The Resurgence of Gout (joining obesity, diabetes and heart disease)

The IHT has an article about the increasing prevalence of gout in the middle class and how this resurgence is a mystery to modern medicine, requiring new drugs, new treatments, etc.

Except that it shouldn't be a mystery at all. In historical times, gout was the affliction of the rich, caused by:

"Indulging the appetite in rich foods, sweet wines, and malt liquors, with defective muscular exercise, is a prolific source of the disease, and occurs more frequently among the wealthy classes. It is not rare, however, to find gout among the poorer classes, who drink large quantities of malt liquors, and whose food is insufficient in quantity and quality."

As our modern diet has evolved, the "Standard American Diet" has shifted to nutrient poor processed foods containing added sugars, simple starches (indistinguishable from sugars in the gut), and vegetable sources of fat. Examine the macronutrient profiles of a modern, largely processed-food diet and the "rich, sweet foods and drinks" diet of the wealthy in times past. See if you can find a substantial difference. I can't. A diet high in fructose, specifically, seems to be the common factor.

People with gout don't need a drug, they need sound dietary advice*, and the real issue is how many people in the US are priced out of implementing that advice.

* Some sound dietary advice:

• Eat more whole foods (eggs, skin-on chicken, untrimmed beef, dairy, vegetables, fruit).


• Don't buy anything with words you don't understand in the ingredients list.


• Added sugar is dangerous, and sugar has a lot of names.
  
  
  • Corn Syrup (corn solids, HFCS, high-fructose corn syrup).
  
  
  • Concentrated grape/apple juice.
  
  
  • Any of the many "-ose" chemicals (dextrose, maltose, galactose, fructose, glucose).
  
  
  • refined sugar (sucrose, sugar, table sugar).
  
  
  • natural sugar (honey, cane juice, agave nectar, maple syrup).
  
  


• Avoid sugars and starches while avoiding grains and pulses in general.**


• Consume only small quantities of soy, and limit that to fermented soy products (soy sauce, tempeh, natto).**

** These two items, and a few missing items, are important. Most people, including any registered dietician, would also be forced to include at least one mention of "low fat" and one mention of "high fiber", usually while mentioning "whole grains"... For now, I'll just say that this controversy deserves it's own discussion, separate from whether people getting gout is suprising.

For now, I'll just put in a mildly controversial book recommendation.

Mystery solved! Which just leaves the mystery about Andrew Pollack (the author of the IHT article) not figuring this out or the IHT editor letting this article be published without any mention of a better solution than yet another drug.