Rethinking Gout

The Apple Fritter connection

No, no, not the Apple Fritter!

Back before my surgery, talking to the VA doc - she was adamant that the reason I had gout was from “purine foods” - meat, organ meats or alcohol food. She was certain. I was perplexed because I did not eat much, if any, of those things.

However, emerging research and clinical observations are challenging this long-held belief. This chapter proposes a controversial yet compelling argument: that foods like apple fritters - and their constituent ingredients - may be the real drivers of gout in our modern diet.

Have you ever had gout? Imagine a sledge hammer pummeling your big toe - over and over. Between bypass surgery and gout, I’ll take heart surgery.

The Traditional View of Gout

Before we dive into our new perspective, let’s briefly recap the conventional wisdom on gout:

• Gout is a form of inflammatory arthritis caused by the buildup of uric acid crystals in the joints.
• It’s traditionally associated with a “rich” diet high in purines, which break down into uric acid.
• Foods typically blamed include red meat, organ meats, seafood, and alcohol.

The Apple Fritter Hypothesis

Now, let’s break down why a seemingly innocuous treat like an apple fritter might be more problematic than a steak when it comes to gout:

1. Seed Oils: The Hidden Inflammatory

• Many apple fritters are fried in vegetable or seed oils (e.g., soybean, canola, corn oil). Often times, these oil vats have been used over and over - leading to oxidation.
• These oils are high in omega-6 fatty acids, which can promote inflammation when consumed in excess.
• Chronic inflammation can exacerbate gout symptoms and potentially trigger flare-ups.

2. Sugar: The Sweet Deceiver

• Apple fritters are typically coated or glazed with sugar.
• High sugar intake can lead to insulin resistance and obesity, both risk factors for gout.
• Sugar can also compete with uric acid for excretion in the kidneys, potentially raising uric acid levels in the blood.

3. Fructose: The Uric Acid Producer

• Apples naturally contain fructose, and additional fructose may be present in sweeteners used.
• Unlike glucose, ¹ fructose is metabolized primarily in the liver, producing uric acid as a byproduct.
• Studies have shown a strong correlation between fructose intake and increased risk of gout. ²

4. Flour: The Glucose Spike

• ³ White flour, commonly used in fritters, is rapidly converted to glucose in the body.
• This can lead to sharp insulin spikes, which may impair uric acid excretion.
• Chronic consumption of high-glycemic foods is associated with increased gout risk.

The Metabolic Perfect Storm

When combined, these four components - seed oils, sugar, fructose, and flour - create a metabolic environment that may be particularly conducive to gout:

1. They promote systemic inflammation.
2. They contribute to insulin resistance and obesity.
3. They directly increase uric acid production.
4. They potentially impair the body’s ability to excrete uric acid.

Challenging Conventional Wisdom

This new perspective doesn’t necessarily invalidate all traditional dietary advice for gout sufferers, but it does suggest that we may need to reevaluate our priorities:

• The occasional steak may be less problematic than daily consumption of processed, high-carb foods.
• Focusing solely on reducing purine intake might cause patients to overlook more significant dietary factors.
• A low-carb, whole-foods approach might be more effective for managing gout than a low-purine diet.

Conclusion

While more research is needed to fully validate the “apple fritter hypothesis,” this perspective offers a fresh look at a centuries-old disease. By shifting our focus from individual nutrients (like purines) to overall dietary patterns and metabolic effects, we may be able to develop more effective strategies for preventing and managing gout.

As we continue to unravel the complex relationships between diet and disease, it’s crucial to remain open to new ideas - even when they challenge long-held beliefs. The story of gout and the humble apple fritter serves as a reminder that in nutrition, as in all sciences, today’s heresy may be tomorrow’s conventional wisdom.