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.
Calling gout purely a “blood disease” is oversimplified because while hyperuricemia (elevated serum urate) is the necessary upstream driver, the actual painful swelling results from urate crystals depositing in joints and triggering a local immune inflammatory response. Many people have high uric acid and never develop gout, which shows that elevated blood levels alone are not the full disease — crystal formation, joint conditions, and immune activation are required for flares to occur. So gout is best understood as a systemic metabolic disorder that manifests as crystal-induced inflammatory arthritis, not just a problem of the blood or just a problem of the joints.
— GPT-5
You called him useless, because truth hurts. I cured my 30 years gout without any pills, just by fixing my metabolism with diet.. By doing my own reading. My doctor ( old school) told me it would not work. he was wrong.
So sorry, the doctors you consult are BIASED. I do not let other people think for me, white coat or not. I don't take poison, to treat poor habits. I change the poor habits.
Every one is free to choose. Even the fools who still think modern medicine is their friend.
======
"Allopurinol — Adverse Effects (Complete Listing Including Death)
Common
Rash
Nausea
Diarrhea
Headache
Drowsiness
Elevated liver enzymes
Hematologic
Leukopenia
Thrombocytopenia
Agranulocytosis
Aplastic anemia
Hepatic
Hepatitis
Cholestatic liver injury
Fulminant hepatic failure
Renal
Interstitial nephritis
Acute kidney injury
Dermatologic / Severe Cutaneous Reactions
Stevens–Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
This all doesnt make sense. In winter there is naturally less light. Everywhere in the world. With some places even mostly darkness. Definitely for most of life people wouldn't have known to eat less fructose and be more in the light. It would have happened naturally. Where I stay citrus fruits are winter fruits. Which makes sense apparently in terms of infections. But most would just eat it those years probably because it was one of the few fruits available in winter. And they'd eat alot since animal hunting is less in winter. In other words sometimes people probably naturally ate lots of fructose without access to lots of light. Perhaps im incorrect but something doesnt add up completely
Really interesting reframing and I appreciate how you widen the lens beyond “red meat → uric acid → sore toe.” Clinically, gout is often the tip of the iceberg of a broader metabolic/renal story, and your observation that many people with gout also carry insulin resistance, hypertension, CKD risk, and fatty liver fits what we see at the bedside.
One nuance I’d add as a physician-scientist: the core mechanism is still very “classical” and very real, sustained hyperuricemia leads to monosodium urate crystal deposition, which can trigger a potent innate immune response (IL-1β/NLRP3 inflammasome biology) and the abrupt, exquisitely painful flares people recognize as gout. The “energy” framing you’re exploring may describe upstream terrain (sleep/circadian stress, cold exposure, overtraining/under-recovery, dehydration, diet quality), but it shouldn’t replace the proven fundamentals: confirm the diagnosis, measure serum urate, and for recurrent flares/tophi/CKD stones, treat-to-target urate lowering (often allopurinol/febuxostat) plus appropriate flare prophylaxis.
Your fructose point is especially clinically helpful, but it’s an underappreciated driver because it can raise urate and worsen insulin resistance. And the hypothyroid connection is plausible too (reduced clearance can contribute). The B-vitamin/caffeine angle is a fascinating n-of-1 observation; I’d just caution readers not to overgeneralize it into a universal “fix,” since the evidence base there is thinner than for urate-lowering + weight loss + alcohol/beer and sweetened beverage reduction.
I had gout which got increasingly worse the more weight i carried until it was a constant thing. I used ibuprofen for the pain, which brought on a heaRt attack.
After changing my diet to very low carb the following happened.
Gout disappeared as a constant thing, until a year later I was free from it.
The diabetes they said I had was gone.
I lost 50 lbs without trying.
My arthritis went away.
My blood pressure is normal.
I don't take ANY big pharma pills.
I ate 90 % meat, red meat only. And salad
One meal a day
,
Now ( 5 years later) I add < 70 net carbs a day.
I take Nattokinase, vit d, k2, magnesium.
I think DIET is most important because metabolic health is the root of general health.
Gracias doctor, interesante artículo, me gustaría conocer las experiencias de otras personas con problemas de gota. Su análisis es muy juicioso y puesto en razón, definitivamente el cuerpo es un laboratorio en el cual debemos estar experimentando constantemente y en forma adecuadamente dirigida para conocernos y así superar los problemas que se nos presentan cotidianamente. Gracias nuevamente.
I’ve not been troubled by gout, but I have had to deal with psoriasis in my dotage. According to Dr. David Perlmutter in his book “Drop Acid”, psoriasis is a symptom of high uric acid. I’ve found that it can be treated by eating tart cherries (the sour ones, not the dark sweet ones). I’ve worked out that the only time I really get an outbreak is when I consume dried fruit, which is a source of concentrated fructose. Sunlight exposure is difficult this time of year, but I do have several racks of plants in my office that are lit by grow lights. And I also start every day with 16 ounces of coffee. As long as I moderate my intake of dried fruit, it’s all good.
You shouldn't take neutraceuticals without reviewing diet and lifestyle too (the Ozempic trap), but Southern Ginseng, Gynostemma, should be beneficial too.
Gypenosides Inhibits Xanthine Oxidoreductase and Ameliorates Urate Excretion in Hyperuricemic Rats Induced by High Cholesterol and High Fat Food (Lipid Emulsion)
"... GPS may be an effective treatment for hyperuricemia via a decrease in xanthine oxidoreductase through the XOD/XDH system; and via an increase in urate excretion through regulating URAT1, GLUT9, and OAT1 transporters."
I had major gout attacks for a period of about twelve years. I am in great health, and I see doctors on average about once every ten years. I nearly never take medications of any kind, (no vaccines ever, no antidepressants, no nothin’) so I simply endured. I live in the desert and walk at least five miles a day, mostly in the sun.
I tried every diet I heard about. I was vegan and teetotal for years. Attacks persisted. I was on crutches for days on end, and crawled to the bathroom on my hands and knees.
One day my landlord called and said the neighbors had complained about my screaming in pain the night before. It was the worst pain I’d ever experienced.
I went to a specialist in Europe who suggested I try Allopurinol. I was skeptical, but finally got on a 100 mg daily dose. It’s been three years with only the most minor flares. I’ve had absolutely no side effects, and since I don’t even take aspirin, no conflicts.
Just out of curiosity, how seriously should I take an article on gout that doesn’t even mention allopurinol?
Allopurinol is used to decrease high levels of uric acid on the blood. That is a preventative measure, not a treatment of symptoms. It is used to prevent gout, while colchicine is used to mitigate pain by treating the symptoms only. That’s why rheumatologists think of gout as a blood disease, not a joint disease. This characterization makes me question your understanding of gout. The swelling in the joints is a result of hyperurecema.
As I said, the only relief I could find was allopurinol. My partner is a nutritionist and naturopath. When a more ‘natural’ equivalent for allopurinol is discovered I am happy to try it. In the meantime I’m very grateful to have a normal life restored to me with, so far, not the slightest compromise or ill effects.
Forgive my bluntness, but I find your column virtually useless, and your knowledge wanting.
I lived in Sedona Az, for a time, where people believe in ‘energy vortexes’ and think they can heal disease with crystals and past life therapy. By any chance, do you live there?
Yes, I too avoid as many prescription drugs as I can get away with. I couldn’t get away with this one.
Apart from codeine for headaches, which I haven’t had in decades, and occasionally antibiotics, I have never taken a prescription drug in the past fifty years. But you haven’t answered two questions: Why did you not explain your objection to it in your article? The absence was unexplained.
And even if your understanding of how it works on the chemical level is correct, that’s still no reason not to take it when nothing else has had any effect. Allopurinol has spared me unbearable pain. I’ve had extensive experience with natural remedies, herbal remedies, spiritual remedies, etc. But an ideological objection to a proven medication is, forgive me once again, unscientific, and suspect.
You’ve deftly avoided the question I asked three times now. You either don’t understand my question, or you’re sidestepping in order to protect your lack of interest in an essential aspect of the problem.
When people start accusing others of “projecting” it takes me right back to EST in the 70’s, a place I have no need to revisit. Thank you for your time.
There’s no need to reply to this, I’ll be moving on now.
Louise Hay’s work identifies the emotional/mental trigger for gout being “the need to dominate. Impatience, anger” - something to consider to round out the remedy
Been following Dr. Kruse for a while and notice positive changes. His "three legged stool" is Light, (sunrise and sunset) Water (DDW) and Magnetism (grounding) and my father lived to 99 following the Light and Grounding. Thank you for the post!
"
Calling gout purely a “blood disease” is oversimplified because while hyperuricemia (elevated serum urate) is the necessary upstream driver, the actual painful swelling results from urate crystals depositing in joints and triggering a local immune inflammatory response. Many people have high uric acid and never develop gout, which shows that elevated blood levels alone are not the full disease — crystal formation, joint conditions, and immune activation are required for flares to occur. So gout is best understood as a systemic metabolic disorder that manifests as crystal-induced inflammatory arthritis, not just a problem of the blood or just a problem of the joints.
— GPT-5
You called him useless, because truth hurts. I cured my 30 years gout without any pills, just by fixing my metabolism with diet.. By doing my own reading. My doctor ( old school) told me it would not work. he was wrong.
So sorry, the doctors you consult are BIASED. I do not let other people think for me, white coat or not. I don't take poison, to treat poor habits. I change the poor habits.
Every one is free to choose. Even the fools who still think modern medicine is their friend.
======
"Allopurinol — Adverse Effects (Complete Listing Including Death)
Common
Rash
Nausea
Diarrhea
Headache
Drowsiness
Elevated liver enzymes
Hematologic
Leukopenia
Thrombocytopenia
Agranulocytosis
Aplastic anemia
Hepatic
Hepatitis
Cholestatic liver injury
Fulminant hepatic failure
Renal
Interstitial nephritis
Acute kidney injury
Dermatologic / Severe Cutaneous Reactions
Stevens–Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Systemic Hypersensitivity
Allopurinol Hypersensitivity Syndrome (AHS)
Vasculitis
Multi-organ failure
Cardiovascular (rare reports)
Bradycardia
Hypertension
Fatal Outcome
Death (reported in association with:
Allopurinol Hypersensitivity Syndrome
Stevens–Johnson Syndrome
Toxic Epidermal Necrolysis
Fulminant hepatic failure
Bone marrow failure
Multi-organ failure)
This all doesnt make sense. In winter there is naturally less light. Everywhere in the world. With some places even mostly darkness. Definitely for most of life people wouldn't have known to eat less fructose and be more in the light. It would have happened naturally. Where I stay citrus fruits are winter fruits. Which makes sense apparently in terms of infections. But most would just eat it those years probably because it was one of the few fruits available in winter. And they'd eat alot since animal hunting is less in winter. In other words sometimes people probably naturally ate lots of fructose without access to lots of light. Perhaps im incorrect but something doesnt add up completely
Really interesting reframing and I appreciate how you widen the lens beyond “red meat → uric acid → sore toe.” Clinically, gout is often the tip of the iceberg of a broader metabolic/renal story, and your observation that many people with gout also carry insulin resistance, hypertension, CKD risk, and fatty liver fits what we see at the bedside.
One nuance I’d add as a physician-scientist: the core mechanism is still very “classical” and very real, sustained hyperuricemia leads to monosodium urate crystal deposition, which can trigger a potent innate immune response (IL-1β/NLRP3 inflammasome biology) and the abrupt, exquisitely painful flares people recognize as gout. The “energy” framing you’re exploring may describe upstream terrain (sleep/circadian stress, cold exposure, overtraining/under-recovery, dehydration, diet quality), but it shouldn’t replace the proven fundamentals: confirm the diagnosis, measure serum urate, and for recurrent flares/tophi/CKD stones, treat-to-target urate lowering (often allopurinol/febuxostat) plus appropriate flare prophylaxis.
Your fructose point is especially clinically helpful, but it’s an underappreciated driver because it can raise urate and worsen insulin resistance. And the hypothyroid connection is plausible too (reduced clearance can contribute). The B-vitamin/caffeine angle is a fascinating n-of-1 observation; I’d just caution readers not to overgeneralize it into a universal “fix,” since the evidence base there is thinner than for urate-lowering + weight loss + alcohol/beer and sweetened beverage reduction.
I had gout which got increasingly worse the more weight i carried until it was a constant thing. I used ibuprofen for the pain, which brought on a heaRt attack.
After changing my diet to very low carb the following happened.
Gout disappeared as a constant thing, until a year later I was free from it.
The diabetes they said I had was gone.
I lost 50 lbs without trying.
My arthritis went away.
My blood pressure is normal.
I don't take ANY big pharma pills.
I ate 90 % meat, red meat only. And salad
One meal a day
,
Now ( 5 years later) I add < 70 net carbs a day.
I take Nattokinase, vit d, k2, magnesium.
I think DIET is most important because metabolic health is the root of general health.
Gracias doctor, interesante artículo, me gustaría conocer las experiencias de otras personas con problemas de gota. Su análisis es muy juicioso y puesto en razón, definitivamente el cuerpo es un laboratorio en el cual debemos estar experimentando constantemente y en forma adecuadamente dirigida para conocernos y así superar los problemas que se nos presentan cotidianamente. Gracias nuevamente.
I’ve not been troubled by gout, but I have had to deal with psoriasis in my dotage. According to Dr. David Perlmutter in his book “Drop Acid”, psoriasis is a symptom of high uric acid. I’ve found that it can be treated by eating tart cherries (the sour ones, not the dark sweet ones). I’ve worked out that the only time I really get an outbreak is when I consume dried fruit, which is a source of concentrated fructose. Sunlight exposure is difficult this time of year, but I do have several racks of plants in my office that are lit by grow lights. And I also start every day with 16 ounces of coffee. As long as I moderate my intake of dried fruit, it’s all good.
You shouldn't take neutraceuticals without reviewing diet and lifestyle too (the Ozempic trap), but Southern Ginseng, Gynostemma, should be beneficial too.
Gypenosides Inhibits Xanthine Oxidoreductase and Ameliorates Urate Excretion in Hyperuricemic Rats Induced by High Cholesterol and High Fat Food (Lipid Emulsion)
"... GPS may be an effective treatment for hyperuricemia via a decrease in xanthine oxidoreductase through the XOD/XDH system; and via an increase in urate excretion through regulating URAT1, GLUT9, and OAT1 transporters."
https://pmc.ncbi.nlm.nih.gov/articles/PMC5347988/
What about vitamin c to increase energy?
I don’t see why not.
I’m generally of the disposition that if there’s something you can intake in large quantities with almost entirely benefits…just do it.
Gout or not gout.
Vitamin C.
Thanks for all your information on red light!! Purchased the Vector last night! Cannot wait to try it!!
I had major gout attacks for a period of about twelve years. I am in great health, and I see doctors on average about once every ten years. I nearly never take medications of any kind, (no vaccines ever, no antidepressants, no nothin’) so I simply endured. I live in the desert and walk at least five miles a day, mostly in the sun.
I tried every diet I heard about. I was vegan and teetotal for years. Attacks persisted. I was on crutches for days on end, and crawled to the bathroom on my hands and knees.
One day my landlord called and said the neighbors had complained about my screaming in pain the night before. It was the worst pain I’d ever experienced.
I went to a specialist in Europe who suggested I try Allopurinol. I was skeptical, but finally got on a 100 mg daily dose. It’s been three years with only the most minor flares. I’ve had absolutely no side effects, and since I don’t even take aspirin, no conflicts.
Just out of curiosity, how seriously should I take an article on gout that doesn’t even mention allopurinol?
If you are new to this publication, I generally avoid as many prescription drugs as I can get away with.
That includes allopurinol, colchicine and febuxostat.
All of which are designed to mitigate or relieve symptoms, not address the problem.
This is not what doctors have explained to me.
Allopurinol is used to decrease high levels of uric acid on the blood. That is a preventative measure, not a treatment of symptoms. It is used to prevent gout, while colchicine is used to mitigate pain by treating the symptoms only. That’s why rheumatologists think of gout as a blood disease, not a joint disease. This characterization makes me question your understanding of gout. The swelling in the joints is a result of hyperurecema.
As I said, the only relief I could find was allopurinol. My partner is a nutritionist and naturopath. When a more ‘natural’ equivalent for allopurinol is discovered I am happy to try it. In the meantime I’m very grateful to have a normal life restored to me with, so far, not the slightest compromise or ill effects.
Forgive my bluntness, but I find your column virtually useless, and your knowledge wanting.
I lived in Sedona Az, for a time, where people believe in ‘energy vortexes’ and think they can heal disease with crystals and past life therapy. By any chance, do you live there?
Like caffeine, allopurinol exerts its effect by inhibiting xanthine oxidase.
Gout is not caused by overactive xanthine oxidase.
Therefore, allopurinol does not treat the cause.
It inhibits a downstream enzyme.
Yes, I too avoid as many prescription drugs as I can get away with. I couldn’t get away with this one.
Apart from codeine for headaches, which I haven’t had in decades, and occasionally antibiotics, I have never taken a prescription drug in the past fifty years. But you haven’t answered two questions: Why did you not explain your objection to it in your article? The absence was unexplained.
And even if your understanding of how it works on the chemical level is correct, that’s still no reason not to take it when nothing else has had any effect. Allopurinol has spared me unbearable pain. I’ve had extensive experience with natural remedies, herbal remedies, spiritual remedies, etc. But an ideological objection to a proven medication is, forgive me once again, unscientific, and suspect.
I'm not sure who you are projecting on to me, but I didn't tell anyone not to take allopurinol. You are free to take whatever you like.
Just as my in-law is free to use colchicine, even if I disagree with the use of chemotherapy to alleviate joint pain.
You’ve deftly avoided the question I asked three times now. You either don’t understand my question, or you’re sidestepping in order to protect your lack of interest in an essential aspect of the problem.
When people start accusing others of “projecting” it takes me right back to EST in the 70’s, a place I have no need to revisit. Thank you for your time.
There’s no need to reply to this, I’ll be moving on now.
Louise Hay’s work identifies the emotional/mental trigger for gout being “the need to dominate. Impatience, anger” - something to consider to round out the remedy
Appreciate your post!
Super interesting--a close family member has struggled with severe gout and that emotional description describes her to a tee!
🙋🏻♂️it hit me like a ton of bricks when I read it too, and has helped me reframe things
Interesting!
Great write up , thank you.
Taking the thyroid medication at night is also helpful for some. Was it you who posted about the man who is suing about this very recommendation?
Been following Dr. Kruse for a while and notice positive changes. His "three legged stool" is Light, (sunrise and sunset) Water (DDW) and Magnetism (grounding) and my father lived to 99 following the Light and Grounding. Thank you for the post!
This is stupendous