The Danger Of Being Fat

Apologies for being so blunt, but I am fat (overweight if you prefer) and my high body-mass index (BMI) puts me at risk for gout. Whenever my weight drops below 105 kg (230 pounds), I get far fewer or no gout attacks. When my weight goes up, I start having attacks again.
I tried to figure out why, so I wrote a book about it. Not about being fat, but about how weight loss is a factor in your gout, and why losing weight can help you not only live longer and have fewer gout attacks, but also help you avoid really unpleasant conditions like diabetes and kidney failure. Your fat is and indirect culprit, but it is much more complicated like that. I guess I should recommend you to read "Gout Simply Explained" to figure it out. 

Yes, I am fat. But I am working on it. Or working it off.

The reason I have gout is my weight. Or rather, the way I gained the weight. I am officially diagnosed with
metabolic syndrome, which is a condition where your body is on the verge of tipping into several more nasty conditions - diabetes, cardiovascular problems, dementia to mention a few. But I did not get there by accident. Nor did I get my gout by accident. I caused it all myself, as most people with gout do. There are those with genetic issues which cause them to have gout even though they have never been overweight in their lives, but those are much, much fewer than those of us who get gout because we have gained too much weight too fast. 

GOUT AND URIC ACID

When you have gout, it is because you are hyperuricemic. Hyperuricemia is simply a term for your liver producing more uric acid than your body can execrete through the kidneys. The remaining uric acid stays in the blood and when it reaches a concentration of 6.8 mg/dL it starts to form crystals. Such crystals are microscopic but your body is not made to have a lot of crystals sitting in it. So it has to store them somewhere. Uric acid has an affinity for cartilage (remember, this is a complex organic molecule), so the uric acid crystals are encapsulated (in thin protein shells) in the cartilage. When they are released, they cause a gout attack.

OVERWEIGHT GOUT RISK

Why is overweight a risk factor for gout? Well, apart from excess fat releasing hormones which can be harmful (or make your body act harmfully towards itself), the addition of body fat at a rapid pace seems to be the trigger for hypoglycemia - that you have too much glucose in your blood. And hypoglycemia is of course the other side of the gout coin, since the hyperuricemia causing gout is caused by the enzymes used to produce glucose being used up and turned into uric acid. Allopurinol acts as a brake of this process, but it can not stop the liver from being hyperactive.

HORMONES ARE TO BLAME

One reason weight is a risk factor for gout sufferers is a hormone called leptine, which controls how you manage fatty tissue. If you have too much fatty tissue, your body starts treating it as something to get rid of and triggers an inflammation. As the hormone (like most hormones) has multiple functions, it also helps the lungs to grow and regulates functions in your brain. The reason people who are overweight is more sensitive to Covid-19 is exactly this inflammation, which makes it easier for the virus to attack your cells.

STRAIN ON THE JOINTS

The weight used to be believed to be the reason for the wear on the joints that often comes with gout, but later research has shown that the explanation is much simpler. The inflammation which is triggered by overweight or obesity is the culprit, and the wear comes from arthritis. Which also explains why you can get problems in your hands, even though you are walking on your feet.

PERSISTENT INFLAMMATION

The inflammation which comes from the overweight causes wear not only on the joints, but on your heart and blood circulation as well. Actually, even if you could be overweight without inflammation, wheighing 120 kg puts more strain on pumping blood around than weighing 80 kg.
But the persistent inflammation is what wears out your body, and makes you more sensitive to gout. That alone is a good reason for lifestyle change and a different diet.

WEIGHT GAIN STARTS GOUT

There is another way your weight is impacting your gout: Your gout started with your weight gain.
As you know by now, the reason you have gout is that you are hyperuricemic, that is, your body produces more uric acid than it can execrete through the kidneys, so the excess has to be stored somewhere - sequestered in your joints. The reason for having so much uric acid is that your liver can not stop producing uric acid, since it can not stop priducing glucose and uric acid is what the enzymes producing glucose become when they are used up. Even when it gets stop signals from the cells in the body, it can not stop. If it has not happened already, you are pre-diabetic as well as hyperuricemic.
So what triggered this excess glucose production in the first place? The most likely culprit is your weight gain. Which would be logical since a weight
loss is the only thing that can cure metabolic syndrome (allopurinol stops the uric acid production but you would still be hyperuricemic if you did not take it).

THE FATTY CANCER

There is another reason I want to get rid of fat: The cancer risk. Being overweight (not to say anything about obese) increases the risk for cancer.
The mechanisms are not clear, but the presence of large amounts of fat (and energy) confuses cells to start dividing uncontrollably - the very definition of cancer.
A lot of stress on the cells also make the risk of cancer higher, and in case of hyperuricemia, your liver is already running away uncontrollably to produce as much glucose (with uric acid as a byproduct) as it can. The cancer risk increases significantly thanks to the additional glucose in the blood.

HIGH FAT MORTALITY

There is another reason to get rid of the fat, and that is life expectancy. Recent studies in England show that overweight people who consume meat more than once a week are at higher risk of developing diabetes, heart disease, and lung inflammation. And lung inflammation is not something you want to have these days (or any day). Minority groups have long been known to be at high risk for Covid-19, and this has believed to be at least partly due to their body composition. Now other studies have shown that the mortality in Covid-19 is higher in countries where people are overweight as a rule, like the UK and the US.

ONE YEAR PER KILO

Not that excess mortality from being overweight should come as a surprise. My doctors over the years have told me that if I would lose weight, I would gain one year of life per kilogram that I lost in weight. That did not seem so attractive when I weighed a hundred, but when my weight went up to 140 kg, then it became a very interesting prospect. Especially as early mortality from congestive heart failure caused by high blood pressure runs in the family.

THE SIMPLE CURE

The cure is simple: Lose weight. Easier said than done, as anyone who has tried knows. The only thing to remember is that you have to manage your weight loss carefully. Dead cells is the primary source of the purine production in your body, and if you provide the liver with too much, it will create excess uric acid from the purines. Which is what gives you gout.

Read more here:
* Why you should go on a diet - and how.
​* The forbidden gout foods
​* How to make your new diet taste better than the old one.
* Great foods for gout beaters
​* What to do when the diet gets boring

And a few links to warn about potential dangers:
* Why gout happens in your big toe
​* Your heart and gout
​* Why you should avoid sugar
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