Disclaimer: I’m not a doctor, I only play one on-line. Obviously none of this should be considered as medical advice – but it does provide a starting point if you want to be one of “those people” and do your own research. How that became a pejorative…
Music to read by:
- As Embers Dance in Our Penis. I mean “Eyes”. “Dance in Our Eyes”
- One Thousand Fires if you prefer
- I was going to just link the entirety of “2112”, but that would only give Threedoor and/or MikeS pain in their penis, not the rest of you fine folk with actual musical taste.
Why am I writing an article on gout? Damned if I know. But someone here mentioned ‘gout’ in the comments recently and I have an entry in my ‘Random Thoughts’ collection/notes: “Gout; red meat? Fuck Off”. I don’t know what that means. Maybe it was mentioned in the comments not to eat meat with gout. Or I recalled hearing about meat causing gout and the comment triggered my gag-reflex. Anyway, there the note sat and I started writing. And it got long. So out of the ‘Random Thoughts’ bin and into stand alone. Does remind me I need to throw out some random thoughts, I can probably get one set of 3 brain farts/Items out of the 8 remaining notes. But for now. Gout.
So the key question, or at least the one I set out to research is: Does red meat cause gout? Probably a good idea to start out with “what is gout?”.
Gout is a type of inflammatory arthritis caused by the accumulation of uric acid crystals in joints – Figures 1 and 2. Roughly 50% of cases occur in the big toe, but it is also commonly seen in finger joints and other joints in the extremities. The proximate cause is the precipitation of uric acid crystals from uric acid in solution in the blood. Since the ability of a substance to stay in solution if generally inversely proportional to its concentration, the precipitation of crystals will occur with elevated serum uric acid. Elevated serum uric acid can also lead to direct precipitation in the urine, facilitating the formation of the calculi responsible for kidney stones. So the direct proximate cause of gout might be thought to be elevated serum uric acid.
Of course, proximate cause doesn’t necessarily tell you anything about root cause, though it can hint at what questions to ask to get to root cause. But we often only deal with a proximate cause – which can often actually mask an underlying fault that will in the long run lead to a much worse outcome. An obvious example in the same space as gout is Type II diabetes – treating the proximate ’cause’ of elevated blood glucose simply masks the underlying root cause of metabolic dysfunction and insulin resistance. In the case of Type II, dealing with the proximate cause/symptom via dosing of insulin is especially pernicious since that exacerbates the root cause.
So what is the root cause of gout, e.g. what is the root cause of the precipitation of uric acid crystals into joints? If it is elevated serum uric acid, what is causing that elevation? Even further, is elevated serum uric acid sufficient on it’s own to cause gout or is it necessary, but requires further conditions to manifest in the ‘disease’? Those are the kind of questions that started bouncing around in my head when y’all triggered me to think about gout; especially since it’s very common to implicate my precious meat in root cause. My precious meat gets implicated in many, many societal ills.
So lets start there – if high serum uric acid is one of the proximate causes of gout, it would logically follow that the root cause probably has some relation to uric acid production. One of the pathways to uric acid production is via the breakdown of purines since one of the byproducts of the complex pathway for processing purines is uric acid. Purines are nitrogenous bases (adenine and guanine) and are the fundamental structural units of genetic code. Purines are, among other structures, essential for building and maintaining DNA and RNA (along with other crucial signaling and bio-molecules including ATP, AMP). Shorter, you don’t want to get rid of purines.
The reasoning goes, if you have ‘excess’ purine intake, one might naively expect the possibility of elevated serum uric acid. Why do I say naively? Because it is susceptible to the usual 0th order thought about complex systems – eat more get more. See e.g. the assumed (and not well supported) connection of dietary cholesterol to serum cholesterol. There is no reason to necessarily assume that, in an otherwise healthy individual, increasing dietary purine intake will necessarily lead to higher serum uric acid, let alone whether said elevation in a healthy individual will lead to an increase in the incidence of gout. That sort of logical connection of high purine (e.g. via dietary intake) leading to elevated uric acid is why we are cautioned that red meat, seafood, organ meat cause gout. They are high in purines, so your body will use what it needs and any excess will be processed and broken down creating high serum uric acid, leading to gout, so the reasoning goes.
Part of the link of high meat diets to gout comes from the historical association of gout with wealth, a ‘rich mans disease’. The wealthy could afford more meat, ergo meat causes gout. Of course what else did the wealthy have access to? Well sugar and refined carbohydrates, both of which, when consumed in excess (value of ‘excess’ TBD), can lead to metabolic dysfunction and perhaps thereby facilitate high uric acid – or manifest other conditions that force serum uric acid to behave pathologically – leading to gout. One obvious problem with this plausible scenario (among many) is that, in the modern era, red meat consumption has largely fallen (unfortunately, people actually do what “experts” – a group that is currently seemingly comprised mostly of people who are good at repeating what they’ve been told in an authoritative fashion without any real knowledge or understanding – tell them to do) while incidence of gout has risen (see Figure 3). Hard to reconcile with red meat as a root cause of gout. Consumption of other foods high in purines – seafood, organ meat, etc. – is, in the United States at least, relatively low and steady, so also an unlikely culprit. Incidentally, essentially all foods contain purines, it’s just that meat and seafood are on the high end. Ascribing higher rates of gout to increased dietary purine requires some model fine tuning – humans evolved on the fine tipping point of dietary purine intake such that changes in the relative consumption of macros, changes that occur all the time over evolutionary timescales as environmental conditions change, tip us over into disease; not a very robust evolutionary pathway.
So what other factor, one that is not subject to evolutionary pressure, e.g. something very new to humans, could we look at for root cause? What one can see in Figure 3 is that, contra red meat consumption, sugar consumption has risen with gout incidence – maybe even down to the detail of a small drop in both recently, though new data will have to bear that out or refute. Yes, correlation on a plot is NOT causation. But you might want to least think about whether there’s a plausible mechanism and do some more careful study.
To the question of mechanism, there is ample evidence to indicate that sugar is a plausible root cause. Common table sugar – sucrose – includes glucose and fructose at a 50/50 ratio. High fructose corn syrup can contain up to 55% fructose. That small increase in percentage and the fact that a fructose and glucose molecule have the same caloric value – why are we always so focused on calories, something our bodies know nothing about? – is why some people have dismissed concerns about fructose and high fructose corn syrup in particular in the past. However, even though they have the same chemical formula – C6H12O6 – they are structurally different with glucose being a 6 member carbon ring with an aldehyde functional group and fructose a 5 member carbon ring with a ketone functional group – see Figure 4.
Those structural difference determine how they are processed in the body and hence their relative metabolic impact. Both are absorbed into the bloodstream through the small intestine. However, while glucose can be processed in any cell (including the liver), fructose is shunted directly to the portal vein and almost exclusively processed in the liver (incidentally part of the reason fructose is implicated in non-alcoholic fatty liver disease). Even more importantly, glucose processing is a strictly ‘rate’ limited process. The enzyme phosphofructokinase (PFK) is the rate limiter, required in the early phases of the glycolysis (conversion to usable energy) of glucose. If the energy currency the cell, ATP, is high, the action of PFK will be inhibited and glycolysis suppressed so glucose will go into limited storage (muscle or liver glycogen) or long term storage (fat cells). On the other hand, the glycolysis of fructose (fructolosis?) in the liver has no rate limiting step; PFK is bypassed and not involved in the fructose pathway, rather the primary enzyme is fructokinase and it’s action is not inhibited by any other process. So long as fructose is available, fructokinase will continue to process it along the primary glycolytic pathway. So what does this have to do with uric acid? In the first step, fructokinase will grab the fructose molecule and an ATP to phosphorylate the fructose – and this process is unregulated, continuously consuming ATP in the cell. So ATP will have to be replenished to fuel the fructokinase reaction and as part of that process, a molecule called AMP is produced. But AMP is precursor to uric acid and will end up as uric acid at the end of they whole cycle of fructose metabolism. So as long as fructose is being processed, the liver will be generating uric acid in what is essentially an unlimited fashion – potentially a lot more than the break down of dietary purines.
If we are too look towards dietary drivers of gout, sugar consumption is a much more likely root cause than meat or seafood consumption. To my mind, it is not at all plausible, for a myriad of reasons, some outlined above, that meat consumption is even a proximate cause of gout.
Just because it’s not plausible to me (and even though I’m always right), is there room to implicate meat consumption in gout or gout flare-ups? Of course it’s possible, but the issue is more subtle than cause and effect and seems to require accompanying dysfunction. Higher uric acid – what consumption of foods high in purine may contribute to – does not equal gout. However, high uric acid combined with a chronic inflammatory state probably does. So if you are not metabolically healthy, increasing purine consumption *might* trigger a gout flare-up. However, if you rather go onto a ketogenic-type diet, which are generally going to be higher in meat products and significantly lower in fructose, you may see uric acid stay high, but inflammatory markers like C-reactive protein and ceramides will generally come down and the likely-hood of gout will decrease. Indeed, there are lots of n-of-1 cases and small epidemiological studies that show improvement/elimination of gout on a ketogenic diet and even more extreme, on pure carnivore diets. That later cannot be reconciled with the root cause of gout being production of uric acid from purine metabolism. But if the primary pathway towards gout is high uric acid production coupled with a chronic inflammatory state, it all holds together.
So bottom line according to me – if you are metabolically unhealthy and are not interested in correcting that, but just want to avoid gout, it may make sense to reduce/control the consumption of foods high in purines – but fructose reduction will likely be a more effective lever arm to control that since it is a completely unregulated pathway to elevated serum uric acid. On the other hand, if you goal is avoiding gout *and* supporting metabolic health more generally, look into keto. You may have to be careful in the initial stages to not overload on the purine to uric acid pathway since you are likely already in a state of chronic inflammation, but the severe reduction or elimination of fructose will likely by enough not to cause an issue. And as metabolic health improves and chronic inflammation is reduced, your gout will also improve or disappear, regardless of how much meat you are consuming. See, for example, Figure 3B of this study.
Incidentally, when thinking about a music link, some AI search helpfully opined that “Heavy metal music itself is not linked to changes in uric acid levels.”, so we can likely eliminate rockin’ out as a proximate or root cause of elevated uric acid.
My precious meat gets implicated in many, many societal ills.
These euphemisms.
BTW, thanks for the “Nitter please”. The only way I can… enjoy? … X. Or at least the occasional link I run across here, like the gem posted below.
How does the Nitter thing work?
How does the Nitter thing work?
substitute nitter.net for x.com
How does the Nitter thing work?
Pat will probably know more than me. He included it in his privacy schizo series.
It’s a front end to Twitter. It gives you read-only access to twitter. I.e. you can’t post.
To use, change x.com to nitter.poast.org. As an example, this is Gustav’s link below changed to nitter. Note the domain change.
BTW, thanks for the “Nitter please”
Thank Pat. He wrote about it in his privacy schizo series.
Nice.
Thanks.
As one who has the trifecta of Peyronie’s, plantar fibromas, and Dupuytren’s contracture I know exactly what pain in the penis feels like.
It is very similar to the pain I get in the ears when I hear that music. Crippling agony.
Peyronie’s, plantar fibromas, and Dupuytren’s contracture
No sounding?
Crippling agony.
You poor, poor man.
Not playing army and getting off of a low fat, high carb ‘healthy diet’ full of seed oils has helped.
I am officially a tenderfoot after having four foot surgeries.
I don’t recommend teasing your urologist who was a former navy corpsman about why he got into urology in the first place.
Narrowed eye gaze that I can only imagine would make Swiss blush.
I saw the family doctor yesterday
“Except for the falling down, keep on doing what you’ve been doing”
Have to worry about selection bias to draw general conclusions, but if it works, it works.
Ha! To be fair, that was frequently the case with me. And it really was the best advice! But Father’s Son, it took a while for me to learn. Aggravating. Hat tip to Ron, learning, or just realizing, the importance of rest. Stoic lessons, those.
But I didn’t know you fell, or fall. Hope you’re feeling well and secure.
AI search helpfully opined that “Heavy metal music itself is not linked to changes in uric acid levels.”
AI is talkin’ crazy.
Not sure what I expected posing “uric acid and heavy metal” as a question/prompt. Maybe Ozzy or Led Zeppelin stories.
A Uriah Heep song?
No Lords of Acid either.
My MIL has suffered with ghout for decades. My wife convinced her to do lower carb and increase he meat consumption after a lifetime of eating big carbs and baking, she was a school cook for some time and treats pies and cookies are her jam.
It worked, she lost about 40 pounds, started feeling better and her ghout and join pain were relieved.
Then one day about six months ago she got sick and decided that she was allergic to meat and reversed all her progress in a matter of a few months.
Is there a connection to oxalates at all?
When we got away from eating vegetables, particularly the brassicas my wife went through some serious oxalate dumping that caused her some skin and joint issues. She’s been in the pre diabetic range and also prone to gout due to forty years of crap diet and familiar history. Been low carb for years now but the vegetables were one of the last things we threw out about a year ago.
I don’t know that I could go vegetable free.
It’s easy. Other than the fact that you have to actively avoid them.
When your joints don’t hurt anymore for almost a year and then you have some Brussels sprouts and can barely walk the next three or four days afterwards you know you have made the right choice.
My wife is more hardcore than I am. Shes avoided dairy and wheat for going on four years or more.
We both eat the occasional pickle and some iceberg lettuce. She more than I on that stuff.
I was trying to think what veggies I eat on the regular. Not much.
Cabbage occasionally, often in the fermented form, raw as an apple cider vinegar delivery device. THICC sliced onions on the grill with steak. Very occasional green leafy salad. Very very very occasional potatoes if you consider that a vegetable. Lots and lots of chilles. Lots of avocado – OK, that’s a fruit. Seasonally, watermelon, occasional berries. So I’ve almost completely given up vegetables, without even really realizing it…
occasional pickle
Oh yeah, those too, but only once or so every couple of weeks.
I do make a pretty mean fruit salsa, if I do say so myself. That’s a base of cucumber, skinned diced tomatoes, whatever chilles are available, sweet onion, cilantro, whatever fruit is in season and looks good – I’ve used mango, peach, and strawberry. Dash of salt and splash of lime juice. Perfect accompaniment to fish/tuna steaks. But also only once ever month or two.
I’ve been jonesing for kohlrabi this season and haven’t found anyone carrying it.
😩
I love watermelon.
My wife and the kids are allergic to it so i don’t have it often. Turns out it makes my guts sensitive too.
Accidentally I’ve done an elimination diet and when I eat something that I’ve given up it often makes me feel like crap.
Fried onions with steak and on tacos.
A little iceberg lettuce, pickles.
I had some canned beats about a year ago. They made me hurt as bad as the Brussels sprouts did.
I have a big salad every lunch and dinner.
Typical celery/carrot/bell pepper/ kohlrabi if fresh/tomato/cuke/ sweet pickle 4-5 slices/olives and lettuce.
I mostly wait for my own kohlrabi/tomato/cuke, the store stuff is tasteless.
Then some meat/fish, then fresh fruit for dessert. 3-4 times a week a handful of peanuts/cashews, etc.
Once in a while Mrs F will buy broccoli/cauliflower to add to the salad. Fresh, never cooked.
Whole grain bread once a week or so. Potatoes if we go to a restaurant. We are eating more
of the convenience frozen stuff though, some things are getting tougher here.
Not an obvious connection that I’m aware of.
It’s a completely different crystal and chemistry. Oxalates form their own crystal structure by binding with calcium (as does uric acid but in the opposite PH conditions I think) and other minerals. They are heavily implicated in kidney stones and, to a lesser degree I believe but still significant, joint pain and inflammation. But only related in the sense of downstream symptoms, not in cause.
Makes since.
Just another layer of the modern ‘healthy diet’ becoming the death of 1000 cuts.
https://x.com/pvtjokerus/status/2079687539779395900
Lol
I never saw a mixed gender unit that wasn’t filled with drama. I don’t know what hell I’m watching there. Assault? Foreplay?
Either way there’s going to be lots of paperwork and witness statements!
Mid ’70s the draft ended and women integrated into TOE units. One of these events improved mission performance, one didn’t.
I was the one that mentioned gout. Good times, until my doctors was in and she could call in a prescription. Indomethacin is a wonder drug.
Ha! Oh, dear. Before I read, I had gout in ’23 when I was 35. That was a really bad day, and near the end of my time at the Tribune, but I gotta say. That was the 2nd quickest diagnosis I’ve ever had, after shingles, and it was by far the happiest one. I thought something much, much worse was going on.
Apparently, ya can get gout several times, semi-persistent, I’ve heard. Ya can shingles more than once, too. Huh.
VALTREX!
Damn it! I’m a Firster putrid; not a doctor!
Dog just took me out. Let him off leash and he was running around. Smacked right into me. Hadn’t done that since one of the first few times.
Knee was already hurting. I went down and he yelped.
Not been a good week.
It’s only Tuesday, Bro, couple more days before the weekend excitement.
I’m going back to last Tuesday when asshole ate part of a stuffed animal. Between that and the retards I work with my sanity may already be lost.
My wife feels your pain. A couple of decades ago our next-to-last dog (a young stray pitty) ran into her at full speed, knocking her over and badly bruising her leg. The leg developed a massive hematoma. Excruciating pain. Bathing the leg with an epsom salt solution significantly relieved her distress.
The ‘hijacking’ of the evolutionary process, without time for us to adapt to ‘our’ new diets, is an interesting one. Hadn’t thought of that, I don’t think. Would apply to many things, methinks.
My first thought was about “Part of the link of high meat diets to gout comes from the historical association of gout with wealth, a ‘rich mans disease’.” <– Have a scapegoat the people will hate. And a persistent one. That's quite a broad, overarching part of being a human in society, apparently, for a lot of folk. Always need something to blame, something /someone / some pronoun, whatever.
It makes people feel better? Bitching *together* can be fun, sure. On the reverse, many/most also have divine 'causes' for good things. (And bad, when convenient.) I find it baffling to complain /bitch out loud, and even more so that it now gets rewarded. See also: FIFA. To whomever it was: Yeah, NHL embellishment is stupid, but so many fucking whistles. And we bitch (ahA!) it, but it's embedded in soccer culture.
(By the way, I'm aware of the irony of bitching online in order to decry it, so don't bother pointing that out.)
There was a recent NY Times article (paywalled, couldn’t find an archived version) discussing gout at length. Apparently British doctors for some reason eschewed continental practices that significantly relieved the pain (I believe laudanum was involved). That is why depictions of the sufferers of gout are primarily British, because victims were basically told to ‘tough it out’.
https://www.nytimes.com/2020/11/13/t-magazine/gout-tormenting-masses.html
How exactly does a DMV “glitch” auto register anyone to vote, let alone 6k non-citizens?
Was reading some derp from the other site that called Dem attacks on voter ID plausible. Cited one study that observed the effect was most pronounced on Latino voters.
There’s no good reason to not have an ID and every other country is allowed to do it. But for some reason Dems fight tooth and nail over a policy that is wildly popular among all demographics. So so strange.
One study they quoted said there was no effect on levels of voter fraud. I’m sure that was real science-y.
The reward for cheating your way to victory in the US is so spectacular that you would have to be especially cynical to claim it isn’t happening.
The amount of wealth and power at stake with each election is massive. We *know* people have cheated at large scale in past elections with far less at stake. It’s documented.
There’s nothing but magical thinking saying that it isn’t happening now. They demand proof while honestly the ballots are less secure and almost certainly easier to fake than ever before.
Here it wasn’t auto registration but clerks selecting the wrong document type during entry. Allegedly. Also, mistakenly marking American Samoans as US citizens (they are non citizen US nationals) due to misunderstanding by clerks.
“Heavy metal music itself is not linked to changes in uric acid levels.”
I had the opportunity to see the most metal painting in my life this weekend in Bologna.
https://cypaint.com/article/why-did-giovanni-da-modena-paint-mohammed-in-hell
The painting was inspired by Dante’s Inferno.
Not gonna lie. That’s fucking righteously metal.
*horn fingers*
Or, you know, Christianity.
I’m not a fervent Christian but it’s pretty fucking obvious what the official position on Islam is – or was, before recent Popes got all “whatever”.
(the actual painting. link didn’t show it. I wonder, oh, I wonder why.)