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.
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!
A 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.