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Gout notes

  • 23 May 2020
  • rob

I’ll describe here what I think are the root causes of gout, and what to do to avoid getting it.

Some background about me:

  • I used to have super high triglycerides (1,000+ mg/dL) which I now know was caused from eating too much carbohydrates, mainly from excessive eating of rice and fruits.
  • I cured my triglyceride problem by strictly following the paleo diet for one month: cut out the rice and carbs, and ate mostly meat and eggs. After a month of strictly following paleo diet, my triglyceride level tested at 135 mg/dL. Seeing the results changed the way I thought about a lot of things. Low carb diets really work.
  • Even when I had super high triglycerides, everything else was normal: blood sugar, blood pressure, HDL, LDL, etc. I’ve never had high blood pressure even during my time with 1,000+ mg/dL triglycerides, which was weird. I attribute this to my practice of drinking a lot of tea since 1997, and in later years, both coffee and tea.
  • Despite following the paleo diet, my uric acid level still remained a bit higher than normal. But this didn’t concern me much.
  • I’m in my mid-forties, skinny (130 - 145 pounds), and I do calisthenic exercises in the form of pushups, pullups, squats, crawling. I consider myself fit, but not necessarily healthy because of my past experience with high triglycerides.
  • My (recently deceased) father also had history with gout and diabetes.

Three years ago (2017), I had my first gout attack near the inner foot. It did not hurt that much, and I still was able to go to work and walk with minimal pain. That lasted for a week. I suspect a combination of consuming high carbs and lack of sleep caused the gout attack.

Two months ago (March 2020), I had a very severe, extremely painful gout attack on my left foot that left me bedridden and unable to walk for a week and a half. It was the most painful thing I’ve ever experienced.

For the past two years prior to my March 2020 gout attack, I had started consuming alcohol (beer, red wine, whiskey), around 1-2 glasses a day, sometimes more. I had started drinking alcohol for health reasons. Since I’ve been drinking, I stopped getting colds and sore throat, and generally felt more resilient to bacteria and viruses.

Looking back, I think a combination of consuming high carbs, mostly in the form of white rice, and alcohol (beer, wine, whiskey) caused my severe gout attack. But at the time I had it, I had no idea what caused it or what to do.

Two weeks ago (early May 2020), I had another gout attack, this time on my inner right foot, but much lighter, not too painful, and I was able to walk and function with minimal pain. This alarmed me because I was scared of getting another severe one, similar to last March, and I didn’t want to get bedridden again.

Present day (May 2020), after seeing some tweets from P.D. Mangan and some of his twitter followers who cured their gout, I do the following to prevent gout. So far I think it’s working (gout has receded), but only time will tell if this is a complete solution:

  • Low carb diet - stop eating rice, bread, all starches.
  • No sugar - I’ve never been a dessert guy, so not much change here.
  • No alcohol - I cut out the alcohol because I read one study (see below) that consumption of (a) fructose, and (b) alcohol causes the body to lessen the excretion of uric acid.

I believe that the main cause of gout is that the body is not able to excrete uric acid. To avoid/eliminate gout, do things that help your body to excrete uric acid.

Most gout articles say to reduce the intake of purine-rich foods (meat, etc.). But from experience, I found this not to be true. It’s not the high-purine food, it’s the carbs and alcohol. Or carbs AND alcohol taken together.

In the same study I read, there’s a brief passage which states that drinking alcohol while fasting will increase the effect of alcohol in reducing the rate of uric acid excretion. When I read that passage, I knew right away what caused my severe gout attack last March - it was drinking whiskey while fasting - something I would frequently do. I do lots of intermittent fasting, while consuming coffee/tea/whiskey during the fasting period.

Right now, I still feel a slight gouty feeling in my inner right foot. I’m waiting for it to be gone completely before going back to consuming alcohol.

For now, I’m strictly following a low carb diet: no rice or bread or starches. And also strictly no alcohol of any kind. So far it’s working.

Here’s the scientific study I read which provided me the breakthrough on fixing my gout: Hyperuricemia Induced by Alcohol (pdf)

Here’s also my twitter thread describing my findings based on the study, and what I did. I reproduced the text below:

Interesting Gout/Alcohol study:

1. Alcohol consumption increases blood lactate, which lessens rate of uric acid excretion by kidneys.
2. When fasting, smaller amounts of alcohol are needed to produce this effect.
3. Amount of alcohol consumed is relevant.

Another study correlates fructose (sugar) consumption with gout. Fructose consumption results in decreased uric acid excretion.

It looks like the chief cause of gout is the decreased kidney function of excreting uric acid. Purines consumption is not the main factor.

In other words, to lessen gout attacks:
- Eliminate or consume less fructose. (Or follow a low carb diet in general perhaps?)
- Eliminate or consume less alcohol. (Alcohol has other health benefits though, so that's one sticking point.)


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