Doctor's Note

What does the Miocene Era have to do with anything? Make sure you see the "prequel" to this video Miocene Meteorites and Uric Acid. No surprise that the meat and sugar industries both got upset with the latest round of dietary guidance from the federal government. See Dietary Guidelines: Pushback From Sugar, Salt and Meat Industries and Dietary Guidelines: Corporate Guidance. Is the sugar in fruit juice as bad as the sugar in the sugar bowl? The title of the next video of the day kind of gives it away: Apple Juice May Be Worse Than Sugar Water.

For some context, please check out my associated blog post:  Uric Acid From Meat and Sugar

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  • John Smith

    So does this mean too much fruit is a bad thing?

    • coacervate


    • Thea

      John Smith: I’m not speaking as an expert here, but I have a thought for you. As you know, too much of anything, even water, is bad. The question is, what is too much? I have a hard time believing that the average person would eat too much whole fruit in a day. My guess is that you would have to really try hard to do so. The vast majority of people in America do not eat enough fruit. So, it seems like that is not a worry we need to have.

      Also, I agree with Veganrunner making a distinction between sugar, juice, and whole berries.

    • BananaBabe

      No. Somebody missed the part about added sugars. Fruit is far too nutritious for it to really be detrimental to your health- even in large quantities. It’s most likely a bad idea to eat truckloads of refined sugars, but please don’t stop eating fruit. To tell a person to stop eating fruit is akin to telling someone to stop eating vegetables- fruit is a health-promoting food. A balanced plant-based diet includes fruit and the fructose within it.

      • ZenTriathlon

        Right. Fruit’s fructose is mediated by everything else that comes with it if you eat a piece of fruit whole. That’s why HFCS is nasty for you – nothing to slow it down. Whole fruit rocks!

  • Rph1978

    The relationship between fructose intake and gout isn’t all that clear according to a study by D. David Wang Nutr. 2012 May; 142(5): 916–923). Although there are limitations to the study, isocaloric fructose consumption was not associated with an increase in uric acid whereas a hypercaloric fructose intake was. This is In contrast to the NHANES III study and Health Professional follow-up study which showed a correlation between fructose consumption and increased uric acid levels. According to Wang’s study, it appears that there may be a threshold at which fructose consumption has an effect on uric acid levels in addition to its metabolic effects since the isocaloric trials mean fructose dose was 93.4g/day and the hypercaloric trial was 215 g/d. The mean dietary intake of fructose is estimated to be 49 g/day (in the US) which may or may not affect uric acid levels.(Bernadette P. Marriott, Nancy Cole and Ellen Lee, National Estimates of Dietary Fructose Intake Increased from 1977 to 2004 in the United States, Journal of Nutrition June 2009 vol. 139 no. 6 1228S-1235S)
    Meat has long been associated with gout but with purine-rich vegetables the results are less clear. (PLoS One. 2012; 7(6): e38123). Vegetarian diets has shown a decrease in plasma urate levels. Interestingly, dairy products has shown to reduce uric acid levels.

  • Veganrunner

    I am sensing a heated discussion here. Coacervate there is a big difference between an 8 oz serving of cola (30,000 mg) and a cup of frozen unsweetened strawberries (12,500 mg). We all are aware that drinking orange juice probably isn’t the best choice.

    Rph1978 has very interesting info in his post from one study cited. (93 grams/day isocaloric)

    That’s a heck of a lot of berries!

  • Combi

    So what’s an endurance athlete to do? I understand strenuous exercise
    increases uric acid levels. I need some kind of carbohydrates on rides
    over 2 hours. Currently I use home-made sports drink consisting of
    water with about 1/2 tablespoon of sugar per 8 oz. plus a dash of salt
    and a dash of crystal lite powder for flavor (I use it mainly because it
    galls me to pay $$$$ for any of the “xxx-ade” products). But now it
    sounds as if my sugar drink plus hard riding is just asking for trouble.

    I assume honey is not much better; my home-made energy gel is mostly honey and black strap molasses.

    there something I can ingest as a sports drink/gel that will provide
    enough carbohydrates and electrolytes for 5-6 hours of cycling without
    also increasing uric acid — without paying through the nose?

    Many thanks!

    • Thea

      Combi: Very interesting question.

      I don’t know the answer to your question, but you may want to check out Dr. Greger’s videos on erythritol (sp?). Perhaps erythritol would not have the same effect as sugar????? I don’t know. Just guessing.

      • Combi

        Thanks, everyone, for your replies. Sorry I don’t have time to respond individually. You’ve all given me good things to think about. I’ll have to experiment with my home-made recipes to try and eliminate fructose and increase magnesium and potassium.

    • Rph1978

      Strenuous exercise increases lactic acid levels in the body which hinders uric acid excretion. You might want to consider adding magnesium and potassium to buffer the excess lactic acid.

    • Veganrunner

      Hi Combi,

      I assume you eat on those long rides? My husband is also a cyclist and he takes a sandwich and fruit. Also coconut water but that isn’t cost effective if that is your main concern. The sport drinks are so full of crap. Plain old water and eating should do the trick. Hibiscus tea is nice. Or green tea.

    • Heidi Wood

      I’m training for a triathlon and I make “dateorade” by blending a few fresh dates in water for long rides

    • Joe Smith

      just eat dates and bananas… As you will see in another video Dr.. Gregor has posted dates don;t negatively effect blood sugar even thought they are sweeter than some candy!

    • KatieLoss

      check out Dr. Greger’s video on Raisins for athletes!

    • Joe

      Combi – look up Brendan Brazier. I have one of his books – Thrive Fitness, and there are some whole food sports drink recipes. It is well worth a read. He uses things like dates, coconut water, lemon / lime juice, green tea and coconut oil to make sports drinks which give sustained energy. He also has some recipes for some energy gels for mid-race nutrition.

      Dates are relatively low in fructose. They have a lot of sugar, but if your an athlete this is not a problem.

      The wood alcohols would not be a good choice. (Xylitol etc) They are good for sweetening, but do not get digested much, so are not a very good energy source! They can also cause digestive problems in excess.

    • Ben

      The night before your ride, but some dates and whatever dried fruit you have, raisins will work, goji berries are fantastic. I like 4-5 dates and a handful of goji berries (blend the goji berries in a coffee grinder first to get them into a powder) in 32 oz of water. Let it soak in the blender overnight in the fridge. Then in the morning just blend it and there is your sports drink. Awesome whole food nutrition.

  • basskills

    what about those 801010 folks, who eat crazy amounts of ‘sugar’? surely they’d be dropping dead with the rate they consume fruits, no? I too am interested in this as I have lots of fruit!

  • Avi Bandel

    My uric acid is pretty high, about 7, for the last 6 years! went vegan 1.5 year ago, 80/10/10 a year ago, and it’s still high. Could I have some genetic disorder, or does anyone has some explanation?

    • Don Forrester MD

      Our levels of uric acid are a factor of our genetics and what we eat. By avoiding meat you will tend to reduce your uric acid. It would be interesting to see how your uric acid changed after changing your diet. The next step would be to lower fructose consumption if your goal is to lower your uric acid level. Clearly avoiding table sugar(half fructose), checking labels to avoid high fructose corn syrup( 55% or more fructose depending on the type of HFCS used) and limiting fruit consumption would be things you could try. By focusing on starch consumption which are long chains of glucose molecules you will also minimize fructose. You might find Dr. John McDougall’s book, The Starch Solution of interest. You can go to his website and view his free lecture, The Starch Solution for an introduction. A level of 7 is outside “normal” limits but may be normal for you and may not cause you long term problems. That is a clinical decision based on you and your physician working together.

    • Guest

      thats pretty high.

  • Thinkabouddit

    I have a friend with gout and I have been unsuccessful at steering him to a vegan diet. He relies on chicken. Is there a vegan diet for gout?

    • Lawrence

      I have gout. When I turned from meat to vegetarian to vegan to raw vegan, the incidents of gout attacks decreased. By habit I still avoid certain plant foods but there is no doubt I am consuming more of them these days and not suffering a gout attack. The point is that you should not be thinking in terms of a vegan diet for gout, just make sure you consume a wide variety of whole plants, preferable organic and raw and you should be just fine. Your body will adjust and produce less uric acid and dispose of it more efficiently, so no or fewer gout attacks. I hope this helps and please check my blog.

    • Therese Dion Cuba

      Go to To find some interesting things about gout. There is no GOUT diet per se. Some things that we need to stay away from are: BEEF, LAMB, SHELLFISH, ORGAN MEATS, SPINACH, BEANS, AND YEAST (in breads and in many other processed foods these days–even soups, and beer). Eating the right caloric diet for your body size (see a R.D.) helps to keep protein intake in line. Most foods have purines, except for fruits and veggies, which are low to none. Intake of at least 2 liters of water/day is essential to flush your system and dehydration makes gout worse. Fat burning exercises increase blood uric acid because I found out, excess uric acid is stored in fat and when you burn fat, it releases the acid back into the blood system. GOUT is complicated and if you have a bout of it, so very painful! :(

      • Therese Dion Cuba

        are lentils bad for gout? I Just read that they are awesome for helping to control sugar in your body. I made a cup of dried lentils this past week and ate them with rice.

  • Karen

    Thank you Dr. Greger. I have been subscribing for a while now, since shortly after becoming vegan. I am a vegan living in a social soup of enthusiastically, decidedly non-vegans: aka chefs and restaurant owners. I own a restaurant with my husband, and it was our foray into the industry that opened my eyes and changed my life and world view. I was put in an interesting, perhaps unusual position, and my decision was to remain in my marriage and business. The reasons I remain relatively sane are that I understand much of why things are the way they are, and I know- even though many food industry people do not wish to think about it- if the people finally accepted and embraced the plant based diet, they would still need restaurants galore; that part would probably remain the same! So my restaurant has in-house made vegan hot dogs, vegetable sides and animal-free baked beans that are to die for (or not). Yes my business markets vast quantities of meat and is poised to expand. Alot. The way I look at it is that more people be choosing our place over something else, and they will be exposed to the vegan option. Also, the majority of the food enthusiasts I associate with are brave and loving people who are thoughtful and accommodating, and I have had wonderful experiences with the most staunch ‘church of meat’ types. I believe that they are faced with certain facts and new findings every day and can only deny or try and circumvent them for so long. And I believe, even if other restaurant people don’t, that we can make positive changes, and evolve with any food revolution without missing a beat. Yes I live on a high wire tightrope in a way, but I can see alot from here. Thanks!

    • Craig Worrell

      Bless you, for introducing “meatless” alternatives in your restaurant. I wish every restaurant owner would have the courage to do just as you have done. My wife and I are plant eaters and find it very difficult to dine out due to the limited plant-based options offered in our local restaurants.

  • Eugene

    Good Day Dr Greger,
    Are all antioxidant products high in uric acid? Based on research, can you tell me which ones are not. Thank you.

    • Don Forrester MD

      Uric Acid is a metabolic product manufactured by your body. It is from the breakdown of purines which are part of nucleic acids in your body and are high in meat products. It is also produced as one of several metabolic byproducts of fructose by the liver. So Uric Acid is not in the food per se but we produce based on the food we consume. So foods that are high in purines (meat especially organ meats) and fructose (table sugar, fruits, some vegetables) that are high in fructose will tend to elevate uric acid.

  • 99bonk

    There are basically two reasons for having high serum uric acid – excessive production and inadequate excretion. Excessive production can be the result of diet, or cell destruction due to chemotherapy for cancer.

    Some people are genetically under-excretors of uric acid and may be predisposed to gout. They are usually treated with medication, either to increase the excretion of uric acid or designed to interrupt the metabolic pathway which ends in uric acid – not very soluble – at an earlier stage, where the metabolite can be more easily excreted.

  • Guest

    there r alot of videos but they r good videos to learn about

  • Stephen Lucker Kelly

    I though fruit juices like apple juice was a problem too… is it not? What about orange juice? Both not from concentrate. Pretty much juiced apples or oranges? from a juicing machine?

    • Martin351

      I would look on the labels.. anything hinting of sugar, I’d stay away from.. stick to the natural sources

  • Martin351

    May be chiming in a bit late, but after a recent attack of gout and a visit to my Naturopath a couple of weeks later.. he told me about the dangers of fructose. Consequently, I eliminated most of it from my diet and it showed in the results of a blood test about 1.5 months later.

    I went from being at a level of somewhere between 7.5 and 8 down to 6.2. It fell quite rapidly. The main concessions I made were: No more energy drinks, barely any soft drinks, my fruit intake consisted of berries and apples now which were all cooked (helps eliminate fructose), and I kept away from fruit juices that had any label of sugar on them.

    I eliminated alcohol for the most part; red meat no more than once a week, but I still continued to eat steamed chicken.

    I do think purines in food may play a roll (all be it a small one), but I’m completely convinced fructose is major contributer to uric acid levels.

    • Jay M

      “fruit … cooked (helps eliminate fructose)”.


  • Uri

    Hello Dr. Greger,
    I have a question about recommended diet for gout:
    My father is 63 years old and diagnosed with Gout. Doctors advised him to stop
    consuming meat, and I wanted to know if you think he should avoid dairy also? And what about legumes?


    • cynthia

      To play devil’s advocate, higher uric acid levels are protective for multiple sclerosis, which very rarely overlaps with gout. In other words, we might not all want rock bottom uric acid levels.

    • DontGetIt

      Lima beans were a trigger for me. A very low fat vegan diet would work wonders for him…

  • DontGetIt

    I’ve been on a very low fat vegan diet for about a year. Prior to this diet, I was eating lean meats and low fat dairy along with fruits/veggies. I consistently would have gout like symptoms and found that lima beans were a trigger. So much so that I stopped eating them. After being on the vlf vegan for a few months I tried limas again and found that I had no gout like symptoms. For me, there is a correlation between eating meat/fat and the effect of purine rich foods such as limas. For me, more evidence of the benefits of the vlf vegan choice I’ve made.

  • Athlete

    80% of my diet is Fructose from fruit such as bananas. I am an athlete and a high carb diet is essential for good performance. If I am not getting my carbs from Fructose in fruit where should I be getting them from? Thanks for the videos they are great.

  • jimmy


  • Jeff Hay

    Most medical advice we’ve read as to how to prevent gout type problems has to do with avoiding foods that contain purines. Along with organ meats, shell fish, sugar and alcohol they normally list beans, legumes, lentils, nuts, and mushrooms. Are all purines created equal? Or is this just an assumption and in fact there is a difference between plant and animal purines?

  • Michael Dean

    This is a very misleading video that should have elaborated upon. This basically makes one think that if they are eating a considerable amount of whole fruits on a daily basis that they are doing their body a disservice.

  • Goutpain

    RE: MEAT AND SUGAR VIDEO. I suffer from Gout. Three months ago I eliminated meat and dairy from my diet. I do eat fish, the odd egg, tea and coffee without sugar. I do eat three, low sugar, tea cookies a day. Otherwise everything else is plant based. (I make my own whole wheat bread and ad wheat germ, flax seed meal and quinoa flour to it.) After about 10 days on this diet I got very tired and it took a couple of weeks for me to get back to feeling normal. I also lost weight though I didn’t start the diet for that purpose. During the first 6 weeks I had no gout symptoms until I veered off the road and baked and ate a white cake covered with sugar icing and drank four glasses of wine over a period of two days. The gout reappeared on the third day and the symptoms took about a week to go away. I remained on the diet for another month with no gout symptoms until two days ago when I baked and ate another white cake smothered with sugar icing over anther two day period. It could be coincidence. It is hard to link sugar directly to maladies in one person’s diet. To test the effectiveness suddenly adding sugar, I have ate pancakes (made from flour and wheat germ which puffs them up so eggs and baking powder are needed) and blueberries. I smothered then with real maple syrup with no ill effects. I presume the sugar in maple syrup turns into fructose and so should have caused a spurt in uric acid and gout. Perhaps I got the symptoms from the cake because I ate it through the day over a period of two days whereas with the maple syrup I ate approx. two tablespoons and no sugar thereafter?
    I will continue on the diet sans the white iced cake and if I have no gout symptoms at all over 6 months I will consider my self, if not cured, then at least, in remission.

    • Coacervate

      How are you doing now?

    • Jay M

      What kind of fat does the icing have? (Fats of any kind give me problems)

  • Carlo

    One of the articles of the video is not reported in the sources. Here:

  • Damian Stoy

    I’m an ultra endurance athlete who eats 90% of my calories from fruit. For me, it doesn’t seem that a diet high in fructose from fruit causes any negative health or performance detriments. I only see amazing results.

    • dogulas

      Congratulations on enjoying your personal success. Gotta stick with studies of a range of people to give general advice though. Some people like you might find an ideal eating what you eat, but it can’t be recommended to the general population.

  • LandSurfer

    I adopted the raw Fruitarian diet supplemented with raw greens and occasional steamed rice or baked potato slices about 6 yrs ago and had gout in my left big toe. Gout symptoms left within a few weeks of beginning the transition. I also run up on average 85 miles per week barefoot on and off road and another 40-45 in Luna running sandals.

    • dogulas

      What exactly are you trying to say? Or just reporting on how much you enjoy your lifestyle?

      • LandSurfer

        Contrary to the fear of… “You name it” “Eat Clean in moderation” and “Eat a balanced diet” what ever that is. The reality of human design has proven to be fruit centered diet crowned with a few greens and colorful veggies. Everyone wants to dance around fruit as the main stay of a healthy menu due to all the fear of sugar not realizing that all primates seek a primarily fruit centered diet supplemented with a few hopefully tender, young greens and shoots. Humans are the only confused species when it comes to what their native foods are. Put a toddler in a play pen with a baby bunny rabbit and a piece of ripe honeydew and watch it choose its native food. Everything from there is confusion pushed down based on false assumptions.

  • fineartmarcella

    John, Whole fruit is good, taking out the sugar and eating just that is bad…. remember our bodies get their premium energy during the Krebs cycle from fructose, we need it.