Gout

Gout is a metabolic disease in which the level of uric acid in the body increases and its crystals deposit in the joints, causing pain, swelling, and inflammation. The joint of the big toe is most often affected, but over time, the knees, elbows, and other joints may also be involved.

Contrary to outdated beliefs, gout does not arise from meat but from metabolic disorders associated with excessive consumption of carbohydrates and fructose.

The True Causes of Gout

The main mechanism is chronic insulin resistance and excessive carbohydrate consumption. Under these conditions, the body is unable to effectively excrete uric acid, and its production increases.

The main causes include:

• excessive consumption of fructose (fruits, honey, juices, sweet drinks);
• high-carbohydrate diet causing constant insulin spikes;
• insulin resistance, metabolic syndrome, and fatty liver disease;
• dehydration and sodium deficiency – the body retains uric acid in an attempt to hold onto water;
• deficiency of magnesium, potassium, and B vitamins involved in energy metabolism;
• use of diuretics, aspirin, or beta-blockers that reduce uric acid excretion by the kidneys.

How Fructose Increases Uric Acid

Fructose does not store as glycogen but is instantly phosphorylated in the liver, consuming ATP. This leads to the accumulation of AMP, which quickly converts to hypoxanthine, xanthine, and then to uric acid. At the same time, insulin levels rise, which in turn blocks the excretion of uric acid by the kidneys.

This is why people who consume a lot of sweets and fruits develop hyperuricemia even without excess meat or protein.

Why Meat and Proteins Are Not to Blame

Purines are found in all living cells – not only in meat but also in vegetables, grains, nuts, and even bacteria. The body can utilize them without pathological accumulation if glucose and insulin metabolism works correctly.

The problem arises not from protein but from the energy shift – when cells live on glucose and fructose instead of fats and ketones.

This is why limiting meat does not solve the problem of gout and can sometimes even exacerbate amino acid deficiency and muscle weakness.

Symptoms and Manifestations

• sudden sharp pain and swelling in the joint, often at night;
• redness of the skin and a feeling of heat in the area of inflammation;
• limited mobility;
• recurring attacks, often after a hearty dinner or alcohol consumption;
• in chronic cases – formation of tophi (nodules of uric acid crystals).

Diagnosis

• blood test for uric acid levels;
• assessment of kidney function, glucose, insulin, and lipid profile;
• microscopy of joint fluid to identify uric acid crystals;
• ultrasound or X-ray of joints to assess tophi and inflammation.

How Diet Affects the Course of Gout

Switching to a low-carbohydrate diet and avoiding fructose is a key step in reducing uric acid.

On a ketogenic diet, the body derives energy from fats rather than sugar, and uric acid levels gradually decrease. During this time:

• insulin levels decrease, and the kidneys begin to excrete uric acid better;
• inflammation and oxidative stress decrease;
• gout attacks disappear, and purine metabolism normalizes.

Recommendations for Gout

• eliminate sweet drinks, juices, honey, and fruits high in fructose;
• reduce the share of starchy foods (bread, potatoes, rice, cereals);
• consume enough water with a pinch of salt – to improve urate excretion;
• include foods rich in magnesium, sodium, vitamin C, and omega-3;
• eat meat, fish, eggs, and fats in reasonable amounts, without restricting protein without indications;
• control body weight and avoid overeating.

The Role of Ketogenic Diet

During ketosis, uric acid levels may initially rise temporarily as ketones and urates compete for excretion by the kidneys. But after 1-2 weeks, the kidneys adapt, and uric acid levels steadily decrease.

In this state, the body virtually does not produce uric acid, as it does not break down ATP through the fructose pathway.

Conclusion

Gout is not a “meat disease,” but a consequence of chronic excess of carbohydrates, fructose, and insulin. Switching to a ketogenic diet, adequate water and sodium intake, restoring mineral balance, and eliminating insulin resistance can fully stabilize uric acid levels and prevent recurrent attacks.

Controlling carbohydrate metabolism and returning to fat metabolism is the physiological way to get rid of gout and related metabolic disorders.