The Real Reason Your Joints Hurt | EP 402.C

Summary

Podcast Summary: The Real Reason Your Joints Hurt | Dr. Gundry Podcast EP 402.C

Release Date: May 15, 2026
Host: Dr. Steven Gundry
Podcast: The Dr. Gundry Podcast
Episode Theme: Unpacking the true causes of joint pain through the lens of gout, uric acid, and modern dietary habits, with practical advice rooted in clinical experience.

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Episode Overview

This episode delves into the condition commonly known as gout—a painful form of inflammatory arthritis that has plagued humankind for millennia. Dr. Steven Gundry explores the evolutionary, dietary, and metabolic reasons behind elevated uric acid levels, decoding why gout (often called "the disease of kings") is making a comeback in modern society. Dr. Gundry also provides actionable steps for listeners to lower their risk and alleviate symptoms, blending historical context, evolutionary biology, and the latest nutritional science.

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Key Topics & Discussion Points

1. History & Evolution of Gout

• Historical References:
  • Gout described by Hippocrates (5th century BC) and ancient Egyptians (2600 BC).
  • Associated in the Middle Ages with royalty and affluence due to rich diets.
  • Famous sufferers: King Henry VIII, Isaac Newton, Benjamin Franklin.
  • Noted for intense pain, sometimes unbearable even under the weight of a bed sheet.
    Quote:
  • "Franklin wrote in a letter that his gout was like a cruel partner nagging him to get off the sofa." (00:41)

2. Understanding Gout and Uric Acid

• Definition:

  • Gout is a type of inflammatory arthritis caused by the buildup of uric acid crystals in joints, most notably at the big toe.

• Uric Acid Formation:

  • By-product of purine breakdown from both the body and various foods.
  • Normally filtered by kidneys; if overloaded or not excreted, it crystallizes. Quote:
  • "These crystals are like tiny microscopic needles stabbing into the joint, triggering pain, swelling, redness, and heat." (03:14)

• Evolutionary Backdrop:

  • Humans (and great apes) lost the uricase enzyme 10 million years ago, which would otherwise dissolve uric acid.
  • The mutation allowed early great apes and humans to store fat efficiently from fruit (fructose), which was once an evolutionary advantage.

3. Diet and Modern Triggers for Gout

• Primary Causes:
  • Fructose from fruit and fruit juices.
  • Alcoholic beverages (wine and beer made from concentrated fruit/sugar).
  • Animal proteins, especially fish and shellfish.
• Relevance Today:
  • Modern diets provide year-round access to fruit and high fructose corn syrup, compounding the risk.
  • Uric acid is tied not just to gout, but to insulin resistance, diabetes, metabolic dysfunction, and kidney stones.
    Quote:
  • "Fruit was never available year round. Even in the jungle, fruit only ripens once or twice a year. We've now made it possible to eat fruit 365 days a year. And that genetic mutation... has now become our Achilles heel." (11:29)

4. Symptoms and Diagnosis of Gout

• Classic Symptoms:
  • Sudden, excruciating joint pain—often at night—in the big toe but possibly elsewhere: elbows, fingers.
  • Redness, swelling, heat, lasting days or weeks.
• Beyond the Big Toe:
  • "Tophi"—chalky uric acid deposits—can form under the skin (ears, elbows, fingers).
  • Uric acid also responsible for about half of all kidney stones.
• Testing Recommendations:
  • Regular uric acid checks; most doctors overlook this metric in standard panels.
    Quote:
  • "Almost no doctors are trained to look at uric acid levels... You are better off knowing your uric acid level and getting it down than suffering the consequences." (10:28)

5. Gout, Metabolic Health, and Insulin Resistance

• Broader Impact:
  • High uric acid is a marker and driver of insulin resistance, metabolic dysfunction, and not just gout.
  • Early intervention via diet can prevent long-term complications.

6. Strategies for Prevention and Relief

• Dietary Moderation:
  • Limit foods high in fructose, high fructose corn syrup, alcohol (wine/beer), and purine-rich animal proteins.
• Supplements and Natural Strategies:
  • Tart cherry extract (but NOT juice due to sugar/fructose).
    • "One of my patients created gout by drinking lots of tart cherry juice. He also made himself a diabetic." (12:14)
  • Vitamin C, quercetin, and luteolin (a flavonoid).
  • Coffee and polyphenols from pomegranate/green tea.
  • Indian herbal supplements noted for their efficacy.
• Medication:
  • Mentions "ancient prescription drug treatments" as effective if natural measures fall short.

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Notable Quotes & Memorable Moments

• On the evolutionary downside of uric acid:
  "The ability to store fat was a thrifty gene. It wasn't until recently that we realized the 'thrifty gene' was actually the mutation that allowed us to keep making uric acid... that now never comes [the period of famine]." (05:55)

• On modern fruit availability:
  "We've made it possible to eat fruit 365 days a year, and that genetic mutation... has now become our Achilles heel." (11:43)

• On self-experimentation gone awry:
  "Please do not drink dark cherry juice thinking that it's going to lower your gout... He also made himself a diabetic." (12:14)

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Timestamps of Important Segments

• 00:05–02:23: History and early descriptions of gout.
• 02:23–04:10: What gout is, how uric acid forms, evolutionary background.
• 04:10–06:00: Why humans have high uric acid; the "thrifty gene" hypothesis.
• 06:00–07:13: Major dietary contributors to uric acid.
• 09:41–11:29: Non-joint effects, kidney stones, need for uric acid testing.
• 11:29–13:49: Modern diets, year-round fruit, moderation strategies, natural treatments for uric acid.
• 13:49–14:25: Recap and practical daily steps.

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Listener Questions & Anecdotes

Q&A Segment: Best Time to Take MCT Oil

• [14:25]
  • Dr. Gundry suggests morning and evening dosing to prolong ketosis.
  • Personal note: MCT oil may help deep sleep; powdered MCT is better tolerated, especially by women.
  • Practical mention of his own MCT Wellness product.

Listener Mail: Nut Butters and Rheumatoid Arthritis

• [16:00]
  • Dr. Gundry links rheumatoid arthritis to leaky gut and "lectins" in certain nuts (almonds, peanuts, cashews).
  • Reiterates dietary adjustments as a step toward resolving inflammation and immune markers.

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Summary & Takeaways

• Gout is not just a disease of the wealthy, but a warning sign of deeper metabolic imbalances driven by our modern diets and ancient genetics.
• Key contributors: fructose (from fruit/juices and processed foods), alcohol (wine/beer), and purine-rich animal proteins.
• Reducing consumption of these can help prevent gout and related metabolic diseases.
• Regular uric acid checks are critical—even in the absence of symptoms.
• Natural supplements like tart cherry extract (not juice), vitamin C, quercetin, and specific flavonoids may help lower uric acid.
• For persistent cases, prescription medications exist and can be highly effective.
• Addressing metabolic health, lectin intolerance, and gut integrity remain vital for overall joint and immune health.

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Dr. Gundry closes with his signature message that "your body was designed to heal," emphasizing practical, actionable steps for lasting wellness anchored in evolutionary biology and modern nutritional science.

Transcript

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[Dr. Steven Gundry]

The disease of kings and the curse of modern diets. Well, let's get a little history of gout. So gout, believe it or not, has been known about for centuries. In fact, hundreds of centuries. Early reference to gout was actually made by Hippocrates in the 5th century BC described this swelling of the big toe, and he made note that it seemed to spare eunuchs and women before menopause. References were made to gout by the ancient Egyptians around 2600 BC when physicians actually described joint pain in the big toe. Now, in the Middle Ages and the Renaissance, gout was known as the disease of kings and the king of diseases. Why? Because it seemed to affect the wealthy, who indulged in rich meals, shellfish and plenty of wine. In other words, the original lifestyle of the rich and famous. Now, famous sufferers included King Henry viii, Isaac Newton, and even Benjamin Franklin. Franklin wrote in a letter that his gout was like a cruel partner nagging him to get off the sofa. Weird fact. In 1683, Dr. Thomas Cideham, sometimes called the English Hippocrates, wrote the first detailed clinical description of a gout attack. He himself suffered from it and described the pain, his big toe, as so intense that even weight of a bed sheet was unbearable. Believe it or not, that's still considered a hallmark of the gout flare. But before we jump into what gout actually is and what causes it, if you like what you're hearing here at the Dr. Gundry podcast, don't forget to subscribe. And most importantly, share this with your friends and loved ones and like us

[Podcast Host/Producer]

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[Dr. Steven Gundry]

Okay, so at its core, gout is a form of inflammatory arthritis. It happens when uric acid crystals build up in the joints, most famously at the base of the big toe. Now, uric acid is a normal breakdown product of purines. These are compounds that make up our DNA and they're also present in many foods. Now, normally our kidneys are pretty good at filtering out uric acid, but when uric acid levels get too high, either because the body manufactures too much of it, or the kidneys can't get rid of it fast enough, these tiny sharp crystals form. Now, these crystals are like tiny microscopic needles stabbing into the joint, triggering pain, swelling, redness and heat. But before we go into that even more, I want you to realize why we're affected with gout and none of our other animal counterparts do. It turns out about 10 million years ago, great apes suffered a genetic mutation in how uric acid is denatured. Up until then, all animals have a enzyme called uricase that basically dissolves uric acid. Great apes lost the ability to make uric ace. So what? It turns out that uric acid is made primarily from two sources. One which turned out to be one of the major benefits is that uric acid is a product of detoxification of fructose in the liver into two seemingly harmless compounds, triglycerides, which you have measured on your lipid profile by your doctor, and uric acid. Now, it turns out that uric acid is very good at raising blood pressure. It's very good at storing fat by promoting insulin resistance. And luckily, if you've been watching this broadcast long enough, you know that insulin resistance is something that most people in America suffer from even though they're unaware of it. And it's the cause of diabetes, pre diabetes, fatty liver. All because we inherited that mutation from great apes. Why was it beneficial to great apes? Because they could out compete monkeys for fruit in a diminished climate change where forests were shrinking and great apes could take the fructose in fruit and convert it into fat and uric acid and store fat for the winter. We inherited that mutation and for years we thought this mutation was the thrifty gene because we had the ability to endure long periods of time with little or no food. And we thought that that ability to store fat was a thrifty gene. It wasn't until recently that we realized that the thrifty gene was actually the mutation that allowed us to keep making uric acid and not dissolve it and allowed us to store fat for the winter that now never comes. So that's why we have these high levels of uric acid. Now, if you watch my episode 194 with my friend Dr. David Perlman, we discussed his best selling book, Drop Acid, which is all about how most of us make far too much uric acid. And most of us make it, as I tell my patients, from three things. Number one, fruit and fruit juices. Number two, concentrated fruit like wine or beer. Number three, animal protein, purines, particularly fish and shellfish. So those are the three major contributors that I see in my patients to raising UR acid levels. Okay, so what are the classic symptoms of gout? Like I said, incredibly painful joint pain, usually in the big toe, but it can appear elsewhere. It can appear in the elbow, it can appear in your big finger. It often strikes in the middle of the night and people suddenly wake up in excruciating pain. It usually rapidly occurs. It kind comes out of nowhere. Now the problem is even though it comes out of nowhere, the pain can last for days or even weeks. And it is one of the worst pains that a human being can experience.

[Podcast Host/Producer]

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[Dr. Steven Gundry]

So even though the big two is classic, you could other joints and you can actually get these uric acid crystals that build up under the skin. They're often on the ears, the elbows and fingers, and they almost look like little chalk areas underneath the skin. Uric acid can cause kidney stones. About half of kidney stones are uric acid stones, the other are calcium oxalate stones. And so this is a failure of the kidneys to be able to handle the amount of uric acid that's coming and it builds up in these stones. Now sometimes people have high levels of uric acid hyperuricemia without even knowing it. That's why you should always have your uric acid levels measured in a routine panel. And quite frankly, almost no doctors are trained to look at uric acid levels. And you are better off knowing your uric acid level and getting it down than suffering the consequences. And the point of all this is the consequences of high uric acid aren't limited to gout. That's kind of the end. It's not limited to uric acid stones. That's kind of the end. Or most of the time it's trouble is in causing insulin resistance, in causing elevated insulin levels, in causing metabolic dysfunction. And the sooner you know and get a handle on your uric acid levels, the easier it is going to be to avoid all these long term complications thanks to that genetic mutation from great apes. So why are we seeing it so much today? Well, as I mentioned, this was in a response to no longer having uric ACE to break down uric acid. Which means that the more fructose in our food, the more likely this process is happening to you right now. So high fructose corn syrup is in almost everything. Our fruit has been bread for sugar content and size. And lastly, we have to take a clue from ancient man and great apes. Fruit was never available year round. Even in the jungle, fruit only ripens once or twice a year. We've now made it possible to eat fruit 365 days a year. And that genetic mutation that was so beneficial to great apes in early man has now become our Achilles heel. And so looking at why that genetic mutation was beneficial and why it's so mischievous really can help you decide what you want to moderate in your diet. Whether it's high fructose corn syrup, whether it's amount of fruit in your diet, whether it's the amount of wine or beer in your diet, whether it's the amount of animal protein, particularly fish and shellfish in your diet, or all of these have an impact and you get to choose where you want to moderate it. Now, the other good news is that there are very effective ancient prescription drug treatments to lower uric acid, but there's also a very good natural substance to lower uric acid levels, and some of those do work. Tart cherry extract does work, however, as one of my patients found out. Please do not drink dark cherry juice thinking that it's going to lower your gout. One of my patients created gout by drinking lots of tart cherry juice. He also made himself a diabetic, all thinking he was going to help himself, not realizing that there's still huge amounts of fructose in cherries. So the extracts of dark cherry may in fact help you, but not the juice. There's also another fascinating compound in India which can lower uric acid levels, and it's available as a supplement. Vitamin C is useful, quercetin is useful, and a very interesting flavonoid called luteolin also is very useful in lowering uric acid levels. Coffee lowers uric acid levels, and polyphenols and pomegranates mentioned cherries and green tea show some uric acid lowering effects. So all of those are options in dealing with uric acid. So if you're now worried about the disease of kings and don't want to follow that path, just remember why we make uric acid in the first place and why we probably don't want to make much uric acid anymore, and the easy steps you can take every day to lower your risk of gout.

[Podcast Host/Producer]

Now it's time for the Question of the week from rankard4b over on YouTube. On my episode about staying in ketosis, they asked, when is the best time to take MCT oil? So that's a great question. My personal feeling is your best time is probably twice a day, in the morning and right before you go to bed. The reason for that is you want to extend the period of time that you are in ketosis for, quite frankly, as long as possible, getting an eating window of about six to eight hours per per day. Many people, when they first start trying to get in ketosis, can't because their insulin levels are too high, and insulin blocks the release of free fatty acids from your fat cells, which the liver then can make into ketones. MCT oil, on the other hand, goes directly to the liver where it generates ketones. Regardless of what your insulin levels are. Also, there's some suggestion that MCT oil at night will actually improve your deep sleep. I've experimented with this myself and I'd say the results are mixed. But again, that's a personal observation, not a study. When I have people who are very, very insulin resistant, I really ask them to take a tablespoon of MCT oil three times a day. But warning particularly for my female listeners, liquid MCT bothers a lot of my female patients, so the powdered MCT works much better. In fact, that's why I created MCT Wellness, one of my best selling Gundry MD products. Now it's time for the review of the week at Diane Kelly3452 over on YouTube on my episode about nut butters, they said, thank you Dr. Gundry. Evidently I've been eating the wrong nuts since 1998 when I learned my inflammation was from rheumatoid arthritis. Since 2001, I've been taking methotrexate, but in 2025 when I turned 75, my inflammation became unbearable. Perhaps eating the nuts that you and your lovely wife enjoy will ease my mysterious inflammation. Well, thanks for writing that. Quite frankly, there's nothing, in my opinion, mysterious about rheumatoid arthritis. It's caused by leaky gut and dysbiosis of the gut microbiome. And when my patients fix this, their rheumatoid arthritis, their rheumatoid arthritis markers like rheumatoid factor and anti CP3 resolve. One of the interesting things about a lot of my rheumatoid arthritis patients is they absolutely react very strongly to the lectins in almonds, to peanuts, which are not a nut, and to cashews. And getting those out of your diet is a great first step to repairing the problem. So let's see what happens. And thanks for writing.

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