Type-2 Diabetes and Gout

alcohol arthritis diet fatty liver fructose glucose glycogen gout high-fructose corn syrup insulin resistance kidneys medications obesity purines sugar type-2 diabetes uric acid Aug 31, 2024

Gout currently affects about 9 million adults in the U.S., making it one of the less common chronic diseases today. But the condition has dogged the human race for a long time.^1,2

It’s been observed in 4,000-year-old mummies from Egypt.²

And it seems to have been first accurately described by Hippocrates about 400 B.C.²

Today, many people still link it to the famous English king Henry VIII’s opulent lifestyle. Some continue to call it the “disease of kings.”²

Throughout its long history, gout has been linked to overindulgence in rich foods and alcohol. It’s widely considered an embarrassing condition to have.³

The social stigma of gout may discourage patients from getting the treatment they need. If left untreated though, the disease can lead to complications like cardiovascular disease and kidney stones.²

In this article, we’ll describe exactly what gout is, and how it has become more prevalent over the years. We’ll also unravel the connection between gout and another much more common condition — type-2 diabetes (T2D):

What is gout?
What causes gout?
The fructose-uric acid connection
Insulin resistance, T2D, and gout

Let’s get the ball rolling with Gout 101.

What is gout?

Gout is a highly painful type of inflammatory arthritis that causes joint pain and swelling. Most often, it affects the joint at the base of your big toe. But it can affect your other joints too, such as your knees, ankles, wrists, and elbows.^4,5

Intense pain isn’t the only symptom of gout. With this condition, your joint may get red or discolored. It may feel stiff or tender, even when touched lightly. It may feel warm as well, as if your joint is on fire.⁴

Symptoms of gout typically come and go. Gout flares or attacks can occur suddenly — often at night — and usually last for a week or two.^4,5

Gout happens when excess uric acid builds up in your body. Your body naturally produces uric acid when it breaks down chemicals known as purines.⁴

Normally, your kidneys remove uric acid from your blood. You then excrete the substance through your urine.⁴

But if your body produces too much uric acid, or your kidneys don’t filter it out quickly enough, uric acid accumulates in your blood.⁴

High uric acid levels in your blood can make uric acid crystals build up in your joints. These crystals have sharp edges, and as they clump together, you experience sudden pain, swelling, and other symptoms of gout.⁴

Not everyone who has high levels of uric acid develops gout. That said, the higher your uric acid levels, the higher your risk of gout.^4,5

What causes gout?

Genetic, physiological, and environmental factors can all contribute to high uric acid levels.^4,6

Changes in some of your genes can make your body reabsorb uric acid more and release less of it through your pee.⁶

Age and sex play a role too. If you’re male, you're likely to have higher uric acid levels than women do. This means you’re more prone to gout at an earlier age — that is, from ages 30 to 50. Meanwhile, if you’re female, your uric acid levels will near those of men — and you’ll be more likely to develop gout — after you reach menopause.⁵

Environmental contributors include medications — in particular, low-dose aspirin, drugs for hypertension (high blood pressure), and anti-rejection drugs for organ transplants.⁵

In addition, being overweight or obese makes your body produce more uric acid, and at the same time hinders your kidneys from filtering it out.⁵

Finally, your diet is a key factor. Your uric acid levels increase when you consume foods and drinks rich in purines. Examples of such foods are red meat (including beef, pork, and lamb); certain fowl (especially goose and turkey); organ meats (liver, tripe, brains, and kidneys); and certain fish or seafood (herring, codfish, mussels). As for drinks, alcohol is a well-known culprit.⁴

But by far, sugary foods and drinks are the most common (though probably least known) offender. In the past, only the rich could afford these items because sugar was expensive. Nowadays though, these foods are widely available to the general population — which partly explains why gout has become more prevalent today.^7,8

So, how do sweetened foods and beverages increase uric acid and lead to gout? The answer lies in their high fructose content.⁹

The fructose-uric acid connection

Fructose is a simple sugar naturally found in fruits. It’s also the main ingredient in high-fructose corn syrup (HFCS). Today, many processed foods and beverages contain HFCS, making it easy to consume fructose in excessive amounts.¹⁰

When your body metabolizes fructose, it produces purines. And as described earlier, the breakdown of purines yields uric acid.¹¹

Plus, fructose helps degrade adenosine triphosphate (ATP) — a molecule that serves as your cells’ energy currency — into adenosine monophosphate (AMP). AMP, in turn, is converted to uric acid. As a result, uric acid levels in your blood rise within minutes of consuming fructose.^12,13

But there’s even another way fructose increases uric acid in your body and promotes gout: insulin resistance.¹³

Insulin resistance, T2D, and gout

Insulin resistance is fairly well known as the precursor to T2D. The high occurrence of gout in people with T2D is the result of several factors involving insulin resistance.^14,15

Insulin resistance makes your body produce a substance called 5-ribose phosphoric acid (R5P) when you break down glucose for energy. R5P is a precursor to purines, and thus, uric acid.^16,17

Plus, when you’re insulin-resistant, it’s common to have higher-than-normal levels of insulin in your blood. This situation encourages your kidneys to reabsorb uric acid instead of eliminating it.¹⁶

One of the most common (though less well known) causes of insulin resistance is a fatty liver. Fat in your liver also enhances the breakdown of purines, and therefore your blood uric acid levels.^9,16

Your liver processes most of the fructose that you consume. To be exact, converts fructose into the simple sugar glucose (your body’s main source of energy) and glycogen (the stored form of glucose).^10,18

The amount of glycogen that your liver can store is limited. Once your glycogen stores are full, any excess fructose gets converted into liver fat. So, consuming excess fructose — as HFCS or from any other source — leads directly to fatty liver, insulin resistance, and perhaps gout.^9,10,19

Conclusion

Gout, a form of inflammatory arthritis, causes pain and swelling in your joints — most often, the one in your big toe — due to a buildup of uric acid in your body.

Many factors, including your diet, contribute to raising uric acid levels in your blood. Consuming too much fructose deserves special mention, considering how ubiquitous fructose (as HFCS) is in today’s foods and beverages.

Over time, excess fructose in your body causes a fatty liver, which then results in insulin resistance.

Insulin resistance increases your uric acid levels and makes you more prone to gout in two ways — first, by enhancing your purine metabolism; and second, by hindering your kidneys from excreting uric acid.

But let’s not forget: Insulin resistance drives T2D as well.

Want to prevent or reverse insulin resistance — and thus, T2D, gout, and many other health problems? Limiting your fructose intake is the ticket.

Need help eliminating fructose from your diet? Sign up for the Diabetes Diet Solution now.

References

Type-2 Diabetes and Gout

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