Gout Uric Acid
I’d like to add gout as another area that Dr. Kats can give us advice on. Gout causes problems for a... View more
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Reply To: Gout: Try, Try Again
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“Elevated insulin inhibits uric acid clearance and excretion. This observation has been made in healthy people and in those with hypertension. The kidneys are especially sensitive to insulin—something easily demonstrated by the effect of insulin on blood pressure: the ‘anti-natriuresis’ action (inhibition of sodium excretion) partly accounts for the role of hyperinsulinemia in hypertension. Elevated insulin increases retention of uric acid as well as sodium.”
Effect of insulin on uric acid excretion in humans
https://sci-hub.ru/https://doi.org/10.1152/ajpendo.1995.268.1.E1…
“Interestingly, evidence suggests higher protein intakes are not associated with increased risk for gout. A paper in The New England Journal of Medicine [see below link] noted that high-protein diets are associated with increased excretion of uric acid and may reduce blood uric acid level. One small study in Caucasian men with gout showed that a proportional increase in protein intake to 30% of calories (along with other dietary changes such as reduced carb intake [to 40% of calories] and emphasis on unsaturated fats) led to a significant reduction in serum uric acid and rate of gout attacks.”
Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men
https://www.nejm.org/doi/full/10.1056/nejmoa035700… ^ but this is NOT high-protein / Atkins diet, rather, efficiently with glutamine (+ niacin) …
“In a small study of overweight or obese subjects, a high-protein diet—actually referred to by name as the Atkins diet—resulted in dramatic decreases in fasting insulin (cut nearly in half) along with lower UA levels, with those with the highest UA concentration experiencing the greatest decrease. Additionally, triglycerides fell by nearly 25% and HDL-cholesterol increased slightly, all indicative of improved insulin sensitivity. The study’s conclusion was clear: ‘Our findings suggest that the Atkins diet (i.e., a high protein diet without calorie restriction) can reduce SUA levels despite substantial purine loading.’
So it seems that increased dietary protein intake may actually be beneficial for individuals with gout—provided that carbohydrate intake is reduced. In noting that dietary advice for people with gout typically calls for limiting protein and encouraging ‘the unlimited use of several food substances high in carbohydrate,’ the authors of a study cited above concluded, ‘Current dietary recommendations for gout may need re-evaluation.’
The underlying pathology of elevated insulin in gout is echoed by findings that serum uric acid levels positively correlate with erectile dysfunction, which in some men may come from chronic hyperinsulinemia. Women with PCOS have been shown to have higher uric acid levels compared to controls as well, even after adjusting for BMI. It’s time to recognize that modern dietary patterns are contributing to gout, but not in the way we once may have thought.”
High-Protein Diet (Atkins Diet) and Uric Acid Response
https://acrabstracts.org/abstract/high-protein-diet-atkins-diet-and-uric-acid-response/…
Gout and Diet: A Comprehensive Review of Mechanisms and Management
https://www.mdpi.com/2072-6643/14/17/3525/pdf…
“Consumption of animal protein and seafood had been linked with elevated hyperuricaemia prevalence, whereas soy product consumption was related with decreased hyperuricaemia prevalence among middle-aged Chinese men [35]. Uric acid concentrations accelerated following fructose-rich food intake, that triggers uric acid formation by accelerating ATP degradation to AMP, a urate precursor [36] including an enormous quantity of purine intake [37]. Purine-rich food consumption is connected with both the incident and acute gout events.”
Functionalities of Purines in Health and Disease
https://zenodo.org/record/2548176
…Role of NifS in maturation of glutamine phosphoribosylpyrophosphate amidotransferase
https://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=943D2DFF329EC422D98A92C646C95CB2?doi=10.1.1.612.6102&rep=rep1&type=pdf…
“These results indicate that the urea and TCA cycles as well as amino acid metabolism were highly activated in the RA group compared with the non-RA group consisting of AS, BD, and gout patients. In addition to citrulline, succinate, asparagine, [low] glutamine, and lysine can be considered as major biomarkers for RA diagnosis.”
Global Metabolite Profiling of Synovial Fluid for the Specific Diagnosis of Rheumatoid Arthritis from Other Inflammatory Arthritis
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0097501So basically gout = pretty prolonged unaddressed flush niacin + glutamine deficiency, with some diet items then leading to outbreaks erratically given these deficiencies.