Reduce fructose intake to lower gout risk

Fructose consumption was examined as a dietary risk factor for gout. Fructose is unique among sugars in its ability to increase uric acid production through purine degradation pathways.

Evidence

Gender-specific risk factors for gout: a systematic review of cohort studies

Authors: Belcher, John, Evans, Peter L., Hay, Charles A., Mallen, Christian D., Prior, James A., Roddy, Edward

Published: December 1, 2019

The systematic review examined fructose consumption as a specific risk factor for incident gout. Across 33 cohort studies searched in MEDLINE, EMBASE, CINAHL and the Cochrane Library through March 2019, fructose intake was analyzed alongside other dietary factors. The review found that most dietary risk factors showed similar effects across genders in the 20 studies (60.6%) that directly compared men and women in general population and primary care settings.

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Avoid excess fructose calories to help manage uric acid

Since hyperuricemia is linked to gout, managing fructose intake is relevant for gout patients. The key finding is that fructose itself is not problematic when it replaces other carbohydrates calorie-for-calorie, but consuming large amounts of fructose that add excess calories to the diet can raise uric acid levels, potentially triggering gout flares.

Evidence

The Effects of Fructose Intake on Serum Uric Acid Vary among Controlled Dietary Trials1234

Authors: Adrian I. Cozma, Alberti, Alexandra L. Jenkins, Amanda J. Carleton, American Diabetes Bantle, Anderson, Arash Mirrahimi, Ardern, Bantle, Becker, Begg, Blayo, Bomback, Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Choi, Choi, Crapo, Crapo, Cyril W. C. Kendall, D. David Wang, David J. A. Jenkins, Denzer, Egger, Elbourne, Ford, Furukawa, Förster, Gao, Grigoresco, Hallfrisch, Heyland, Huttunen, John L. Sievenpiper, Johnson, Johnson, Joseph Beyene, Jüni, Kneepkens, Koh, Lathyris, Laura Chiavaroli, Lawrence A. Leiter, Livesey, Lê, Madero, Mann, Marco Di Buono, Marriott, Matthew E. Yu, Miller, Moher, Moher, Nakagawa, Ngo Sock, Osei, Osei, Perez-Pozo, Pillinger, Reiser, Russell J. de Souza, Sievenpiper, Stirpe, Sumino, Sun, Thomas M. S. Wolever, Vanessa Ha, Zhu

Meta-analysis of 21 controlled trials (425 participants) found that isocaloric fructose substitution for other carbohydrates did not affect uric acid [MD = 0.56 μmol/L (95% CI: −6.62, 7.74)]. Hypercaloric fructose supplementation at 213–219 g/d (+35% excess energy) significantly raised uric acid [MD = 31.0 mmol/L (95% CI: 15.4, 46.5)] in nondiabetic participants. These findings suggest that fructose-containing foods are acceptable when consumed as part of a calorie-balanced diet, but excess fructose consumption adding to total caloric intake should be limited.

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