Ask the Doctor—Gout

By Mark Hyman, MD



Q My husband has been bothered by a tender big toe, which he attributes to arthritis. I think the rich food he loves has given him gout. How can we find out?

Gout is an ancient malady brought on by overindulgence. Charles Dickens wrote about it, and Rembrandt painted roly-poly characters with big red toes eating and drinking to excess. It is a totally preventable lifestyle disease.

A by-product of protein metabolism called uric acid causes gout. At high concentrations in the blood it forms crystals, which end up in the joints, typically the big toe, causing razor-like pain and redness.

Some people have genetic problems with uric acid metabolism, but most gout suffers bring the problem on themselves.

Most people don’t realize, however, that gout may presage a much more serious problem—insulin resistance or pre-diabetes. You can find out if you have gout by getting a blood test for uric acid, but you shouldn’t stop there. You should have a two-hour insulin and glucose tolerance test, which measures glucose and insulin levels after fasting and one and two hours after consuming a sugar drink. These will let you know if you have more serious problems.

Your husband faces some simple choices: He can keep enjoying his rich food, suffer from gout, get diabetes, be at risk for premature heart disease, cancer, and dementia, and take a medication such as colchicine, allopurinol, or indomethacin with significant side effects; or he can stop eating refined flour and sugar, cut out red meat, organ meats, and alcohol, and get more exercise to improve blood sugar metabolism.

While he’s waiting for his lifestyle changes to have effect, he can take cherry extract 2 to 3 three times a day for an acute attack or twice a day for long-term prevention.