[ExI] Gout and primary sources

[J. Stanton]

BillK wrote:

> These articles don't say that fructose causes gout.
> They say that fructose might be one of many factors that aggravate gout.

They also show that fructose consumption is much more strongly 
associated with gout than meat consumption.  (And I can't figure out if 
the studies that show gout correlated with meat control for sugar or 
alcohol intake...this is the problem with associational studies.  Red 
meat and alcohol consumption correlate reasonably well AFAIK.)

However, it is most important to understand the mechanisms by which gout 
occurs.  The body retains uric acid in the blood because it's a powerful 
antioxidant: high uric acid levels are associated with oxidative stress. 
  Further in support of its protective role, uric acid levels correlate 
with lifespan in primates:
http://www.ncbi.nlm.nih.gov/pubmed/6532339

Dietary purine is mostly a red herring: more purines in = more uric acid 
excreted.  The important question is "What causes the body to retain 
uric acid?"  And an important part of that is most likely that fructose 
is tremendously reactive in vivo (~10x more than glucose) and the body 
retains uric acid in the presence of fructose in order to reduce 
oxidative stress.  This is a perfectly reasonable response in an 
evolutionary milieu that lacks refined sugar, HFCS, and fruits bred to 
contain pathological quantities of fructose.

> I prefer to believe what sites like WebMD say, rather than paleo
> support sites where almost everything can apparently be cured by a
> paleo diet.

I have no interest in "believing" anything.  I want to know how things 
work, or admit that I don't.  As one of the foundational principles of 
any reasonable paleo diet is to greatly reduce fructose intake, it is 
unsurprising that gout is a solvable problem via eating paleo.

Moving on:

Both the articles I linked feature plenty of primary source citations.

WebMD is not a primary source.  It is an advertising-sponsored, 
for-profit institution.  And their articles don't appear to ever cite 
any primary sources.

WebMD doesnt provide a list of sponsors, but here are some I found by 
removing my ad-blocker and clicking on sponsored articles:
Forest Laboratories
Procter & Gamble
Eli Lilly
Cephalon
Amgen
Pfizer
In other words, 100% of their sponsors are drug companies.

I prefer to get information from peer-reviewed and unsponsored sources 
that cite and link their primary sources.

> Gout often has nothing at all to do with diet. Genetics, obesity,
> alcohol consumption, enzyme deficiency or even some medications can
> cause or aggravate the condition.

Obviously there is variation in susceptibility to gout!  However, it is 
trivially untrue to say it has nothing to do with diet (of which alcohol 
consumption is a known part).

JS
http://www.gnolls.org