Does diet really fix gout? What's new at Peak Human this week

A note from Dr. Goel

Colleagues, here's what's new at Peak Human this week. I published four evidence reviews aimed at the questions your patients keep asking you: does diet really fix gout, are polyphenol and urolithin A supplements worth the money, and where does oral hygiene sit in cardiometabolic risk.

— Dr. Sanjeev Goel

1. Does diet actually fix gout?

In a 2018 meta-analysis of five US cohorts (16,760 people), whole-diet scores explained 0.3% or less of serum urate variation vs 23.9% for common genetic variation (Major et al., BMJ). Vitamin C lowered urate 0.23 mg/dL vs 1.9 mg/dL with allopurinol in a 40-patient trial (Stamp et al., 2013).

2. Does urolithin A actually work?

Five randomized trials, 236 participants; pooled six-minute walk +17.03 m (95% CI -5.33 to 39.40), low certainty (Dao et al., 2026). Three of five trials were sponsor-funded.

3. Do polyphenol supplements work?

COSMOS (21,442 older adults): cocoa flavanols missed the primary cardiovascular endpoint (HR 0.90, P=0.11); cardiovascular death, a secondary endpoint, HR 0.73.

4. Floss, electric toothbrush or Waterpik?

Cochrane: powered brushes reduced plaque ~11% at 1-3 months and ~21% beyond 3 months (moderate certainty); interdental device evidence low/very low certainty.

My take: The gout review is the one I'd send to your waiting room. Diet matters at the margins, but the data point to treat-to-target urate lowering: in a nurse-led trial 95% of patients reached under 6 mg/dL at two years vs 30% with usual care (Doherty et al., Lancet 2018). Genetics explain far more of the variation than diet does.

⚕️ Important disclaimer

This newsletter is for educational purposes only and is not medical advice. Compounds discussed may be investigational and not FDA-approved. Nothing here is a recommendation to start, stop, or change any treatment. Peptide and metabolic therapies carry real risks and should only be used under qualified medical supervision. Always consult your physician before making health decisions.