9 ms·

Started having severe gout attacks in 2004. Doctors are particularly unaware about gout. Despite having extremely painful and long attacks (during one attack, s

by jjav 6y ago

Started having severe gout attacks in 2004. Doctors are particularly unaware about gout. Despite having extremely painful and long attacks (during one attack, spent more than a month in bed unable to walk), all the doctors I saw had no idea despite endless tests. Finally based on my own research I suggested gout and they were like "oh yes, I suppose it could be that". Once diagnosed, doctors are quick to get you on daily drugs for the rest of your life. While these help, there's a price to be paid in liver damage from chronic medication. I spent the next ~8 years bouncing from attack to attack despite the drugs, sometimes every few weeks, sometimes months would go by. Finally around 2012 I stumbled on the work of Robert Lustig (UCSF medicine professor) and particularly this talk (not about gout, but touches on it): https://www.youtube.com/watch?v=dBnniua6-oM https://www.youtube.com/watch?v=dBnniua6-oM Fructose is processed by the body into: uric acid. Finally light bulb moment! I hardly ate any of the things traditionally associated with gout (red meat, shellfish) so couldn't modify my diet based on those. But fructose? Yes, turns out I was consuming way too much. I drastically cut back on fructose, limiting myself to no more than 10g/day. I have been gout-free now for 7 years. I don't take any gout drugs anymore. Just avoid fructose at all cost.

rusk 6y ago
By cutting out “fructose” surely you don’t mean cutting out fruit? Do mean derivatives like fructose syrup and stuff?
- jjav 6y ago
  I avoid fructose, from any and all sources. Yes, it does mean limiting fruits but I eat them in moderation within my self-imposed 10g/day limit. I sometimes go up to 25g/day but only on special occasions no more than once a month or so. Here's one list of fructose content per type of fruit. I mostly stick to the ones with least fructose: http://nograiner.com/ingredients/fructose-content-common-fruits-chart http://nograiner.com/ingredients/fructose-content-common-fru...
  - jkinudsjknds 6y ago
    Were fruits the thing most commonly cut out of your diet though? Most people (Americans at least) don't eat that much fruit, but eat a lot of fructose from other sources.
  - ntsplnkv2 6y ago
    Looking at that list it seems easy to get in one or two servings of fruit a day with that fructose requirement, so long as you don't get it elsewhere. Thanks for sharing.
- AndrewDucker 6y ago
  I don't have gout, but my IBS is set off by fructose, and yes, I've had to drastically cut down on fruit. Fortunately, vegetables are even healthier for you, and don't have significant levels of fructose.
  - simtel20 6y ago
    Since you mention IBS in the context of fructose, are you aware of the the phenomena of fructose malabsorption? My wife has this combination of issues at times, strongly related to eating or drinking of apples or apple juice and other similarly high fructose fruits and extracts like agave.
    - AndrewDucker 6y ago
      Yup. I follow a FODMAP diet and that really works for me.
      - fodmap 6y ago
        I can vouch for the FODMAP diet as well, it really saved me from my daily misery.
    - draw_down 6y ago
      I hadn’t heard of that but I have the same problem when I eat apples. Makes sense now.
- megablast 6y ago
  Exactly. Such a weird thing to write. What were you eating too much of?
- Ragib_Zaman 6y ago
  Most fruit are nowhere near as healthy as most people expect they are. They have been selectively bred over many hundreds of years to be far larger, sweeter and more devoid of micronutrients than they were hundreds of years ago. The amount of sugar (especially fructose) in fruits like apples, oranges and bananas is shockingly high, and can cause or exacerbate conditions such as obesity, fatty liver, type 2 diabetes, gout and other metabolic or inflammatory diseases. Replacing some fruit with vegetables instead, and choosing less sweet fruit like various berries or melons may be a good idea for most people.
  - kleiba 6y ago
    Most national dietary guidelines encourage eating fruits and vegetables, with an emphasis on the vegetables. The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar.
    - HighlandSpring 6y ago
      Most national dietary guidelines are backed by weak epidemiology and are rarely corroborated by RCTs. See: the food pyramid
      - nerdponx 6y ago
        And are instead heavily guided by ag industry lobbyists.
    - nordsieck 6y ago
      > The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar. I think a more precise way to say this is: Due to the water and fiber in fruit, they tend to be more satiating than eating something like a chocolate bar on a calorie normalized basis.
      - 6y ago
- pjc50 6y ago
  High-fructose corn syrup is in a lot of American food.
- zests 6y ago
  The worst offender is fruit juice. It is practically soda with some vitamin C. Suppose I'm from a country that does not have fruits. How do you convince me to start eating them from a health perspective? Fibre is in vegetables and I'm not too keen on increasing sugar intake for no reason.
  - hinkley 6y ago
    Fruit juice removes all of the fructose from the fiber your body has to scrounge through to absorb the sugar. The overall quantity of sugar may be roughly equivalent, but the glass of juice is going to hit your blood stream almost as fast as a can of coke. Probably as fast since a typical bottle of fruit juice is running about 20 calories more than a soda. Also PSA: Watch out for apple juice in your 100% fruit juice. It is at this point a very old industry trick to use apple juice that's concentrated, increasing the sugar content drastically. If you got a press and juiced your own apples, it would taste like flavored water to you compared to the 'worst' case in bottled juices.
ourcat 6y ago
Have you tried Cranberry juice/extract? I've often heard that it can help the body break down the Uric acid.
- LogicX 6y ago
  I hadn’t heard of cranberry - but cherry juice is claimed to help. Never did much for me (diagnosed with Gout a few years ago)
  - jessaustin 6y ago
    Tart cherries (sometimes called Montmorency cherries) are pretty much miraculous gout treatments. I regularly take varying amounts as a prophylactic (I pour the concentrate into other drinks), but back when I was getting acute attacks I could knock them out in an hour if I drank say half a cup of the concentrate. (again, not straight: it's too tart by itself!) There is a local grocery store that carries this concentrate in the refrigerated section, but even the hot-on-the-shelf jugs at GNC seem to work.
stronglikedan 6y ago
> doctors are quick to get you on daily drugs for the rest of your life. When all you really need is an 8oz glass of tart cherry juice per day [0]. If you have "trigger" foods [1], then those still need to be avoided, but the cherry juice will allow you to enjoy a normal, non-excessive diet of pretty much everything else. [0] Sweet cherry juice works too, but you need a lot more of it, to the point where it would be excessive and unhealthy. [1] By trigger foods, I mean those that will cause a gout attack regardless of how much is consumed. For me, it's spinach - as little as one leaf will make my toe sore for a couple of days. Most people never learn their trigger foods, so consider yourself lucky if you know yours.
- gizmo385 6y ago
  Do you have any sources for this?
  - wyldfire 6y ago
    "Consumption of 100% Tart Cherry Juice Reduces Serum Urate in Overweight and Obese Adults" [1] seems relevant. Also, it's not precisely advice for gout, but cherry juice has also been studied [2] for pain relief. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483050/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483050/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874510/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874510/
- ndsipa_pomu 6y ago
  I've had some success with tart cherry juice (Montmorency) as well. I had my first gout attack in my mid-40s - I'm pretty fit and not noticeably overweight (lots of cycling) and got a foot pain that I thought was a small broken bone or some-such. My GP had one look and realised it was gout (red inflammation is a giveaway). Anyway, I just took Ibuprofen and lots of liquid for a few days and it went away. I've had a few minor bouts of it that seem to be brought on by either eating asparagus or mackerel or not drinking enough water, so I tried the cherry juice for a while which seemed to work. After a year or so of that, I thought I'd just try drinking more water instead - that works most of the time though I did have a minor gout episode just last week.

by jjav 6y ago

rusk 6y ago

By cutting out “fructose” surely you don’t mean cutting out fruit? Do mean derivatives like fructose syrup and stuff?

jjav 6y ago
I avoid fructose, from any and all sources. Yes, it does mean limiting fruits but I eat them in moderation within my self-imposed 10g/day limit. I sometimes go up to 25g/day but only on special occasions no more than once a month or so. Here's one list of fructose content per type of fruit. I mostly stick to the ones with least fructose: http://nograiner.com/ingredients/fructose-content-common-fruits-chart http://nograiner.com/ingredients/fructose-content-common-fru...
- jkinudsjknds 6y ago
  Were fruits the thing most commonly cut out of your diet though? Most people (Americans at least) don't eat that much fruit, but eat a lot of fructose from other sources.
- ntsplnkv2 6y ago
  Looking at that list it seems easy to get in one or two servings of fruit a day with that fructose requirement, so long as you don't get it elsewhere. Thanks for sharing.
AndrewDucker 6y ago
I don't have gout, but my IBS is set off by fructose, and yes, I've had to drastically cut down on fruit. Fortunately, vegetables are even healthier for you, and don't have significant levels of fructose.
- simtel20 6y ago
  Since you mention IBS in the context of fructose, are you aware of the the phenomena of fructose malabsorption? My wife has this combination of issues at times, strongly related to eating or drinking of apples or apple juice and other similarly high fructose fruits and extracts like agave.
  - AndrewDucker 6y ago
    Yup. I follow a FODMAP diet and that really works for me.
    - fodmap 6y ago
      I can vouch for the FODMAP diet as well, it really saved me from my daily misery.
  - draw_down 6y ago
    I hadn’t heard of that but I have the same problem when I eat apples. Makes sense now.
megablast 6y ago
Exactly. Such a weird thing to write. What were you eating too much of?
Ragib_Zaman 6y ago
Most fruit are nowhere near as healthy as most people expect they are. They have been selectively bred over many hundreds of years to be far larger, sweeter and more devoid of micronutrients than they were hundreds of years ago. The amount of sugar (especially fructose) in fruits like apples, oranges and bananas is shockingly high, and can cause or exacerbate conditions such as obesity, fatty liver, type 2 diabetes, gout and other metabolic or inflammatory diseases. Replacing some fruit with vegetables instead, and choosing less sweet fruit like various berries or melons may be a good idea for most people.
- kleiba 6y ago
  Most national dietary guidelines encourage eating fruits and vegetables, with an emphasis on the vegetables. The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar.
  - HighlandSpring 6y ago
    Most national dietary guidelines are backed by weak epidemiology and are rarely corroborated by RCTs. See: the food pyramid
    - nerdponx 6y ago
      And are instead heavily guided by ag industry lobbyists.
  - nordsieck 6y ago
    > The sugar amount in fruit has a direct impact on the overall calories you consume but since fruit are also high in fibre, the contained sugar is not comparable to, say, a chocolate bar. I think a more precise way to say this is: Due to the water and fiber in fruit, they tend to be more satiating than eating something like a chocolate bar on a calorie normalized basis.
    - 6y ago
pjc50 6y ago
High-fructose corn syrup is in a lot of American food.
zests 6y ago
The worst offender is fruit juice. It is practically soda with some vitamin C. Suppose I'm from a country that does not have fruits. How do you convince me to start eating them from a health perspective? Fibre is in vegetables and I'm not too keen on increasing sugar intake for no reason.
- hinkley 6y ago
  Fruit juice removes all of the fructose from the fiber your body has to scrounge through to absorb the sugar. The overall quantity of sugar may be roughly equivalent, but the glass of juice is going to hit your blood stream almost as fast as a can of coke. Probably as fast since a typical bottle of fruit juice is running about 20 calories more than a soda. Also PSA: Watch out for apple juice in your 100% fruit juice. It is at this point a very old industry trick to use apple juice that's concentrated, increasing the sugar content drastically. If you got a press and juiced your own apples, it would taste like flavored water to you compared to the 'worst' case in bottled juices.

ourcat 6y ago

Have you tried Cranberry juice/extract? I've often heard that it can help the body break down the Uric acid.

LogicX 6y ago
I hadn’t heard of cranberry - but cherry juice is claimed to help. Never did much for me (diagnosed with Gout a few years ago)
- jessaustin 6y ago
  Tart cherries (sometimes called Montmorency cherries) are pretty much miraculous gout treatments. I regularly take varying amounts as a prophylactic (I pour the concentrate into other drinks), but back when I was getting acute attacks I could knock them out in an hour if I drank say half a cup of the concentrate. (again, not straight: it's too tart by itself!) There is a local grocery store that carries this concentrate in the refrigerated section, but even the hot-on-the-shelf jugs at GNC seem to work.

stronglikedan 6y ago

> doctors are quick to get you on daily drugs for the rest of your life. When all you really need is an 8oz glass of tart cherry juice per day [0]. If you have "trigger" foods [1], then those still need to be avoided, but the cherry juice will allow you to enjoy a normal, non-excessive diet of pretty much everything else. [0] Sweet cherry juice works too, but you need a lot more of it, to the point where it would be excessive and unhealthy. [1] By trigger foods, I mean those that will cause a gout attack regardless of how much is consumed. For me, it's spinach - as little as one leaf will make my toe sore for a couple of days. Most people never learn their trigger foods, so consider yourself lucky if you know yours.

gizmo385 6y ago
Do you have any sources for this?
- wyldfire 6y ago
  "Consumption of 100% Tart Cherry Juice Reduces Serum Urate in Overweight and Obese Adults" [1] seems relevant. Also, it's not precisely advice for gout, but cherry juice has also been studied [2] for pain relief. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483050/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483050/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874510/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874510/
ndsipa_pomu 6y ago
I've had some success with tart cherry juice (Montmorency) as well. I had my first gout attack in my mid-40s - I'm pretty fit and not noticeably overweight (lots of cycling) and got a foot pain that I thought was a small broken bone or some-such. My GP had one look and realised it was gout (red inflammation is a giveaway). Anyway, I just took Ibuprofen and lots of liquid for a few days and it went away. I've had a few minor bouts of it that seem to be brought on by either eating asparagus or mackerel or not drinking enough water, so I tried the cherry juice for a while which seemed to work. After a year or so of that, I thought I'd just try drinking more water instead - that works most of the time though I did have a minor gout episode just last week.