Hi Dr Pete, Another metabolic factor for consideration in all this. Lipoprotein (a), aka Lp(a). I am 59 with a long history of chronic, severe gout that developed into refractory gout that was no longer responding to treatment at the maximum dose of allopurinol; obesity, sleep apnea, high blood pressure, and pre-diabetes. All problems were reversed when I started keto 4 years ago. Currently, no medical problems, no medications. Vitals and blood work are all very good. In my case, I was first diagnosed with gout at age 24. However, I was having gout attacks for several years before I was diagnosed. I just had some detailed blood work done, including a NMR lipoprofile and Lp(a). Lp(a) is a type of LDL that is highly correlative (likely causitive) factor that is known to correlate with CV plaque and CVD. The Lp(a) level is genetic. The level cannot be changed with diet and/or exercise. There is no pill or treatment to lower the level of Lp(a). However, there is a genetic condition known as the Lp(a) null allele that is found in 3% of the general population. The Lp(a) null allele is found at marker rs41272114 on chromosome 6. The Lp(a) null allele results in a non-detectable level of Lp(a) and is known to be highly protective of plaque and CVD. My Lp(a) level is non-detect. My "23 and me" DNA test raw data confirms I have the Lp(a) null allele at marker rs41272114. My Coronary Artery Calcium (CAC) score indicates I have plaque score of zero. While protective of plaque and CVD, I am now wondering if my non-detecable level of Lp(a) might be inversely implicated in driving the severity of my gout? In the vein of there is no such thing as a "free lunch", the liver must be producing Lp(a) for some useful purpose. From what I found, there does not seem to be anything known about the benefits and purpose of Lp(a). Everything about Lp(a) seems to be focused solely on its negative role in the development of CV plaque and CVD. I am inclined to think that mother nature has not made a mistake in producing Lp(a). It seems a wide open unanswered question as to discovering the metabolic benefits of Lp(a). I am wondering if there might be some type of inverse correlation to be discovered between the most chronic, severe cases of gout and Lp(a) null allele genetic status at marker rs41272114? Lp(a) level is easy to add to a standard lipid panel blood test. A stand-alone Lp(a) test retails for $30.80 through the "Own Your Labs" website. The Lp(a) null allele status at marker rs41272114 can be easily searched and viewed within the raw data of a consumer "23 and me" DNA test. My genotype at the Lp(a) null allele marker at rs41272114 is C/T.

I suffered from gout in 2013 and 2014. In April of 2014 I had a sleep study and diagnosed with OSA. I recieved a CPAP and life was good. My gout did continue until early 2015 when I had my last flare up. I was taken off Niacin for my cholesterol. I have never had a flare up since until this week. I attribute it to indugling on beer and sugary desserts a week ago. I normally have a very clean, plant based whole food diet. Soaking my foot in hot water seems to help, as you recommened in another video. I'll report back in a few days an let you know.

This is good info. I think the issue with CPAP goes beyond noise (it's not too loud) and having a mask on your face (and then you can't turn on the side!!). The issue may be - there's a class action lawsuit against Phillips. Seems the material used to sound-insulate the pump, breaks down slowly, and is CARCINOGENIC. Not sure if it's actual pieces, or fumes. Now, the CPAP pumps air under pressure, so carcinogen into lungs - which is worse, that or the other potential side effects of sleep apnea? AFAIK it is only Phillips, but, know how manufacturing is often outsourced and that this technology is not rocket-science (only air), I'll bet all the other manufacturers are doing and using the same. The other interesting thing is the "acidifying" of the blood due to all this. Is there some way to "alkalinize" the blood - some smoothie - and thus reduce the uric acid concentration? That doesn't solve the sleep apnea, but at least the uric acid. Thanks!