A perspective on diet and gout.

The epidemiology of gout has changed dramatically over the past century. Once thought of as a disease of the nobility, it is now an egalitarian disease that affects patients across the socioeconomic spectrum. The incidence of gout has also risen in recent years, to the point that we are now seeing what is regarded by some as a "second epidemic" of gout. This change coincides with a significant dietary shift for many Americans - in particular, the advent of high-fructose corn syrup as the most prominent sweetener in the modern American diet and what may be a related rise in obesity. Fructose is a powerful driver of ATP catabolism that, in turn, leads to the production of uric acid. The new epidemic of gout is likely secondary in significant part to the rise in fructose consumption, as well as to the increase in obesity, the endurance of other dietary and non-dietary gout risk factors such as consumption of meat and alcohol, the continued use of culprit medications and potentially to the under-recognition of the benefits of certain foods and drinks (such as dairy products and coffee). Though the exact reasons for the rise in gout are yet unproven, this reopens the opportunity for dietary control of hyperuricemia through restraints that curtail not only exogenous but also endogenous pathways of purine production.