The Fructose-Gout Connection

Add gout to the list of possible health problems to which high fructose corn syrup may contribute.

By Linda Rath | Updated Nov. 16, 2023

More than 9 million people in the U.S. have gout — a painful form of inflammatory arthritis. That number more than doubled in the past few decades, along with a sharp rise in obesity. Rates of other chronic conditions are soaring, too, including diabetes, heart disease and kidney and liver disorders — many linked to obesity and common in people with gout. In addition to increases in these chronic conditions, life expectancy among Americans has fallen behind that of peer countries.

It’s not entirely clear why Americans are getting heavier and sicker, but some experts partly blame high-fructose corn syrup (HFCS), a liquid corn sweetener that made inroads into industrialized food starting in the 1970s. Today, it is a key ingredient in most sodas and processed and fast foods in the U.S. It’s also found in many breakfast cereals, breads, rolls, canned soups, salad dressings and condiments.

What’s So Bad about HFCS?

The problem isn’t just that HFCS is high calories — it’s about the same as table sugar — but also the way it’s broken down and used in the body. HFCS starts out as simple corn syrup, which is mostly glucose — the sugar your body burns for energy and is regulated by insulin. But when corn syrup is treated with acids and enzymes, about 55% of the glucose turns to fructose. Although research is mixed, there is evidence that, unlike glucose, which the body uses right away as energy, the body stores fructose.

HFCS has been shown to contribute to obesity, diabetes, heart disease, nonalcoholic fatty liver disease among other health problems. It can also contribute to gout. Purines are released when the body breaks down HFCS. This produces uric acid — the substance that can form painful crystals in and around joints and trigger gout attacks. Uric acid levels briefly rise just minutes after HFCS is consumed. 

Table sugar, which is also about half fructose, can lead to many of the same health problems. Although it’s not directly linked to gout, it can cause unwanted weight gain. People who are overweight produce more uric acid, and their kidneys don’t remove it as quickly.

One study found that the relative risk for gout is nearly double in people who are obese compared to those who aren’t. And when very overweight people develop gout, it occurs about three years sooner than in those of healthy weight.

The best course, experts say, is to avoid HFCS and limit sugar. You’ll need to become a label detective to figure out where HFCS is hiding because it’s often in things you wouldn’t expect. Some ketchup, for example, contains both corn syrup and HFCS. Many health care providers say closely reading labels is worth it. 

What about Fruit?    

There’s no getting around it: Fruit is loaded with fructose. The sweeter the fruit — figs, mangos and grapes, for example — the more fructose it usually has. Many vegetables, especially leeks, onions and asparagus, are also high in fructose. 

But fruit also has a lot to recommend it — it’s rich in antioxidants, nutrients and fiber, and many fruits are powerful anti-inflammatories. If you have gout or are trying to prevent it, you don’t have to give up fruit entirely, just focus on lower-sugar varieties like berries, peaches, plums, papaya and cantaloupe. And, though they’re higher in sugar, you can eat cherries, which may help prevent or reduce gout symptoms.

With the possible exception of cherry juice, it’s best to stay away from fruit juice, where fructose is highly concentrated. That glass of freshly squeezed OJ you had for breakfast? It could contain anywhere from 25 grams to 45 grams of sugar — a full day’s sugar allotment, according to new standards from the World Health Organization (WHO). 

Controlling Gout Risk

Limiting or avoiding sugary sodas and processed foods is one way to lower your odds of getting gout, although some experts say it’s better to adopt an overall healthy eating plan, like the Mediterranean or Dash diet, than avoiding certain foods. Those diets focus on veggies, some fruit, healthy fats and a little protein — none of which contain HFCS.

In addition, some doctors hold that long-term medication is necessary to control gout, although many patients aren’t so sure. In fact, patients are least likely to take their gout drugs as prescribed than any prescription medicine. Talk to your doctor. If you have mild gout attacks or no more than one a year, you may choose to treat flares only when they occur and control uric acid levels with diet.

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