Subtitle: Does it even matter which came first (the chicken or the egg)?
I’d like to thank u/jotii (Reddit User) for raising a very good point on a recent Reddit thread in r/gout.
I do believe that the metabolic factors is a part of the puzzle for sure, for some bigger than others. But it is obvious that there are yet some missing pieces that we don’t understand yet and are to be discovered in the future. I strongly believe in the microbiome as a potent factor (which is of course connected to metabolism), read more in this study about microbiome and gout and genes is probably another.
u/jotii, r/gout, Is allo for life?, 2/10/2022
Love the fact that u/jotii provided a link to a study that gave me another viewpoint to consider. It also gave me some evening reading. A few evenings actually, as I read it a few times.
The Study: Intestinal Microbiota Distinguish Gout Patients from Healthy Humans
- The study itself was about a new way to clinically diagnose gout more accurately, and earlier, than testing uric acid, which may have its shortcomings.
- There seems to be a role for specific bacteria in the microbiome in breaking down uric acid into urea so that it can be excreted in urine. These appear to be Faecalibacterium prausnitzii, Clostridium (which produce butyrate in the gut) and Bifidobacterium pseudocatenulatum.
- If these bacteria are in short supply then the breakdown of uric acid to urea may fail to occur, resulting in high uric acid and gout.
This is what really caught my eye:
On the pathway of purine metabolism, the xanthine dehydrogenase which can degrade the purine to uric acid was enriched in the gout patients, whereas the allantoinase that degrades the uric acid to urea was depleted. Thus it is possible that in the intestinal microbiota of gout patients, a significant amount of purine were degraded to uric acid which however could not be further degraded to urea, leading to abnormal accumulation of uric acid in gout patients.
Guo, Z., Zhang, J., Wang, Z. et al. Intestinal Microbiota Distinguish Gout Patients from Healthy Humans. Sci Rep 6, 20602 (2016). https://doi.org/10.1038/srep20602
This is a tantalizing bit of information and drives me in two directions. First, does it matter? Second, can you do something to improve the gut microbiome futher?
Is it the Metabolic Syndrome or the Screwed Up Microbiome? Does the answer change the approach to curing gout?
My overarching theory is that most people (maybe not all) end up with gout because of a poor diet and the resulting metabolic syndrome. And that dumping the Standard American Diet and improving metabolic health will cure gout. Taking medication for gout is simply providing temporary coverage of symptoms. That relying on medication alone will still leave you with a constellation of other health problems down the road.
So on the one hand we have studies to show that metabolic syndrome is closely associated with gout (and Type 2 Diabetes, and Heart Disease, and and and…). Metabolic syndrome impairs the function of liver and kidneys and therefore impairs the ability of the body to properly handle and get rid of excess purines and uric acid.
On the other hand, the microbiome of gout sufferers may not have enough of the microbes necessary to break down uric acid to urea. But what causes a screwed up microbiome? It can be lots of things but, chief among them are alcohol, processed carbs and sugars. In other words, bad diet that pushes you further toward diagnosed metabolic syndrome. But it’s a spectrum, not an on/off. You likely just have a lesser degree of, but still worsening, metabolism until you are finally diagnosed with metabolic syndrome – usually at the same time you are told you have Type 2 Diabetes and need insulin for life. (Don’t believe this).
The microbiome is highly impacted by what we eat. Metabolic syndrome is highly impacted by what we eat. If we get rid of the highly processed carbs and seed oils and eat real food BOTH our metabolism and our gut microbiome improve naturally. So… while the distinction may be of interest to scientists does it change our approach? My vote is no!
Can You Improve Gut Microbiome to Improve Uric Acid to Urea Conversion?
Did you know the human body has 10 times the number of microorganisms than it has human cells (according to the U.S. National Institutes of Health)? They are all over our skin but even more live in our gut. If you think the quality of our diets is irrelevant, its time to rethink that assumption.
If you believe gut microbes can indeed be part of the solution to improving uric acid excretion (and I’m leaning that way) then what can you do?
A reminder, the single biggest thing you can do to improve your long term prospects for curing gout is to get to a truly healthy diet. But, next, it would seem there is case to be made for eating foods that help nourish Faecalibacterium prausnitzii, Clostridium, and Bifidobacterium pseudocatenulatum.
There are at least two studies showing that Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum can be increased by adding certain types of fiber to the diet (See Notes 1, 2 at Bottom). Specifically, these studies highlight inulin. While you can get inulin by itself I’m not a fan of highly processed foods (e.g. a package of inulin).
Turns out inulin is also available naturally in fruits and plants such as chicory roots, wheat, onion, banana, garlic, and leek. I’m still focused on improving my metabolic flexibility and reducing my overall insulin, gut permeability, and blood glucose so I’ll skip the wheat and banana. However, I’m all in to add onion, garlic, and leek to my diet. These foods *may* help my gut bacteria and they will also provide sources of beneficial nutrients that I hope will help my bone mineral density.
One last note for consideration… Yet another study with mice showed that Far Infrared Radiation exposure produced a significant increase in Clostridium, which like F. prausnitzii and B. pseudocatenulatum was found to be higher in non-gout patients (See 3 at Bottom). So, going for a Far Infrared Sauna with some regularity *may* also help the body better process and excrete Purines and Uric Acid. I’ve been doing it for several months now to improve recovery after strength training. Worst case it feels amazing!
- Dietary Factors and Modulation of Bacteria Strains of Akkermansia muciniphila and Faecalibacterium prausnitzii: A Systematic Review
- Bifidobacteria and Butyrate-Producing Colon Bacteria: Importance and Strategies for Their Stimulation in the Human Gut
- Far infrared radiation induces changes in gut microbiota and activates GPCRs in mice
