Gout arises from metabolic dysfunction combined with uric acid production, not solely from consuming purines or uric acid.

“what's going on it's something underlying which is metabolic dysfunction and how is metabolic dysfunction connected this is where things got really interesting for me if you remember the podcast i did with tommy wood we talked about the neutrophil lymphocyte ratio specifically immuno-metabolism and how the neutrophil to lymphocyte ratio becomes disordered when you are metabolically broken how does gout actually happen you have to have this immunologic response to the uric acid there's a spark and i think that spark is coming from the immune system and my hypothesis my belief which i would hypothesize is that in people who have metabolic dysfunction there is dysregulation of the immune system there's more neutrophils to lymphocytes you see an abnormal neutrophil lymphocyte ratio and that is the ultimate imbalancing arbiter at the immunologic level that allows excess uric acid to become problematic in humans because you cannot resolve the inflammation”

“more uric acid in your diet or at least getting more purines doesn't lead to more uric acids how do you get gout you eat things that create uric acid while you have metabolic dysfunction if you eat things that create uric acid and you don't have metabolic dysfunction what happens you thrive nothing happens”