frequent finding of obesity in those suffering from gout... people with historically high protein intake who also ate lots of fats and soup broths, with no refined carbohydrates, rarely if ever suffer from gout."
3. For more, check out Life Without Bread Chapter 6 (99-100). Here's a juicy quote about diets for gout:
"For a long time, it has been known that infusion of sugar solutions, especially fructose and sorbitol, causes a quick elevation of uric acid... Carbohydrates stimulate uric acid production. This alone should be a reason to put people with elevated uric acid levels on a carbohydrate restricted diet."
This is only the tip of the iceberg in terms of the evidence that can be mustered to support the proposal that obesity and gout arise from eating diets abnormally high in carbohydrates and that the best diets for gout must be low carb.