GOTTA, PROTEINS AND URIC ACID

GOUT, PROTEIN AND URIC ACID

One of the main concerns about protein is "but doesn't eating too much protein give you gout?" As we have seen many times in nutrition there are many false myths and this is one of them. Today I saw an interesting video by Dr. Ken Berry on the topic and decided to do a little background. Dr. Ken Berry has been a family physician in Tennessee for more than 20 years. He has seen more than 25,000 patients. Dr. Ken Berry is a great exponent of low carb, ketogenic, and carnivore nutrition. He has written two books:

Lies my doctor told me (the lies my doctor told me).
Kickin ass after 50 (going great after 50)

I really like Dr. Ken Berry because he reasons using critical sense and bringing scientific evidence to support his reasoning. From here on I quote Dr. Ken Berry's words in the video. The current assumption is that eating lots of purines (protein) increases uric acid and that this causes gout. There are actually several problems with this hypothesis....

Our body produces purines when:
- uses ATP or GTP to produce energy
- degrades DNA or RNA
These purines are called endogenous purines and are 5 to 10 times greater than what we could introduce through food (exogenous purines). Our bodies produce many more purines than we could eat, so the cause of gout cannot be purines.
During my 20 years as a doctor, I have analyzed the uric acid level of thousands of patients: many had a high level but had never had gout. If a high uric acid level causes gout, why did these people never have it?
Uric acid crystals are like shards of glass and that when they get into the joints they cause gout. The problem is that when you aspirate synovial fluid from a healthy joint, you find uric acid crystals (1). But these people have no pain and no gout. So how is it possible that uric acid crystals are responsible for gout?
Did you know that uric acid is an antioxidant produced by our body? In fact, the 90% of uric acid filtered by the kidneys is reabsorbed (2,3)? If uric acid were so harmful, why would the kidneys reabsorb 90% of it????

Elena's note: See how she used critical sense in these four points? If something does not make logical sense, it is not possible to believe it, even if doctors 98% support it. This means using critical sense: thinking critically for yourself. The advice that is usually given for gout is NOT helpful:

eat little protein
eat lots of fruits and vegetables
Take medicines (you will not need them if you eat properly)
take supplements
Alkalize the blood (it is not possible to change the pH of the blood by eating vegetables)
reduce fat (of any kind)
do not drink coffee

So what is the real cause of gout? There are several:

Inflammation: in fact, when a patient comes to me with an attack of gout I prescribe an anti-inflammatory
Fructose: as an ingredient in foods and beverages (fructose syrup), what is found in sugar (sucrose is composed of 50% glucose and 50% fructose), fruits, and especially fruit juices (4, 5)
High insulin: having constantly high insulin (because you consume so many carbohydrates) will increase the risk of gout
Alcohol: of all kinds (6)
Being overweight (7)

Here's what you can do to improve gout:

Stop drinking alcohol
Slimming down: losing excess fat
Decrease inflammation: reduce seed oils (peanuts, canola, margarine, soy, corn) contain too much omega-6, which causes inflammation, a major cause of gout
Reduce fructose: eliminate fruit juices, all foods that contain fructose syrup, and limit fruit to sporadic consumption, preferring red fruits
Eliminate sugar and grains: they increase blood sugar and thus insulin production, which is one of the causes of gout and inflammation
Keep insulin low by consuming a low carb, ketogenic or carnivore diet
Take magnesium and potassium: through foods or supplements. They are scientifically proven to decrease the risk of gout attacks
Produce as many ketones as possible: beta-hydroxybutyrate is an excellent anti-inflammatory. I do not want you to take exogenous ketones, I want your body to produce ketones through a ketogenic or carnivorous diet (8)
Drink coffee if you want to, there is research showing that coffee drinkers have fewer gout attacks (9) (Elena's note: beware this is epidemiological research, which does not have a high value of scientific evidence since they are observational studies from which it is not possible to prove that X is the cause of Y. In epidemiological studies one can only observe correlations. To show whether there is causality in these correlations (thus that X is the cause of Y) requires randomized controlled trials RCTs. Dr. Berry mentions this because in my opinion he loves coffee, and because he is a human being, he too has biases, i.e., interpretations of reality influenced by our subjectivity)

Dr. Berry's video ends here, now I would like to make a reflection on uric acid: I learned that uric acid was an antioxidant only a few months ago. This surprised me quite a bit, because I had always associated uric acid with something negative. Unfortunately, however, I've become accustomed to it by now: it seems that all things that are good for us are painted as negative-why is that? Let everyone draw their own conclusions.

Since Dr. Berry also stated in this video that uric acid is an antioxidant, I decided to elaborate a little bit.

It seems that uric acid is one of the reasons why Homo Sapiens' life span was extended (10). The first to postulate the hypothesis that uric acid was an antioxidant was Bruce Ames in 1981. Just think that the study (10) where he published this hypothesis was cited by other studies 3,759 times!!! This is a HUGE number: the total number of published studies is 58 million, but of these only 14,500 studies have more than 1,000 citations. One study is cited by another only if it is relevant.

Uric acid is a powerful plasma antioxidant and plays a protective role in DNA and in neurodegenerative diseases. Consider that both Alzheimer's and Parkinsons patients have reduced levels of uric acid in the blood. (11)

The increase in uric acid in the blood occurred over 60 million years of evolution and coincided with an increase in life length and brain size in Homo Sapiens.

During evolution from prosimians to apes, the ability to synthesize vitamin C was lost but the ability not to degrade uric acid was gained. Ames speculates that these two events are related and that uric acid took over the antioxidant functions of vitamin C. Ames states "it is possible that the utility of vitamin C may be limited by its propensity, under certain conditions, to self-oxidize and generate free radicals and mutagens."

Last fascinating observation: uric acid is more in the blood, while vitamin C is more in the cerebrospinal fluid, as if they have antioxidant roles in different parts of the body. The cerebrospinal fluid in the human body is 150 ml while the blood is 5000 ml (5 liters). So it is evident that the body needs greater amounts of uric acid rather than vitamin C. In fact, uric acid we can synthesize while vitamin C cannot.

The presence of uric acid is associated with several diseases: hypertension, obesity, insulin resistance, type 2 diabetes, kidney disease, cardiovascular disease, and cerebrovascular disease (12). Unfortunately, science seems to believe that uric acid may be one of the causes of these diseases. Personally, after reading these studies, it occurs to me that uric acid is high in people with these diseases because it is trying to fight the inflammatory and oxidative state. It seems to me it's the same story with cholesterol: they are blaming the consequence. Let me explain: it would be like saying that because when there is a fire there are firefighters, then firefighters are the cause of fires. It doesn't make any sense.

After this in-depth study, my personal conclusions are:

Eating protein will not give us gout, but eating carbohydrates might
Having uric acid in the blood is a good thing because it is an antioxidant. Also because if it were harmful why would the kidneys reabsorb 90% of it? Nature does something ONLY if it is useful. If it reabsorbs 90% of uric acid, that means it is something very valuable!
if there is excess body fat, insulin resistance and/or inflammation, high uric acid is a red flag: you need to restore metabolic health. Eating low carb/ketos, exercising, and losing weight is an easy and inexpensive way to do this.

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