Sugar, Fructose, High Fructose Corn Syrup and Gout

Sugar, Fructose, High Fructose Corn Syrup and Gout

Sugar: The big controversy that everybody is talking about

Sugar! What are brains do for this stuff, we go coo-coo over sugar, it is just as addictive as cocaine and we consume so much of it every year in North America that we are slowly destroying our health. The single largest source of calories for Americans comes from sugar, specifically high fructose corn syrup.

Americans consume about 134 grams of fructose a day! Then we wonder why that 1 in 4 Americans is pre-diabetic or has type 2 diabetes. In 1700 the average person consumed about 4 pounds of sugar a year. This increased in 1800 where the average person consumed 18 pounds of sugar a year, then in 1900 increased to 90 pounds of sugar a year.

Where are we in 2013? We are consuming 180 pounds of sugar a year on average! That is absolutely astonishing! So let’s dwell into this food and see how it links to gout.

What science has to say about sugar and gout

The same study from Dr. Hyon Choi, M.D. of the Boston University School of Medicine, the one with the 46 000 men with no previous history of gout that I have written about in other posts; the researchers also examined the consumption of sugar of those men for the 12 year period. They did this by compiling data on food intake of more than 130 foods and beverages which included regular and diet soft drinks, as well as fruits and fruit juices.

What the researchers found was that as one drank more sweetened soft drinks the more risk increased for a gout attack. Compared to men who only drank one soft drink a month, those that drank 5-6 soft drinks a week had a 29% higher chance of developing gout and those that drank 2 or more soft drinks a day had a 85% chance of developing the disease.

The study also concluded that diet soft drinks were not linked with the risk of developing gout. What about drinking fruit juice? Nothing wrong with that, right? Wrong! Foods that are rich in fructose such as fruits like apples, oranges and fruit juices were linked with an increased risk of developing gout.

Furthermore, fruit juice contains more fructose than the actual fresh fruit itself! Please also keep in mind that whole fruits also contain vitamins and antioxidants that decrease the hazardous effects of fructose. Fructose alone is not entirely evil since fruits are beneficial for our health but too much will wreak havoc to your health. Fructose is also found in veggies, especially root vegetables such as carrots, but in most vegetables there isn’t enough to be a significant source. So there you have it folks!

The culprit appears to be fructose which increases uric acid levels and when uric acid levels get high enough, they harden and crystallize which causes a gout attack to occur. Our modern day diet consists of a very high consumption of fructose, mainly in the form of high fructose corn syrup (HFCS). Other studies have also been conducted on rats that were infused with fructose and their uric acid levels also rose. The link is there although some dispute the evidence; at the end you must use your common sense in order to be able to discern fact from fiction.

What should a gout sufferer do?

This is why gout sufferers should pay attention to how much fructose is consumed in the form of fruit juices and fruits; and not just from soft drinks and processed foods. I personally recommend that you don’t consume more than 25 grams of fructose a day from all types of foods whether it be fruits, juices, soft drink, cookies, cereals etc…

Since all processed foods contain high fructose corn syrup, it would be a good idea to also limit consuming no more than 15 grams of fructose daily coming from fresh fruits. Why? Because you can very easily exceed the maximum 25 grams due to the hidden fructose in your diet, even if you consumed no soft drink or fruit! Remember that if you already have gout, your uric acid is more sensitive and responsive to fructose than if you do not have gout.

NutriGout Dietary Supplement for Gout


Fructose and Glucose

Note this fact and write it somewhere so you can never forget this: Fructose is the only sugar that raises uric acid in your body and usually does this within minutes of ingestion. Fructose, a carbohydrate, is a leading sugar in fresh fruit and fruit juices and is the pre-dominant sugar is some fruit. Fructose also forms half of the molecule of white table sugar, sucrose. The other half of the sucrose molecule is glucose.

Although glucose will not increase uric acid levels in the blood, it will fasten the absorption of fructose. Glucose and fructose are connected in sugar, but fructose is metabolized differently to glucose. On a side note if you want to have more control of your weight and prevent disease, by mixing glucose and fructose together, you will actually absorb more fructose than if you consumed fructose alone! So glucose actually increases the harmful effects of fructose.

The evil High Fructose Corn Syrup

What about high fructose corn syrup? Unlike sucrose and table sugar, which is a 50-50 split of fructose and glucose, high fructose corn syrup contains these sugars in a mix dominated by fructose. In a study conducted by Michael Goran at the University of Southern California’s Keck School of Medicine, in Los Angeles, collected 23 different samples of canned, bottled and fountain sugar sweetened beverages. What they discovered was that all of the soft drinks are 58% fructose or above and the three most popular soft drinks which are Coca-Cola, Pepsi and Sprite contained 65% fructose!

The corn syrup industry insiders are a bunch of liars because they claim that the amount of extra fructose is small at about a 55 fructose and 45 glucose split. Food and beverage manufacturers began switching their sweeteners from sucrose to corn syrup in the 1970s when they discovered that high fructose corn syrup was not only far cheaper to make, it’s about 20 percent sweeter than conventional table sugar that has sucrose.

Due to its chemical form HFCS is more metabolically risky to you. The fructose and the glucose are not bound together in HFCS, as they are in table sugar, so your body doesn’t have to break it down. Therefore, the fructose is absorbed immediately, going straight to your liver. Glucose is the form of energy you were designed to run on.

Every cell in your body, every bacterium—and in fact, every living thing on the Earth—uses glucose for energy.[i] But now our sugar of choice is fructose. When eating fructose, it mostly metabolizes through your liver whereas with glucose, your liver metabolizes only 20%!

Fructose will turn into fat once consumed whereas glucose is usually burned up right after consumption since every cell in your body uses glucose.

How our bodies produce uric acid

A great article written by Dr. Solomon Fourouzesh does a good job of explaining how our bodies produce uric acid:“It’s a byproduct of cellular breakdown. As cells die off, DNA and RNA degrade into chemicals called purines. Purines are further broken down into uric acid.Fructose increases uric acid through a complex process that causes cells to burn up their ATP rapidly, leading to “cell shock” and increased cell death.

After eating excessive amounts of fructose, cells become starved of energy and enter a state of shock, just as if they have lost their blood supply. Massive cellular die-off leads to increased uric acid levels.And cells that are depleted of energy become inflamed and more susceptible to damage from oxidative stress.

Fat cells actually become “sickly,” bloating up with excessive amounts of fat.There is a simple, inexpensive blood test for determining your uric acid level, which I recommend you have done as part of your routine health checkups. Your level should be between 3.0 and 5.5 mg/dl, optimally.There is little doubt in my mind that your uric acid level is a more potent predictor of cardiovascular and overall health than your total cholesterol level is.

Yet virtually no one is screening for this.Now that you know the truth you don’t have to be left out in the cold, as this is a simple and relatively inexpensive test that you can get at any doctor’s office. Odds are very good your doctor is clueless about the significance of elevated uric acid levels, so it will not likely be productive to engage in a discussion with him unless he is truly an open-minded truth seeker.

Merely get your uric acid level, and if it is over 5 then eliminate as much fructose as you can (also eliminate all beer), and retest your level in a few weeks.”Dr. Robert J. Johnson author of The Sugar Fix: The High-Fructose Fallout That is Making You Fat and Sick ( a must read book for the gout sufferer) argues how there is a connection between high uric acid levels and excess sugar consumption, how your body can develop disease and many other conditions:

“There are more than 3,500 articles to date showing a strong relationship between uric acid and obesity, heart disease, hypertension, stroke, kidney disease, and other conditions. In fact, a number of studies have confirmed that people with elevated serum uric acid are at risk for high blood pressure, even if they otherwise appear to be perfectly healthy.”

Dr. Johnson further elaborates how being sensitized to sugar is so dangerous to your health:

“Sugar activates its own pathways in your body—those metabolic pathways become “upregulated.” In other words, the more sugar you eat, the more effective your body is in absorbing it; and the more you absorb, the more damage you’ll do.You become “sensitized” to sugar as time goes by, and more sensitive to its toxic effects as well.

The flip side is, when people are given even a brief sugar holiday, sugar sensitization rapidly decreases and those metabolic pathways become “downregulated.” Research tells us that even two weeks without consuming sugar will cause your body to be less reactive to it.”

Enter Gary Taubes

Another important scientific contributor in the debate of fructose and gout is Gary Taubes author of the book Good Calories, Bad Calories. He argues that evidence supports the notion that low cholesterol diets have a small effect on serum cholesterol levels, low salt diets has barely any effect on blood pressure and low purine diets have a minimal effect on uric acid levels.

For example, a vegetarian diet will decrease serum uric acid levels by 10-15% compared to the typical American diet and there is barely any proof that such diets do anything to reduce a gout attack. This is the reason that low purine diets are no longer prescribed as a treatment for gout.

He goes on to present 2 arguments as evidence that fructose is the main culprit and cause for gout. Firstly, he explains how the availability of sugar over the centuries is related to the increase of gout in the West.

Secondly, he strongly argues how fructose raises uric acid levels but researchers have abandoned conducting studies on the subject since the discovery and clinical application of allopurinol in the Sixties, so the hypothesis of sugar/fructose was dropped by researchers and ignored due to this bad timing because now a gout sufferer could eat and drink whatever he/she wanted to by taking allopurinol.

You can read more about Gary Taubes in this page from Timothy Ferriss’ blog which is one of my favorite pages on the net about gout. Check out the comment section too, this post is packed with good information.

As of March 2014, the World Health Organization has finally recommended that we should aim to consume no more than 5% of our daily calories as sugar, something I have been advocating for the longest time. Dr. Francesco Branco, head of nutrition for health and development for WHO was quoted as saying: “Sugar might become the new tobacco in terms of risk”. He also said: “To put it into context, five per cent would be about six teaspoons of sugar a day; a can of sugar-sweetened soda contains about 10 teaspoons of sugar”.

The recommendations  don’t apply to “intrinsic sugars”, those sugars you find in fruits and vegetables. The goal of the recommendation to limit sugar consumption is to lower obesity and tooth decay. What is also very interesting and needs to be pointed out is how in 2004 the WHO tried to recommend limiting sugar to no more than 10% of daily calories as sugar but the US Congress under the pressure of the sugar industry lobby threatened the WHO that it would remove all funding for the agency. Special interest groups are a hazard to people’s health!

An April 2016 study that appeared in the May 2016 issue of Arthritis & Rheumatology suggests that lowering sugar intake or reducing your dietary glycemic index is associated with a reduction in uric acid levels in overweight adults. The study used 163 obese adults and tried 4 different randomized diets over a 5-week period. Again, it’s been what I’ve been saying all along in this website and in my eBook.

[i]High Fructose Corn Syrup & Gout” 20 April 2010 Dr. Solomon Forouzesh

Posted by Spiro Koulouris

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  • Mark Frame

    Reply Reply January 30, 2019

    Hi Spiro!

    I was wondering if you had an advise or knowledge of how artificial sweeteners 950 & 951 affect us gout suffers.

    951 Aspartame and 950 Acesulphame Potassium

    I am from Australia and find these 2 ingredients on soft drinks like Pepsi Max.

    Not sure do you guys in the USA have these artificial sweetness in your diet style soft drinks – I Know you mention Corn Syrup as a n artificial sweetener from time to time

    Any info would be appreciated!

    • Spiro Koulouris

      Reply Reply January 30, 2019

      Hi Mark!

      I don’t know enough about those 2 but I do know that all artificial sweeteners should be avoided since they raise uric acid levels.

      Avoid soft drinks both with sugar and artificial sweeteners.

      Drink only water, herbal teas and coffee. That is what I advise.

      Try brewing herbal tea and put it in the fridge, that’s what I do.

  • Steve

    Reply Reply January 1, 2019

    After reading this article, simply stated I lost easily over 25 lbs and 6 inches in the waist by trying stay at abut 26 sugar grams a day. And the weight is staying off. No more emotional ups and downs from sugar highs. Great article! Thanks so much! #lifeChanger

    • Spiro Koulouris

      Reply Reply January 4, 2019


      Glad to hear that Steve!

      You’re on the right track my friend!

      Keep it up!

  • Simon

    Reply Reply January 17, 2018

    I’m not overweight, I don’t drink excessively, and eat a typical amount of meat. I have suffered from gout for about 5 years (I’m 44 now) on an off. I took all the advice and attacks got less frequent, but never really went away. It felt as if a gout attack was just one too many beers away, and eating red meat was like playing Russian Roulette.

    So I went to a party before Christmas, after a long week and drank several Mountain Dews. Next day, bam, gout attack. I figured the sugars played a part so stopped added sugar. Basically anything with “sugar” as an ingredient was off the table. I noticed an improvement in a few days and a couple of weeks later I’m the most gout free I’ve been in years. I’ve even experimented with steak and beers and seen no worsening of the gout.

    I know this is anecdotal, and a short term study, but I’m convinced that sugar plays a significant part in gout. No HFCS again for me!

  • Jake

    Reply Reply September 28, 2017

    I’ve recently (6 months ago) noticed that my recent gout attack was caused by really too much fruit and/or fruit juice in short period. I’ve done a query on that and indeed there is some interesting research on that (several white papers as mentioned in this article). Since I’ve stopped eating more then very little Fructose in all forms (moderate glucose is ok in gout scenario) I’m basically gout free when before I’ve been getting several very long attack every year.

    My uric acid level decreased by 30% only in 1 month after I’ve started that diet. I eat anything else I want also high purines foods. So, watch your fruit and (juice and soda and other junk high fructose foods, that contain corn fructose, the worst kind), wine is ok as long is not a sweet variety of more then 1.8 glm. That works for me so far. Take care, J.

  • Nick L

    Reply Reply December 20, 2016

    Hi Spiro

    Boy I wish I had read this page a year ago. With hindsight it seems very stupid, but I followed a half-baked diet for 11 months, when I drank about 3 litres, sometimes more, of fruit juice a day. Then I had my first ever gout attack in my big toe. That was about a month ago and it’s still not back to normal, if it ever will be.
    I’ve radically changed my diet now including hissing at any juice containers I see. Obviously I must have a genetic predisposition for gout, but for the time being I’m hoping (perhaps unrealistically) that I can control this in the long term by diet without taking medicine. Great site by the way. Nick

  • Madelyn McCullough

    Reply Reply October 22, 2016

    Dean mentioned sleep apnea.. While doing research on gout, I came across an article stating sleep apnea and it’s relationship to gout. Have you heard anything about this?

  • Denton Achenbach

    Reply Reply September 27, 2016

    I have been a decade long suffer of severe gout. I was finally able to wean myself ON to Allopurinol. It controlled my uric acid at a level 8.0. In May of this year I went on a KETO diet to reduce blood sugars and get off diabetes medication. I have lost 60 lbs off all but on Blood pressure medication and last week my Uric acid was 6.0. I now believe that the Allopurinol is actually artificially holding my Uric acid up at 6.0 and it would go below 5.0 if I got off of the drug. My only concern is that I am still losing a lot of weight and am concerned as times in the past that with the fat breakdown willbe fat cells full of uric acid…and cause GOUT. Should I wait to drop Allopurinol or go for it? Anyone worked through a similar issue.

  • Eugene

    Reply Reply September 22, 2016

    Does the 25g fructose recommendation include the sugar that comes from dairy? I have been really surprised to see how much sugar there is in milk and yogurt.

    • Spiro Koulouris

      Reply Reply September 22, 2016

      Yes Eugene it does. Sugar is sugar. Even sugar from fruit and vegetables.

      • bjmsam

        Reply Reply September 24, 2016

        Fructose is far more harmful than lactose.

    • Eugene

      Reply Reply September 22, 2016

      Wow! In that case the 25g is tough, very tough as I thought I was doing great on 65g and none of it added or juiced. All fruit and veg. Actually the rest of the advice and recos are really great. Your site is the best I have come across as I try to educate myself without recourse to docs and meds. In my case it is pretty simple as it’s down to 35 years of booze and some great dinners. Great fun at the time but paying the price now. However have given it up, lost 25 pounds and really enjoying the journey. Have rediscovered Greek yogurt and Greek salads so many thanks indeed, really great to hear from you Spiro and keep up the great work. Best wishes from London.

  • David Peterson

    Reply Reply September 8, 2016

    I was diagnosed with gout when I was 18. I used to come home from college with a big Dr Pepper as I drove. Once I stepped out of the car I thought I broke my foot. My doctors diagnosed me and then told me to stay away from red meat. I literally went vegetarian but nothing worked because I was still pounding the Dr. Peppers. Years later I told my doctor it was the Soda….He did not agree. I have known it has been HFC for years but no doctor would listen. Since giving up all soda and drinking a ton of water, I am able to live without gout attacks. No more surgeries each year cutting Tophi out of my feet, knees, elbows and ankles. HFC is the devil.

  • Tom

    Reply Reply August 31, 2016

    I’ve been a gout sufferer for years. Allergic to allopurinol, hate colchicine, indocine doesn’t seem to work anymore. Anyway, for unrelated reasons, I decided to give up added sugar and most carbs about 9 months ago. And since that time, I haven’t even thought about gout. But over the last two weeks, I’ve been dealing with the mourning and the stress of making final arrangements that goes with a death in the family, and I’ve gotten away from my diet and have just eating what friends and family have sent us during our time of need, plus a healthy dose of restaurant junk food while on the road and running from here to there. And what do you know…I was set to go back to work today and BAM, worst gout attack in years.

    Anyway, I know it’s anecdotal, but it seems clear to me that, at least in my case, sugar is more of a problem for gout sufferers than we realize.

    • Spiro Koulouris

      Reply Reply September 1, 2016

      Hi Tom!

      Thanks for your commnent and sorry for your loss. It shows how if you stray away from a strict diet, that gout comes back. Wish you a speedy recovery from this latest attack.

    • Ben

      Reply Reply February 1, 2018

      Hi I read that prolonged stress plays a key role for flare ups too. I have experienced that.

  • Tamara Anne

    Reply Reply June 16, 2016

    Hi Spiro: I’m new to this site and glad to have found it.
    I am a 2 year gout sufferer and in the middle of an attack to end all attacks. My doctor started me on a steroid last night and my foot is dark red and swollen today still. I don’t expect it to be gone yet of course but it’s a nasty experience. I have had kidney stones, and my gall bladder out, both packed with stones and sludge. Charming!

    When I have my five days of steroids and 2 months of colchicine meds I would dearly like to get off the big pharmaceuticals guns and try to stay healthier by losing weight, eating a better diet and ingesting cherry extracts on a daily basis and anything else you might like to advise. Thanking you in advance for this very informative forum, I hope to hear from you soon. Take care, Tamara Anne.

    • Spiro Koulouris

      Reply Reply June 17, 2016

      Hi Tamara!

      Always work with your doctor cause everybody’s gout is different, but follow my dietary recommendations for a gout diet on this website and in my ebook, change your lifestyle to include non-strenuous exercise and you’ll do fine but to get off meds, only your doctor can recommend that. Good luck! and let me know how you do sometime in the future.

  • Maev

    Reply Reply December 29, 2015

    For many years I have been tweaking my diet…diabetes…cholesterol (pills cause me muscle pain..extreme)…and I am ‘A’ allergic..and of course gout…my 1st episode was in my left elbow…pain pills..even strong ones …no help…just ice packs….wound up in hospital….
    I recently discovered…under my own steam…that unsuspecting sugar/fructose was an issue…in certain fruits and veg…I thought I was being healthy…bananas and pineapple are now my two mainstays…
    I have been reading your site for an hour and half now…and bookmarked it…
    I just came to see if there was anyway I could eat tomatoes…and linked on from there….as you do…*G*…

  • Dean

    Reply Reply May 13, 2015

    Hi Spiro

    I was researching Gout and Sugar because a friend sent me an excerpt from the 4 Hour Work Week on Gout and the link to sugar. While I was researching my daughter was reading over my shoulder and saw your name and said it and I saw it as a sign that I should get your book since my name is Couluris and I have cousins in the Syracuse, NY area that spell it Koulouris too – George Koulouris.

    Anyway, great book and I am going to work on incorporating the ACV pills into my regimen and reduce/eliminate sugar. I have had three major attacks in about 18 months and have been taking tart cherry extract pills that have worked great – except when they didn’t. Just went to rheumatologist yesterday and am waiting for blood test results after having to take steroids to bring me back from really bad episode last week. Not on any medicine even though I have a friend who is on it for almost 30 years. Don’t like taking meds.

    I am encouraged but nervous about eating…anything.

    Will finish reading your book and start the ACV – I don’t like smell or taste. I also have reflux and sleep apnea and use a cpap machine. I should also lose weight – 215lbs and 5′ 10″.

    Again, great blog and book. Will keep you posted.


    • Spiro Koulouris

      Reply Reply May 13, 2015

      Hi Dean!

      That’s so cool!

      We may have common ancestry from back in the homeland. You could be my 4th cousin or something!

      Thanks for the comment, I appreciate it!

      Ya for ACV I had reflux many years ago and since I’ve been taking ACV supplement daily, I no longer experience acid reflux and I used to have it bad. If you don’t like the taste then just buy the supplement at your local drugstore or health-food store. As for the weight you know what to do, if you shed it, you’ll be healthier. Try and cut down on your meat intake, I know it’s tough but think about living longer, that should motivate you. Sugar, yes limit it to 25 grams a day and try and get it from fruits mostly. I no longer buy anything with High Fructose Corn Syrup in the ingredients label.

      Have a good one Dean!

      Pleasure to make your acquaintance.


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