Is Sugar a Risk Factor for Gout? Find Out Now!

March 16, 2024

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Gout arises from excess uric acid accumulation, causing painful swelling in joints. Sugar influences gout in several ways – directly promoting uric acid production, indirectly fueling inflammation, and spurring obesity. Understanding how various sugars impact gout provides a framework for making informed diet choices to better manage the disease.

How Does Sugar Relate to Gout?

The link between sugar and gout occurs via multiple pathways:

  • Fructose Metabolism – Fructose breaks down into uric acid, driving production.
  • Cellular Inflammation – Sugars trigger inflammatory pathways, worsening flares.
  • Fat Storage – Excess sugar calories promote obesity, itself a gout risk factor.

These mechanisms create a perfect storm, whereby sugar intake uniquely elevates both urate levels and attack risk.

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Why is Fructose Worse for Gout?

Of all sugars, fructose possesses the greatest gout risk. The body handles fructose differently than glucose and other carbohydrates. Specifically, the rapid liver metabolism of fructose generates various intermediaries that boost uric acid production.

Additionally, fructose metabolism depletes cellular ATP energy stores. The resulting AMP then further drives uric acid formation. This combination of direct and indirect mechanisms means even small amounts of fructose substantially worsen hyperuricemia.

Sources of Fructose in the Diet

Understanding common sources of fructose allows those with gout to make informed food choices:

High Fructose Corn Syrup

This ubiquitous sweetener made from cornstarch contains up to 90% fructose. It is found in sodas, juices, sauces and thousands of processed foods. Just 8 ounces of a HFCS-sweetened soda may contain 25 to 30 grams of fructose.

Fruit and Fruit Juice

Even natural fruits contain fructose, with juices, mangoes, apples and cherries being especially high. Fruit still carries nutritional benefits in moderation, though juices tend to have less fiber and more concentrated sugar.

Honey and Maple Syrup

Although perceived as wholesome natural sweeteners, both honey and maple syrup contain at least 50% fructose with negligible fiber. Just two tablespoons of honey has 30 grams of fructose.

Agave and Brown Rice Syrups

Trendy sweeteners like agave and brown rice syrups contain comparably high amounts of fructose as high fructose corn syrup. Despite alternative origins, their metabolism likely impacts gout similarly.

Multiple studies have now linked higher intakes of sugar-sweetened foods and beverages to elevated incidence of gout. For example:

  • Sodas – Men drinking 2 or more sodas daily had an 85% increased gout risk compared to less than 1 per month. For sugary fruit drinks, the heightened risk reached 45%.
  • Candy – Every additional daily serving of candy raised gout incidence by 35% in men. Jelly beans and lemon drops appeared most contributory.

Further research is needed to clarify differential roles of various sugars. Nevertheless, current data supports limiting high intakes among those battling frequent gout attacks.

Why Do Simple Sugars Worsen Inflammation?

Sucrose, dextrose and other simple sugars strongly impact inflammation pathways. Consuming these carbohydrates rapidly raise blood glucose and can indirectly spur inflammatory flares through several mechanisms:

  • Advanced glycation end products (AGES) formed
  • Reactive oxygen species production triggered
  • Pro-inflammatory NF-kB and NLRP3 pathways activated
  • Insulin, leptin and other hormone disruptions induced

So while not directly increasing uric acid like fructose, large amounts of sugars still negatively impact gout.

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Do Artificial Sweeteners Increase Gout Risk?

In contrast to sugar, most studies suggest commonly used artificial sweeteners like aspartame, saccharine and sucralose do not worsen gout or raise uric acid levels.

A 2019 study found that individuals substituting one daily serving of sugar-sweetened beverage with an artificially sweetened one had a statistically significant 9% lower risk of developing gout. This suggests smart swapping sugars for non-nutritive sweeteners could benefit those prone to gout.

Why Limit Sugar When Losing Weight with Gout?

The interplay between obesity, poor glucose metabolism and gout means diets lowering both weight and blood sugar provide excellent holistic therapy:

  • Up to 75% of gout patients are overweight
  • Fat cells increase inflammation and insulin resistance
  • Hyperinsulinemia reduces kidneys’ uric acid excretion
  • Fatty liver itself impairs uric acid processing

Therefore, refined carbohydrates spurring fat storage and glucose spikes indirectly worsen gout control in those struggling with excess weight.

What is the Best Gout Diet Approach?

When considering sugar’s impact on gout, the most rational dietary approach involves:

  1. Avoiding high fructose intake from processed foods, sweetened beverages and concentrated sugars like honey and syrups.
  2. Eating whole fruits in moderation due to their additional nutrients and fiber.
  3. Minimizing refined flours/grains, sugar/syrups, as the resultant surges in blood glucose and inflammation remain counterproductive.
  4. Employing alternative sweeteners prudently – sugar alcohols, stevia, erythritol and aspartame appear the safest options.
  5. Pairing the above with an overall gout-friendly low purine diet higher in vegetables, whole grains, legumes, dairy, eggs and vegetable-based proteins.

Adjusting the diet to control both uric acid production and systemic inflammation makes the most sense scientifically when attempting to prevent debilitating gout flare ups.

Takeaway Points: Sugar and Gout

In summary, key high-yield pearls regarding sugar’s role in gout:

  • High fructose intake strongly incites gout attacks by directly raising uric acid levels
  • Sodas, juice and processed foods are common culprits containing risky sweeteners like high fructose corn syrup
  • While less direct, large amounts of dietary refined sugars worsen cellular inflammation
  • Artificial sweeteners are suitable alternatives not clearly shown to negatively impact gout
  • Added sugars should be substantially limited in any gout diet, with attention to managing both uric acid levels and inflammation

A nuanced approach targeting reduction in sweeteners, refined grains, and high glycemic foods provides the best odds of dampening gout attacks triggered by sugar.

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Frequently Asked Questions

Is fructose from fruit dangerous for gout sufferers?

While fruits do naturally contain fructose, they tend to pose less risk than fructose-rich processed foods and beverages. The fiber, antioxidants and phytonutrients in whole fruits likely buffer negative impacts on uric acid levels. Moderation remains key however, as excess will vary by individual.

Should those with gout avoid desserts and baking?

Baked goods do undergo unique chemical reactions forming intermediaries called advanced glycation end products capable of provoking inflammation. Nevertheless, enjoying sweets modestly does not need to be fully avoided in a healthy gout diet. Spotlighting ingredients like nuts, whole grains, Greek yogurt and dark chocolate makes for smarter choices.

Can eating too much sugar actually trigger a gout attack?

Yes – directly and indirectly. Lab experiments confirm large sugar doses rapidly increase uric acid. And in those with preexisting gout, sudden surges of glucose and insulin can clearly serve as instigating factors that provoke acute inflammatory arthritis flares through cell signaling disturbances.

Is table sugar considered safer compared to high fructose corn syrup for gout management?

Sucrose found in white granulated sugar contains a 50/50 ratio of glucose and fructose. This makes it incrementally better than high fructose corn syrup skewed more towards pure fructose. However, smart restriction of all added and concentrated sugars makes for good preventative medicine when dealing with recurrent gout.

Should fruit juice be avoided if aiming to prevent gout attacks?

Most experts recommend limiting fruit juice intake to no more than 4-6 ounces daily in those with gout. While fruit juice contains helpful plant nutrients and antioxidants, concentrations of fructose in juice often approach levels similar to sodas. Overall, emphasizing whole fruits over their juiced derivatives provides better dietary balance.

References

  1. Rai, S.K., Fung, T.T., Lu, N., Keller, S.F., Curhan, G.C. and Choi, H.K., 2017. The dietary approaches to stop hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ, 357, p.j1794.
  2. Major, T.J., Dalbeth, N., Stahl, E.A. and Merriman, T.R., 2018. An update on the genetics of hyperuricaemia and gout. Nature Reviews Rheumatology, 14(6), pp.341-353.
  3. Batt, C., Phipps-Green, A.J., Black, M.A., Cadzow, M., Merriman, M.E., Topless, R., Stamp, L., Dalbeth, N. and Merriman, T.R., 2014. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout. Annals of the rheumatic diseases, 73(12), pp.2101-2106.
  4. Choi, H.K., Gao, X. and Curhan, G., 2009. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis & Rheumatism, 59(1), pp.109-116.
  5. Garrel, D.R., Verdy, M., PetitClerc, C., Martin, C., Brule, D., Hamet, P. 1991. Milk-and-dairy-product-induced gastroenteritis and hyperuricaemia in lactose malabsorbers. Lancet. 337(8735):114–116.
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