What Is Gout and How We Treat It.

By paying close attention to my grandfather-in-law's health and joint problems, I'm starting to see Gout in a new light. One that goes beyond simple joint disease.

Photo by Anna Auza on Unsplash

This holiday season has been a bit of a roller coaster for my family. With our third child expected to arrive in the middle of January, we purchased and moved into our first house a mid-December.

Moving in, unpacking, settling, and making the home comfortable for my wife was a time-sensitive matter. In large part because we were planning to deliver at home, with our midwife. This would be our second home birth.

I’m happy to report that the delivery went beautifully and smoothly, thank God.

But, leading up to this we were in an “all hands on deck” scenario. My parents flew in to help, and shortly thereafter so did my grandfather-in-law.

To provide a little context about grandpa, he is one of the most active and fit people I know, especially when you consider he’s pushing octogenarian status. His help would definitely be felt.

The only chronic and serious health concern I know about him, other than his gout, is his hypothyroid status.

A Little History

For as long as I’ve know grandpa, he has avoided red meat quite strictly and alcohol to a lesser extent. In large part to avoid a gout flare-up.

This is the standard recommendation. Avoid these triggers, and take something like colchicine to alleviate flareups.

One of the increasingly appreciated and understood contributors to gout is overconsumption of fructose. But, this starts to beg the question…what is gout?

Is it the red meat? Is it the uric acid? Maybe there’s something more to this story.

Fast-forward to this visit, and we see a somewhat different and more lax grandpa. He is consuming meat, drinking beer, and enjoying the holidays.

What changed?

He tells us that he has started a combination of a B-vitamin complex and morning caffeine. This, he claims, prevents his flare-ups.

Interesting.

One final component we need to consider here, before we build a broader understanding of gout, is that grandpa also has low thyroid function for which he has taken levothyroxine.

Before we dig in, let’s summarize the factors:

1. Diet and alcohol

2. Vitamins and Caffeine

3. Fructose

4. Hypothyroidism

5. Joint pain

At first glance, it’s very hard to unify all of these factors.

So, let’s get started.

A Krusian Perspective

During my many attempts to try and understand Gout, I stumbled upon a couple of articles written by Dr. Jack Kruse on this topic. For those of you familiar, he’s a very large proponent of Solar and Circadian health.

Personally, I find his work astounding and informative. In the past his writing has been very hard to penetrate, and his ego on podcasts difficult to stomach. But, he has been improving.

In any case, this is Kruse’s basic assertion about Gout:

Gout is a marker of impaired mitochondrial energy flow caused primarily by light deficiency, with uric acid rising as a downstream signal and nitric oxide (NO) being chronically inhibited.

Like many aspects of health and disease, Gout (which is commonly understood as a joint problem) is a symptom of a biochemical impairment which is marked by uric acid elevation.

From Kruse’s perspective, the pathway to gout looks like this:

Sunlight → energy flow → mitochondria → waste handling → repair

Without appropriate Solar signals (UV and infrared), the ability of your body to produce and move energy, recycle nitrogen waste, and repair the body becomes impaired.

High uric acid is a warning sign that these energy processing systems are not functioning properly.

Thus, all of the various things which contribute to elevation of uric acid (waste) without recycling of nitrogenous amino acids and compounds…can contribute to gout flare-ups.

This includes factors like:

1. Vitamin deficiency for recycling nitrogenous compounds

2. Fructose overconsumption (relative to sunlight exposure)

3. Purine and hypoxanthine rich foods

4. Factors which modulate xanthine oxidase (an enzyme).

Kruse’s core beliefs are in alignment with this model, including:

• All energy ultimately comes from the Sun

• Food is simply a secondary storage form of Sunlight

Nitric oxide is one of the core players in circulatory health, energy production, and redox balance. In the presence of high uric acid, we enter a low nitric oxide state.

Low nitric oxide → poor energy and poor tissue repair.

Why does fructose matter? It’s not simply that Fructose is producing uric acid.

In nature, fructose is most abundant in tropical fruits. Tropical fruits get a ton of sunlight. If you are consuming tropical fruit, you should typically be under the exposure of the Sunlight. However, if you consume tropical fruit (grandpa is from Colombia) without getting adequate sunlight (as in modernity and in cities)….well, that’s a mismatch that leads to metabolic trouble.

More Than Joint Disease

The natural question you should be asking is, if gout is really a manifestation of something so systemic, then why does everyone complain of joint disease?

Well, this is one of the few felt symptoms of gout.

In reality, gout has several systemic manifestations:

• Hypertension - can’t feel it.

• Atherosclerosis - can’t feel it.

• Chronic Kidney disease - can’t feel it.

• Insulin resistance - can’t feel it.

• Non-alcoholic Fatty liver - can’t feel it.

What can you feel?

• Joint pain

• Fatigue/Sleepiness

• Peripheral neuropathy

Now, if I think back to all of the people I know who have Gout…these association are confirmed. Other’s I know who have gout flare-ups have pretty bad metabolic disease, including insulin resistance, hypertension, and atherosclerosis.

During This Visit

This visit was unlike others.

We’ve done a lot of work around the house, the yard, and the workshop. Grandpa has been helping as much as anyone else.

Everyone had some sort of soreness, pain or exhaustion from all the work we got done in a short period of time.

One day, grandpa told us his foot hurts. “It’s the gout.”

I thought to myself…are you sure?

I mean…my foot hurts too. So does my shoulder, my forearm, my hands…a lot of soreness. Why is this gout?

Maybe because he’s been consuming meat and imbibing during festivities, he thinks it must be the gout?

Then, it dawned on me.

B-vitamins…thyroid…overworking…exhaustion.

Kruse was right.

It is an energy problem.

Let me ask you, the reader, something.

Imagine you are healthy and fit. You decide to embark on extended period of strenuous activity, in the cold winter, with short periods of daylight. You keep doing it for weeks.

What is the first pain you expect to experience?

If you are like me, the answer to this will be obvious. Musculoskeletal…and most likely joints first.

These parts of our body are constantly in motion, under strain, requiring lubrication and clearance of waste/damaged tissue.

If we overload these processes, we get joint pain.

How B-Vitamins and Caffeine Help

Purines (which are nitrogen containing biological compounds) can either be recycled or degraded.

Uric acid rises when these purines are degraded.

To recycle purines, and prevent uric acid build-up, we need B vitamins, including B2, B3, B9/B12.

Furthermore, other B vitamins helps with inflammation, including B6 and B1.

Thus, a B-vitamin complex is precisely what a person with this energy dysregulation needs.

Caffeine also plays a role. Caffeine acts like a methylxanthine which binds to a mildly inhibits the activity of xanthine oxidase. Furthermore, caffeine is a natural diuretics, which promotes the clearance of nitrogens via urate in the urine.

This account fits perfectly into Kruse’s model. From his perspective, B-vitamins do not fix the problem, they improve metabolic efficiency when the light signal is weak. B-vitamins improve electron flow (via oxidative phosphorylation), improve recycling of NAD/FAD, and overall improve our redox balance.

In the absence of appropriate solar signals, the B-vitamins help minimize the consequences.

Even the caffeine fits into his model, but caffeine somewhat increase nitric oxide signaling (which the uric acid worsens).

What About Thyroid Hormone?

From the energy balance perspective, this fits in perfectly.

Let’s take Kruse’s perspective here, to keep things consistent.

He would assert that metabolic rate of our body is not created by thyroid hormone. Instead, it is created by sunlight. Thyroid hormone simply acts as the facilitator/conductor of this energy throughput.

So, when light signals are weaker, the thyroid will turn down its rate…adaptively.

Morning UV light lead to nitric oxide production/release. Infrared activated cytochrome C (a critical protein in production of ATP).

When these signals are missing…energy flux slows down. This leads to reduced demand on the thyroid gland.

As is the theme with most of medicine, low thyroid hormone production in this case is yet another symptom. Because of the impact of thyroid hormone on electron flow and energy coupling…since the light inputs are impaired, the body turns down thyroid hormone production to protect itself.

This state also feeds back into gout.

Low thyroid function → Slow ATP turnover → increased uric acid production.

This is the tradeoff. Uric acid production goes up to reduce oxidative stress.

This is why thyroid supplementation temporarily helps reduce gout flares. This is not without its risks. Without getting lost in the weeds of quantum electrodynamics…let’s put it this way.

You can’t crank up thyroid hormones without the appropriate light signals required to drive this higher metabolic state. If the underlying light deficiency is not addressed…

Solar light sets the ceiling on metabolic activity. Thyroid hormone modulates the throttle.

How Do We Fix This Problem?

We return to foundational health.

Step 1: Address morning UV light exposure.

• More exposed skin

• No Sunglasses

• Within an hour of waking up

Step 2: Near-infrared to mitochondria from any source

• Sunlight

• Fire

• Incandescent light bulbs

• Infrared panels

Step 3: Circadian Alignment

• Eat during daylight

• Sleep when its dark outside

• Avoid blue light at night

Step 4: Cold exposure

Step 5: Diet

• Eat during daylight

• Pair fructose consumption with sunlight exposure

• Avoid seed oils

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Since sharing my initial Note regarding grandpa’s gout status, I got ton of feedback with many stories about how people fixed their gout.

Let me know how the above jives with your experiences in a comment below.

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