Speaker 1 (00:04):
Gout the disease of kings and the curse of modern diets. Well, let’s get a little history of gout. So gout, believe it or not, has been known about for centuries. In fact, hundreds of centuries. Early reference to gout was actually made by Epocrates in the fifth century BC described this swelling of the big toe and he made note that it seemed to spare eunuchs and women before menopause. References were made to gout by the ancient Egyptians around 20600 BC when physicians actually described joint pain in the big toe. Now, in the Middle Ages and the Renaissance, gout was known as the disease of kings and the king of diseases. Why? Because it seemed to affect the wealthy who indulged in rich meals, shellfish, and plenty of wine. In other words, the original lifestyle of the rich and famous. Now, famous sufferers included King Henry IIIs, Isaac Newton, and even Benjamin Franklin.

(01:09):
Franklin wrote in a letter that his gout was like a cruel partner nagging him to get off the sofa. Weird fact, in 1683, Dr. Thomas Cydaham, sometimes called the English Hipocrates, wrote the first detailed clinical description of a gout attack. He himself suffered from it and described the pain in his big toe as so intense that even the weight of a bedsheet was unbearable. Believe it or not, that’s still considered a hallmark of the gout flare. But before we jump into what gout actually is and what causes it, if you like what you’re hearing here at the Dr. Gundry Podcast, don’t forget to subscribe and most importantly, share this with your friends and loved ones and like us.

(01:53):
Real quick, before we dive in, if you’ve gotten value from this show, I’d love for you to take 15 seconds and leave a five-star review on Apple Podcasts or Spotify. Those ratings are literally how the platform decides to show this podcast to new people. So something that takes you no time at all could put life-changing information in front of someone who desperately needs it. Okay, let’s get into today’s episode. Okay. So edits core gout is a form of inflammatory arthritis. It happens when uric acid crystals build up in the joints, most famously at the base of the big toe. Now, uric acid is a normal breakdown product of purines. These are compounds that make up our DNA and they’re also present in many foods. Now, normally, our kidneys are pretty good at filtering out uric acid, but when uric acid levels get too high, either because the body manufactures too much of it or the kidneys can’t get rid of it fast enough, these tiny sharp crystals form.

(03:03):
Now, these crystals are like tiny microscopic needles stabbing into the joint, triggering pain, swelling, redness, and heat. But before we go into that even more, I want you to realize why were affected with gout and none of our other animal counterparts do. It turns out about 10 million years ago, great apes suffered a genetic mutation in how uric acid is denatured. Up until then, all animals have a enzyme called uricase that basically dissolves uric acid. Great Apes lost the ability to make uricase. So what? It turns out that uric acid is made primarily from two sources. One, which turned out to be one of the major benefits is that uric acid is a product of detoxification of fructose in the liver into two seemingly harmless compounds, triglycerides, which you have measured on your lipid profile by your doctor, and uric acid. Now, it turns out that uric acid is very good at raising blood pressure.

(04:24):
It’s very good at storing fat by promoting insulin resistance. And luckily, if you’ve been watching this broadcast long enough, you know that insulin resistance is something that most people in America suffer from, even though they’re unaware of it. And it’s the cause of diabetes, pre-diabetes, fatty liver, all because we inherited that mutation from great apes. Why was it beneficial to great apes? Because they could outcompete monkeys for fruit in a diminished climate change where forests were shrinking and great apes could take the fructose in fruit and convert it into fat and uric acid and store fat for the winter. We inherited that mutation. And for years, we thought this mutation was the thrifty gene because we had the ability to endure long periods of time with little or no food. And we thought that that ability to store fat was a thrifty gene. It wasn’t until recently that we realized that the thrifty gene was actually the mutation that allowed us to keep making uric acid and not dissolve it and allowed us to store fat for the winter that now never comes.

(05:47):
So that’s why we have these high levels of uric acid. Now, if you watch my episode 194 with my friend, Dr. David Perlman, we discussed his bestselling book, Drop Acid, which is all about how most of us make far too much uric acid. And most of us make it, as I tell my patients, from three things. Number one, fruit and fruit juices. Number two, concentrated fruit like wine or beer. Number three, animal protein purines, particularly fish and shellfish. So those are the three major contributors that I see in my patients to raising uric acid levels. Okay. So what are the classic symptoms of gout? Like I said, incredibly painful conjoint pain, usually in the big toe, but it can appear elsewhere. It can appear in the elbow. It can appear in your big finger. It often strikes in the middle of the night and people suddenly wake up in excruciating pain.

(06:53):
It usually rapidly occurs. It kind of comes out of nowhere. Now, the problem is even though it comes out of nowhere, the pain can last for days or even weeks and it is one of the worst pains that a human being can experience.

(07:13):
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(08:08):
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(09:10):
So even though the big toe is classic, you could hit other joints and you can actually get these uric acid crystals that build up under the skin. They’re often on the ears, the elbows and fingers, and they almost look like little chalk areas underneath the skin. Uric acid can cause kidney stones. About half of kidney stones are uric acid stones. The other are calcium oxalate stones. And so this is a failure of the kidneys to be able to handle the amount of uric acid that’s coming and it builds up in these stones. Now, sometimes people have high levels of uric acid, hyperuricemia without even knowing it. That’s why you should always have your uric acid levels measured in a routine panel. And quite frankly, almost no doctors are trained to look at uric acid levels. And you are better off knowing your uric acid level and getting it down than suffering the consequences.

(10:08):
And the point of all this is the consequences of high uric acid aren’t limited to gout. That’s kind of the end. It’s not limited to uric acid stones. That’s kind of the end. Where most of the time it’s trouble is in causing insulin resistance in causing elevated insulin levels in causing metabolic dysfunction. And the sooner you know and get a handle on your uric acid levels, the easier it is going to be to avoid all these long-term complications thanks to that genetic mutation from great apes. So why are we seeing it so much today? Well, as I mentioned, this was in a response to no longer having uricase to break down uric acid, which means that the more fructose in our food, the more likely this process is happening to you right now. So high fructose corn syrup is in almost everything. Our fruit has been bred for sugar content and size.

(11:10):
And lastly, we have to take a clue from ancient man and great apes. Fruit was never available year round. Even in the jungle, fruit only ripens once or twice a year. We’ve now made it possible to eat fruit 365 days a year and that genetic mutation that was so beneficial to great apes in early ma, has now become our Achilles heel. And so looking at why that genetic mutation was beneficial and why it’s so mischievous really can help you decide what you wanna moderate in your diet, whether it’s high fructose corn syrup, whether it’s amount of fruit in your diet, whether it’s the amount of wine or beer in your diet, whether it’s the amount of animal protein, particularly fish and shellfish in your diet, all of these have an impact and you get to choose where you wanna moderate it. Now, the other good news is that there are very effective ancient prescription drug treatments to lower uric acid, but there’s also a very good natural substance to lower uric acid levels and some of those do work.

(12:25):
Tart cherry extract does work. However, as one of my patients found out, please do not drink dart cherry juice thinking that it’s gonna lower ear gout. One of my patients created gout by drinking lots of tart cherry juice. He also made himself a diabetic all thinking he was gona help himself, not realizing that there’s still huge amounts of fructose in cherries. So the extracts of dart cherry may in fact help you, but not the juice. There’s also another fascinating compound in India, which can lower uric acid levels and it’s available as a supplement. Vitamin C is useful. Cursedin is useful and a very interesting flavonoid called luteolin also is very useful in lowering uric acid levels. Coffee lowers uric acid levels and polyphenols and pomegranates mentioned cherries and green tea show some uric acid lowering effects. So all of those are options in dealing with uric acid.

(13:31):
So if you’re now worried about the disease of kings and don’t want to follow that path, just remember why we make uric acid in the first place and why we probably don’t wanna make much uric acid anymore and the easy steps you can take every day to lower your risk of gout.

(13:54):
Now it’s time for the question of the week from at FrankRD4B over on YouTube on my episode about staying in ketosis. They asked, when is the best time to take MCT oil? So that’s a great question. My personal feeling is your best time is probably twice a day in the morning and right before you go to bed. The reason for that is you want to extend the period of time that you are in ketosis for quite frankly, as long as possible, getting an eating window of about six to eight hours per day. Many people when they first start trying to get in ketosis can’t because their insulin levels are too high and insulin blocks the release of free fatty acids from your fat cells, which the liver then can make into ketones. MCT oil, on the other hand, goes directly to the liver where it generates ketones regardless of what your insulin levels are.

(14:53):
Also, there’s some suggestion that MCT oil at night will actually improve your deep sleep. I’ve experimented with this myself and I’d say the results are mixed, but again, that’s a personal observation, not a study. When I have people who are very, very insulin resistant, I really ask them to take a tablespoon of MCT oil three times a day. But warning, particularly for my female listeners, liquid MCT bothers a lot of my female patients. So the powdered MCT works much better. In fact, that’s why I created MCT Wellness, one of my bestselling Gundry MD products. Now it’s time for the review of the week at Diane Kelly 3452 over on YouTube on my episode about nut butters. They said, “Thank you, Dr. Gundry. Evidently, I’ve been eating the wrong nuts since 1998 when I learned my inflammation was from rheumatoid arthritis. Since 2001, I’ve been taking methotrexate, but in 2025, when I turned 75, my inflammation became unbearable.

(16:02):
Perhaps eating the nuts that you and your lovely wife enjoy will ease my mysterious inflammation.” Well, thanks for writing that. Quite frankly, there’s nothing in my opinion mysterious about rheumatoid arthritis. It’s caused by leaky gut and dysbiosis of the gut microbiome. And when my patients fix this, their rheumatoid arthritis, their rheumatoid arthritis markers like rheumatoid factor and anti-CP3 resolve. One of the interesting things about a lot of my rheumatoid arthritis patients is they absolutely react very strongly to the lectins in almonds to peanuts, which are not a nut or and to cashews. And getting those out of your diet is a great first step to repairing the problem. So let’s see what happens and thanks for writing.

Speaker 2 (16:58):
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Speaker 3 (17:30):
I hope you enjoyed this episode of the Dr. Gundry Podcast. If you did, please share this with family and friends. You never know how one of these health tips can completely transform someone’s life when you take the time to share it with them. There’s also the Dr. Gundry Podcast YouTube channel, where we have tens of thousands of free health insights that can help you and your loved ones live a long, vital life. Let’s do this together.