Insulin and gout
When you look at the factors that are associated with gout andcompare them to the factors that are associated with diabetes thereis too much overlap to be coincidence. I am writing about thiscoincidence of risk factors from pure intuition here but the medicalcommunity is also aware of the overlap. They often comment about itinformally in conversation as well as more formally in writing.
I want to focus on the recent post by “tony8167″ who lost 14 poundsin two weeks on the Atkins diet. From many of the discussions we havehad on here we can conclude that if Tony is indeed a gout sufferer,and his overall uric acid level is above what his body is able toexcrete, we would conclude that losing that much weight that fast, asfat mind you, will surely induce a gout attack if you are prone togout. With uric acid being stored in the fat tissues and that tissuebeind depleted by 14 pounds, that will leave a lot of uric acid thathis body has to remove. If you think about it, he may not even be areal gout sufferer long term and he simply overloaded his excretioncapability while on the “fat burn”.
This is a critical point we need to look at and understand. I finallygot Dr. Atkins new book, sort of new, at least some of the statisticsare new. I read his first edition about 10 years ago. When it firstcame out I was maybe 2 pounds over weight, in great shape and figuredthat I didn’t need to pay attention to it. However, there are somevery important points covered in his book that I believe affect allof us and I am ready to conclude, in my own mind, that the root causeof my gout, is that I live in a “glycogen excess” state, all thetimes. My body never has depleted glycogen levels, unless I am losingweight, and in my normal operation mode, I keep my glycogen level,that is my blood sugar level, at or over the max level it can orshould be. I am definitely not diabetic yet but I am doing abouteverything I can to move myself into being a diabetic and it is areally, really stupid thing to be doing.
I suspect that many of you are doing the same thing. Each and everyday, when your blood suger gets even slightly low, you put acarbohydrate in your mouth and voila, you fix the hunger symptombefore it gets too bad. The older I get the worse this seems to getand although I feel I am living in a perpetual state of hunger, Istill manage to gain weight, albeit slowly, month after month andyear after year. I seem to be gaining about 2 pounds a year andalthough that may not seem like much, after 10 years now, the 20pounds are here and it is ever so hard to get motivated to get rid ofit.
Moreover, remember that the #1 risk factor associated with gout istoo much weight. Clearly there are gout sufferers who are skinny as arail, my grand father was skinny and he was wracked with gout painalmost all the time. However, most of us are not skinny and we knowthat if we could lose the weight, we would reduce the rate of, andseverity of, our gout attacks.
It will take a while to get this all organized so that it is easy tounderstand but I’ll start with a simple fact that Atkins covers inhis first few chapters.
When you have excess glycogen, your body makes insulin to get rid ofthe glycogen and from that glycogen the body makes as much energy asyou need to live on and then it turns the rest into fat. The riskfactors associated with this kind of behavior, with keeping a highblood sugar level all the time, are astonishing and it can bepredicted-with absolute certainty by the way-that it will lead us toan early grave. High blood pressure, heart disease, diabetes,arterial schlerosis and all the other problems associated with beingover weight-much higher cancer risk, etc., etc., etc..
If there is not enough blood sugar in your system to live on, thatis, if there is not enough blood sugar there to generate the energyit takes to go through the day, your body turns to the fat andprotein in your body for energy. If you have excess protein from yourdiet it will leave your mscles alone, and then it will then turn toyour stored fat and convert your stored fat into energy. The energycycle from “FAT BURNING” does not involve insulin and this is what Iwant to focus on. As I said in the beginning of this post, theoverlap with diabetic factors is just too great for me to believethat insulin is not the main culprit in triggering my gout.
For those of you that need a mechanism, or a proof of details, Iain’t gonna even try but my belief is that I can go on a controlledatkins diet-yes higher protein intake, much higher in fact, and Ibelieve I will not increase my gout probability unless I do it tooquickly.
In simple terms, I am going to target 1 pound a week, not 7 pounds aweek, and I will drink lots of water, and I plan to reduce mycarbohydrate level to where I am getting most of my energy to liveon, from either the fat I eat or from the fat I already have stored.I’ll stay on allopurinol, watch my BP and go back to my exercizeroutine.
As Atkins says, it is very hard to live when you are hungry all thetime and high carbohydrate intake but insufficient calories makes youhungry and keeps you hungry…
Oh yes, one thing I didn’t mention but Atkins does cover, and I haveknown it since graduate school and my biochemistry work in the late60’s. When you eat one spoon full of sugar, that sugar will triggerinsulin release and the insulin will work on reducing your bloodsugar. It will take about an hour to deplete your system of that onespoon full of sugar. The problem is that when the blood sugar levelreaches normal, there is still insulin in the system and that insulingets eaten up by completely depleting your system of blood sugar.The low blood sugar level sets off bells in your brain that say toyou-FEED ME- it says-FEED ME- FEED ME-FEED ME- and, if it fails toget food it will then start to shut the system down and you willprobably take a nap.
After another hour, your system will have been able to restore theblood sugar level by burning some fat, if it has to, and your hungerwill go away.
My proposal, based on nothing other than intuition, is that theconstant cycling of my glycogen-insulin system-causes my gout.Clearly this is not the case for all people with gout,but I am smackin the middle of this “too much sugar” thing and my gout attacks seemto correlate well with having been in that cycle too long.
Malia Berthelette on August 22nd, 2007
I haven’t gone to the same level of research as most of the regularposters on this list, but I believe that for me the root cause of goutis being overweight. And that obesity is negatively affecting myendocrine system (potential type II diabetes) at the same time.
The reasoning for this is that I’ve been fluctuating over the last 15years between being slightly overweight and severely overweight. Mystable weights over the last 15 years have been 230, 260, 315, 280, 265,245, 290, now 315. When I get above 280 lbs, my glucose intolerancebecomes quite bad, and I display two of the three test criteria for typeII diabetes. (just had another fasting glucose test today - wish meluck) My gout attacks have occurred when I’ve been 300+ and when understress. I’ve also had difficulty with tolerating gluten and lactose,both of which get worse with increasing weight.
I’ve spoken with two doctors over the last 8 days about gout. Both ofthem had similar hypotheses and independently referred to a “cascade ofmetabolic symptoms.” I’m not certain that this is a widespread phrasein the medical community. Both of these doctors are GPs, one at amedical center I attended during a gout attack accompanied by abdominalpain, and the other my regular GP for follow up. Basically they bothsaid that obesity causes widespread related changes (in organefficiency, in hormones, in metabolism, . . .) and that significantchanges, like type II diabetes, can cause (or happen at the same timeas) other metabolic issues, like gout.
So these two GPs obviously agree that there is a relationship betweengout and diabetes. Whether it is a causative relationship is anotherquestion entirely, of course.
Anyway, as I posted quite a while ago, I am focused on loss of weight(at a reasonable rate) to improve my health overall. It is quite likelythat I will have to go on allopurinol to support the attempt. I’ve cometo the conclusion that without allopurinol, I’ll likely not feel up toregular exercise, since the gout flares up after every evening ofteaching dance, every trip to the gym, and every family walk. I’vedropped 5 pounds over the last two months, but have a long way to go,and without allopurinol it may be a painful voyage.
On a side note, I’ll be able to post about my level of uric acidshortly, as it is one of the panel of tests that my regular GP asked meto have done today at the medical lab.
Hope everyone is doing well, and that none of you are suffering an acutegout attack today,
Sabina Shamel on August 24th, 2007
Thank you for the comment and for the information. At least one personunderstood what I was getting at.
I believe you desperately need to get and read the Atkins book andunderstand it. Glucose intolerance is, I believe, based soly on mycareful monitoring of my own gout inflamations versus my food intake,the root cause of your, and my gout. When I load heavily oncarbohydrates, my gout flares. When we take too many carbohydrates inour diet, our insulin levels go up and our ability to use thatinsulin decreases. I don’t have to understand why the relationship isthere to notice and record that it is there, and I am certain that itcauses flare ups when I take in too much sugar and pasta.
I believe we are looking at the wrong factors when we focus onpurenes alone. I know I cannot tolerate shrimp or lobster and I won’tpretend that a big shrimp dinner will fall immediately to my big toeand stay there for a few weeks, but….steak seems to be OK for meand I plan to try Atkins, on a modified diet of course.
I would suggest that you learn how to hold your weight at where it ison an Atkins diet, that is with a controlled amount of carbohydrate,and target to let yourself lose weight at the rate of 1 to 1.5 poundsa week at the most. The object is to reduce weight in a way that willlet you keep eating at that level as long as you live and if you stayaway from fats, that is if you load up on carbohydrate, you willalways be hungry. You will also be so hungry that you will not beable to maintain the weight loss. Look at it this way, Christmas issome 20 weeks away and if you are 20 pounds lighter by then, so muchthe better. Moreover, as you move toward a diabetic condition, ifyou are in the ketosis phase of metabolism from the Atkins diet, thatis slightly starved for carbohydrates, your need for and reaction toinsulin will be almost completely eliminated. When you burn fat youdo not need insulin to generate glycogen.
As for allopurinol, I feel it is foolish for any person with gout tonot automatically go on allopurinol. Do it! Go on allopurinol andthen lose the weight. I need to lose 25 lbs and by my formula Ishould be able to get there by Christmas too.
Sanjuana Manser on August 25th, 2007
Obesity does indeed lead to a cascade of metabolic effects.
Few people really consider adipose tissue to be a part ofthe endocrine sytem. Yet it clearly is. If you have excess weight,that excess fat sends messages throughout the endocrine system. Itcertainly affects insulin levels and usage.
Those who are overweight will have higher uric acid levels and theprimary cause of gout is believed to be uric acid levels. Otherfactors may play a role. Genetics certainly does. Uric acid howeveris the major factor and excess weight means higher levels of uricacid.
Sabina Shamel on August 27th, 2007
“Uric acid however is the major factor and excess weight means higherlevels of uric acid.”
And when you lose that weight, you are left with uric acid becausethe body cannot metabolize it. It has to excrete it. Lose the weighttoo fast and you get gout.
Your previous post is, I believe, critical to this discussion becausealthough you did not say it, I suspect that you, and Tony in the theprevious post from tony8167 on 9/11, both refer to losing a largeamount of weight in a relatively short period of time and then havinga gout attack.
My question is this.
Was your gout attack preceeded by an intake of a large amount ofcarbohydrate after having starved yourself for carbohydrate to losethe weight?
The question is to Tony as well as Don for I am building a suspicianthat it is the excess carbohydrate in our systems that cause us tolose renal function enough to get the gout. My suspicion is that youwent off your carbohydrate wagon, so to speak, and I further suspectthat the gout attack was caused by insulin and by glucoseintolerance reactions.
I firmly believe we can lose the weight efficiently on a relativelyhigh purene diet if we make sure we drink at least 2x what would beconsidered normal amounts of water and if we lose that weight muchmore gradually than the Atkins perscription suggests we shouldloose. .