Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
23 Apr

Dear Mark: Risk of Gout?

goutEvery so often, a health malady arises that seems to clash with Primal living. And when a doctor brings it up, or a family member with intimate knowledge of the illness expresses concern, it can be intimidating and troubling. We’ve all heard how we’ll suffer heart attacks, diabetes, ketoacidosis, lowered marathon performance, kidney disease, and osteoporosis from “eating all that meat,” but that’s not what I’m covering today. No, today the subject is gout, which occurs when excess uric acid crystallizes and accumulates in the extremities. The jagged shards embed themselves in the joints, tendons, and other tissues, causing excruciating pain, inflammation, and swelling, particularly in the big toe. Suffice it to say, it is extremely unpleasant. Sounds great, right?

Let’s move on to the question that prompted today’s post:

Hi Mark,

What’s your take on gout? It apparently runs in my family, and while I haven’t gotten an attack yet, I’ve heard that a “rich diet” is the cause, which as I understand refers to meat and animal fat. Does this mean I shouldn’t eat Primal? What does the science actually say?

Thanks,

Will

In previous centuries, gout was described as a “rich man’s disease” or “the disease of kings.” Ambrose Bierce called it “A physician’s name for the rheumatism of a rich patient.” Basically, it primarily affected the upper class, the royalty, the aristocracy – those who could afford “rich” foods like meat, sugar, and port. In the mid-19th century, uric acid was identified as the causative agent in gout. Where does uric acid come from? Purines.

Purines are in pretty much every cell – plant and animal alike – because they provide some of the chemical structure of both DNA and RNA. When cells are broken down and recycled (like in digestion – yum, love those delicious cells!), their purines get metabolized right along with everything else. Uric acid is a major product of purine metabolism, and this is a good thing; uric acid acts as an antioxidant in our blood, protecting blood vessels from damage. But if for some reason an excessive amount of uric acid (hyperuricemia) is produced, enough to crystallize and lodge in joints and other tissues, you might get gout.

And so the standard tale goes like so:

Since we get uric acid from breaking down purines, the natural solution is to reduce one’s intake of purine-containing foods – right? That seems sensible. Reduce purines, which turn into uric acid, and you reduce hyperuricemia, which causes gout. Boom. Problem solved.

The problem for a Primal eater given this advice, however, is that the richest sources of purines also happen to be some of our most treasured foods: organ meats like sweetbreads, kidneys, liver, and brain; seafood like sardines, anchovies, herring, mackerel, scallops, and mussels; and wild game meat. Even beef and pork are moderate sources of purines. In short, everything we talk about eating on MDA is apparently contraindicated for gout prevention. How do we reconcile without destroying our brains with cognitive dissonance?

Easy. We look for the real problem. What’s more logical? That purines, which appear in all foods and particularly in some of the most nutrient-dense foods (like organs and seafood), are the problem? Or that hyperuricemia, an excess of uric acid, is the problem?

Let’s table the purine talk for awhile, given the importance of purine-rich foods in the ancestral human diet, to look at some other causes of high uric acid. What else causes uric acid to rise?

Dietary Fructose

When the liver is loaded with fructose, whether by excessive intake or a lack of liver-glycogen-burning activity, purine metabolism is disturbed and uric acid spikes. One study (PDF) found that 0.5 g/kg body weight was enough to increase uric acid levels by this mechanism.

Fructose also decreases urinary excretion of uric acid, so it’s a double whammy: fructose both increases uric acid and decreases its excretion.

Insulin Resistance and Metabolic Syndrome

Elevated insulin levels, especially the chronically-elevated levels (hyperinsulinemia) seen with insulin resistance, also reduce urinary excretion of uric acid. It’s no surprise that gout patients often display the classic trappings of metabolic syndrome, too, including diabetes, vascular disease, and poor glucose tolerance.

Back to purines. Does the advice to drastically reduce purine intake hold up?

Not really, according to this 2002 review paper (PDF). And the fructose/alcohol connection is looking stronger. Among their findings:

“A diet rich in purines will produce only a small and transient (read: impermanent) rise of serum urate by about 60–120 μmol/l (1–2 mg/dl).”

“Conversely, an isocaloric purine-free diet for 7–10 days will slightly lower serum urate by about 60–120 μmol/l (1–2 mg/dl).”

“A dietary study of 61 men with gout and 52 healthy men showed that although the average daily intake of most nutrients, including total purine nitrogen, was similar in both gout sufferers and control subjects, the group with gout drank significantly more alcohol than the controls.”

“Alcohol intake, whether alone or with a purine-rich meal, produces greater effects on serum urate levels than a high purine diet.”

“There is growing evidence that a low energy, calorie restricted, low carbohydrate (40% of energy), high protein (120 g/day, or 30% of energy) diet, with unsaturated fat (30% of energy) and high dietary fiber, is more beneficial in terms of lowering serum urate, insulin, LDL-C, and triglyceride levels, and hence reducing CAD risk, than the conventional low purine diet…”

Furthermore, research shows that eating purines actually increases uric acid excretion in order to maintain balance, almost like the body knows what it’s doing or something. Nah, couldn’t be.

It’s also worth noting that dietary protein has also been shown to increase uric acid excretion and lower serum uric acid. Hmm. It’s starting to sound like a low-carb Primal eating plan might just help, isn’t it?

What else should people at risk for gout or showing high uric acid levels do, other than reduce/avoid fructose, clear out liver glycogen every once in awhile (maybe by occasionally sprinting, which I could have sworn I’ve heard someone recommend before), and avoid hyperinsulinemia?

You could make sure you’re getting enough vitamin C, which is inversely associated with uric acid levels. Vitamin C is known to be uricosuric (increases the excretion of uric acid), so this association is likely causal. While I don’t think the average person needs to megadose vitamin C, it is exceedingly safe, and it’s worth a shot for people at risk for gout or hyperuricemia. If you’re at risk, shoot for at least a gram or two a day.

Be careful with intermittent fasting, which has been shown to reduce uric acid excretion (PDF). This may not matter, as in one study, complete fasting by obese subjects did not increase incidence of gout, even in one individual who had previously suffered it. Just be aware of the possibility.

Stay hydrated. Dehydration (at least through exercise) can increase uric acid retention and concentrations.

I’ve also heard a number of anecdotal reports from gout sufferers who successfully staved off attacks with a quarter teaspoon of baking soda dissolved in water, supposedly by increasing alkalinity. There haven’t been any actual studies on it, though, so bear that in mind.

But perhaps the best way to avoid gout? Get healthy. Eat well. Exercise intensely from time to time. Avoid refined sugar. Avoid obesity, hyperinsulinemia, and metabolic syndrome. If what you’re eating and how you’re living are giving you those things – or moving you toward them – they’re also likely to reduce your chances of developing or exacerbating gout.

Gout sufferers, what have you experienced since going Primal? Has it helped, or has it made the problem worse? Let us know in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Uric acid is a toxic metabolite of yeast and fungus, Dr. A.V. Costantini, former head of the World Health Organization believes that high levels of uric acid is a result of mycotoxicosis not a ‘metabolic disorder’.

    “Nearly every medical school in the country teaches its students gout is caused by uric acid. They teach that when uric acid reaches critical levels that it forms crystals in the joints causing gout. These schools teach that uric acid is created by the body itself and not from outside sources.

    Dr. Costantini, retired head of the World Health Organization (WHO) Center for Mycotoxins in Food 1994, concluded from the work of he and fellow researchers, that it can’t be proven that the body creates uric acid. They found that uric acid is more than likely of fungal origin, and entered the body from the outside.

    Further studies revealed that urate crystals found in patients with gout occurred days after the the inflammation became present. So he stated that uric acid was not the cause of pain experienced by gout patients. He offerred a $1000 reward to any one that could prove him wrong. To this day no one has collected.” http://goo.gl/RzY32

    “The unified concept of a fungal etiology and an anti-fungal mode of action of anti-gout drugs provides a clinically meaningful therapeutic drug and dietary approach not only for the physician, but, most importantly, for the patient afflicted with gout, particularly those who are beer drinkers and are consuming other yeast-fermented beverages and foods such as wine, bread and cheese.” http://goo.gl/baq53

    cancerclasses wrote on April 23rd, 2012
  2. Never had another case of gout after I increased my water hydration daily to 8 glasses per day. The water flushes everything away.

    Stella wrote on April 23rd, 2012
  3. I am a student in chiropractic school and we, in our pharmacology class talked about how it is the fructose that causes gout and not animal products…glad to see this topic becoming more popular and the truth coming out!

    Ryan DeBell wrote on April 23rd, 2012
    • Which chiropractic school do you go to? I was just about to forward this to the person who taught our clinical lab class at the University of Western States.

      Rebecca Schacker, DC wrote on April 23rd, 2012
  4. For me, alcohol=gout. I have had no gout issues while eating primal (and keeping my alcohol in check).

    shannon wrote on April 23rd, 2012
  5. Hi Mark,

    Great article on gout! I wish I had read this fifteen years ago.

    Prior to going on a primal diet I suffered from severe gout for fifteen years. During the last couple years I spent literally 50% of my time limping, and that’s if I could walk at all. Since going primal 6 months ago my gout has completely disappeared.

    As for background information; I’m a 47 years old male, 6’1” @ 175lbs. I have always been athletic and exercised regularly – when I wasn’t laid up with gout. My mother had suffered from gout for many years until she had a successful kidney transplant, which ended her problems with gout, among other things. My guess is her kidney failure may have been linked to gout or her daily gout medication (allopurinol) of thirty years. My nineteen year-old son also has gout, so it’s likely there’s a genetic component at work here.

    I first began having gout symptoms around the age of 30 and it got progressively worse each year. I tried every “natural” remedy I could find (cherry juice, apple cider vinegar, baking soda, lemon juice, garlic pills, fish oil, ground ginger, berries, etc. etc. etc.) and all the standard pharmaceutical recommendations from my doctor (allopurinol, uloric, colchicine, colcrys, indomethacin, etc.). Nothing worked and things only got progressively worse as time went on. Surprisingly, doctors have no idea what causes gout and I spent countless hours researching gout on my own and never heard about fructose being the cause until after I went primal. A quick Google search on gout cures will produce an amazing array of web sites and forums devoted to gout related quackery. I say “quackery” because I tried it all systematically and nothing came close to working. As much as I like cherries and apple cider vinegar, I am now convinced that there is nothing you can eat, drink or rub on yourself that’s going to prevent or cure gout. Forget about grandpa’s magic gout elixir. If you don’t want to get gout, don’t eat anything with fructose. Period. It’s all in the studies Mark cites in this post. And although I haven’t experienced a correlation myself, I think there’s some evidence that alcohol may play a role in amplifying gout, especially when combined with fructose. If you’ve got a serious case of gout it probably wouldn’t be a bad idea to also consider giving up booze for while in order to establish a baseline for yourself. If all goes well you can add alcohol back in gradually and see what happens.

    My diet had always been pretty decent, at least according to conventional wisdom. I didn’t consume much sugar, fat, red meat, purines or excessive alcohol. I was fit, I exercised, I didn’t smoke, I got plenty of sleep and I wasn’t stressed out. What I have since learned is that I am particularly sensitive to fructose and even relatively small amounts of sugary food will bring on an acute gout attack. I could have saved myself a lot of trouble if someone had told me to just cut out the sugar fifteen years ago. I don’t understand why something so simple is so entirely unknown in the medical community.

    I hope a lot of people who are suffering from gout find this post and give the primal diet a try. In addition to gout, I had chronically painful foot and knee joints that I thought were the result of residual damage caused by repeated gout attacks over the years. Whatever those arthritic-type problems were, they were eliminated along with the gout and my feet and knees are virtually pain free now. I also experienced the total disappearance of irritable bowel symptoms and heartburn. When I think back on it I’m amazed at how much discomfort I was putting up with on a regular basis. I think I just chalked it up to getting older. I think if I didn’t make the move to a paleo style diet I could have ended up with some very serious health problems before too long. I’ve also been able to drop 25lbs almost effortlessly along with improving my body composition. Moving to a more high intensity training program has allowed be to get better results while spending a lot less time doing it. My wife and several family members have had some great results as well. I’ve been able to glean a lot of good information from the MDA web site and I thank you for all the good work you are doing.

    Best regards, *LB

    *LB wrote on April 23rd, 2012
  6. I have had gout for 20 years. I have been primal for the last two. It has not caused me to have any flare ups. I have learned to combat gout entirely through nutrition. Folic acid and VItamin E help suppress the uric acid. I also read in Poor RIchards Almanac that cherries will help as well. So when I start to feel it I drink a swallow of pure organic black cherry juice. Also if you do get a flare up capsaicin will actually null the pain.

    I have found that monitoring my intake of sugars to be far more important that purines. I eat steak and chicken almost every day.

    Also stress has been linked to outbreaks. Not sure if this is anecdotal or what. But exercise helps with gout and stress so it seem fairly obvious.

    I find that as long as I am exercising, watching sugar, taking folic acid and vit E everyday I nearly never get it. It is only when I fail to do these thing that I get flare ups.

    Hope this can help somebody.
    I love living primal. I will never stop eating and living this way.

    jeff wrote on April 23rd, 2012
  7. It’s been about a year since my last gout attack, which happens to coincide with eliminating sugar from my diet. I had started with a 6 days clean/1 cheat day per week to drop weight, and found that after most cheat days, I would suffer from a gout attack. The relationship between sugar and gout was painfully clear, and the science solidified in my mind after watching Dr. Lustig’s lecture on “Is Sugar Toxic?” I decided to go sugar-free for the entire summer to see if I could eliminate gout as well as the daily intake of allopurinol. I get the 80/20 rule, but for some conditions, 80/20 just isn’t worth the pain. I’ve continued to refine my diet and now eat on the paleo/primal spectrum 95% of the time – although I don’t eat organ meats because I’ve never liked the taste. In 1999, I had noticed a clear relationship between alcohol and gout and stopped drinking completely. Just last week, I had my first beer since 1999 (gluten-free, of course), and had no ill effects. Eliminating sugar was the key for me.

    Rick wrote on April 23rd, 2012
  8. Another great benefit from going primal and one that I can use to help more of my clients, thanks for the article. Also, I’ve haven’t noticed any incidences of gout or flareup in clients. It’s easy to overlook the simple advice in the post… “Stay Hydrated” but so important during workouts on IF.

    Alby wrote on April 23rd, 2012
  9. My husband suffers from gout, and while we have done a great deal of research his 2 main triggers appear to be yeast in bread and prawns. If he eats a lot of bread, or prawns twice in a week, he gets an attack. Other friends have gout attacks and all seem to be linked to yeast. Vegemite, brewers yeast (especially in beer) sometimes red wine. Cherries and cherry juice, water (adequate hydration) and gluten free all seem to help. Gout is a form of arthritis, and there is also a genetic and sex-linked (hormonal) component. Women tend not to get gout until after menopause. Doesn’t really seem to be any reason why primal eating would hurt, unless it includes your personal triggers.

    Tinkingbell wrote on April 23rd, 2012
  10. Alpha Lipoic Acid completely normalizes my uric acid level.

    Don wrote on April 23rd, 2012
    • Don,

      Did ala drop your uric acid level below 6 mg/dL? Do you recall the before and after?

      Mike Gallagher wrote on April 24th, 2012
  11. First of all great post.
    I’m much like Adam G, I will get flare ups every summer, usually from mild dehydration. I would play ball 3-4 nights a week, and usually have a few beers by the pool to finish the night off. (Might have been a little more than mild dehydration)
    I usually spent about a week not drinking/re-hydrating and getting a few more vitamins in my diet (the vitamin c is a good hint).
    I’ve definitely noticed reduced flare ups since I’ve started the diet and as I’ve grown up some and had a child I tend to not drink as often and don’t quite have as much time to play ball as often.
    I love knowing the way I eat is not attributing to it!!

    Travis Milne wrote on April 23rd, 2012
  12. Interesting. Didn’t know much about Gout before reading this. Nice to know that the PB doesn’t cause Gout and seems to actually be anti-Gout. Cool :-)

    TokyoJarrett wrote on April 23rd, 2012
  13. Funny you should mention this, I’ve got an uncle who has the occasional outbreak of gout from eating too much cauliflower. He’s a vegan and doesn’t drink.

    anon wrote on April 23rd, 2012
  14. I am going to start using baking soda. My Dad had gout and he always put baking soda in his tomato soup and had soup about 3 times a week. I do all the other things. I have gout but I keep healthy and have not had an attack for years. I am diabetic and eat right. I eat low cholesterol, etc. I have lost weight but gained some back and will try to lose it again. I water exercise, bike, etc. I am a retired nurse of 69 years young. Thanks for the ideas. I do eat meat in moderation, green vegetables, no cheese or milk but I do tolerate yogurt. Tonight I went out for Chinese and had sweet and sour pork and boxed up half of it for another time. Be happy and healthy and move-Ever Onward!

    Colleen Lemkuil wrote on April 23rd, 2012
  15. I am using vitamin C. I do believe it is an auto-immune disease. Do not eat over 4 oz. of meat at a meal, do not eat rich banana splits, do not eat excessive any thing-nuts gave me a flare up once, chocolate once. All things in small amounts. Take care.

    Colleen Lemkuil wrote on April 23rd, 2012
  16. Try a couple capsules 3x/day of quercetin with bromelain. Knocks down gout quickly for me.

    Rik Reynolds wrote on April 23rd, 2012
  17. One important aspect of the disease which this article misses is that Gout is an auto-immune disease or it is a manifestation of auto-immune disorder.

    Vizeet wrote on April 24th, 2012
    • I doubt gout is a single disease. I believe all the diagnosis “gout” defines are the consequences of high levels of uric acid.
      An effective “home remedy” may treat the cause. Allopurinol likely only removes uric acid. One theory is that high levels of uric acid may be acting as an antioxidant to deal with an underlining metabolic disorder. What are the long-term consequences of using Allopurinol?

      Don wrote on April 24th, 2012
      • I agree that Gout can be caused by anything that causes excess uric acid deposition. I think the reason why primal diet and vitamin C helps and the reason why fructose increases problem is that it is associated with underline auto-immune disease.
        And you could be right that uric acid is produced by body to deal with the inflammation or oxidative stress.

        Vizeet wrote on April 24th, 2012
  18. My husband suffers from gout attacks about 4 times a year… the doctor of course told him that the cause was purines and to avoid those foods containing high levels of purines. Then prescribed the pills. Funny he never told him NOT to drink so much beer.
    Still can’t get him on board to change his lifestyle. :(

    Maryann wrote on April 24th, 2012
  19. My husband has familial gout, and when his flares up, I simply adjust his plate from 50/50 meat and produce to 75/25 produce and meat. It’s the calcium in the greens that helps him most.

    He still eats meat–even crab and beef–but he gets less of it when an attack is happening or about to happen.

    For quick relief, he drinks a glass of water with 1T. calcium carbonate powder in it. Diet takes care of the rest.

    Wenchypoo wrote on April 24th, 2012
  20. Wish I could have read this article 5 years ago! Outstanding article Mark.

    I suffered from gout for 5+ years with attacks becoming worse and occurring more often. I searched for answers, followed eating recommendations, even went as far as going vegan for 6 months while searching for a cure. The only help I ever found was drinking dark cherry juice (which helped immensely in reducing the pain quickly) and a few other antioxidants (acai, blueberries) seemed to help. Had a very bad attack after drinking a liter of freshly made carrot juice, started digging for info in different directions.

    That is when I came across an unpublished Gary Taubs chapter / article posted by Robb Wolf at his site. It connected fructose intake with gout and explained the theory that for most people it wasn’t the purines but the clogging up of the kidney and it’s ability to clean out Uris acid that was the problem.

    I began a primal diet and lifestyle almost 18 months ago, had a couple minor gout attacks in the first 2-3 months, but have been gout free since. I drink alcohol moderately, enjoy lots of red meats and shellfish, and have more energy than I’ve had since my early twenties…

    I firmly believe that excess fructose was the primary driver of my gout attacks and I was probably getting lots of it from all of the ‘healthy’ fruit juices I was consuming.

    Kevin wrote on April 24th, 2012
  21. I’ve had gout for 20 yrs. Always active and healthy otherwise. Started taking allopurneol 100mg about 15 yrs ago and still had about 1-2 minor outbreaks per year. Been primal for about 14 months and got more attacks and in new places over the first several months when I first went primal. I upped my dosage to 200 mg and haven’t had a problem since but I still have two small bumps on my toe that remain. Has anyone seen a reduction in their tophi while on a primal diet? I understand to get tophi to disolve the uric acid needs to be consistantly below 6mg/dL.

    MWG wrote on April 24th, 2012
  22. My first gout attack was about 7 years ago and fairly prolonged. I was able to cut the “trigger” foods out and seemed to find a correlation with – BEER! with more minor flare ups I’ve experimented a bit and the correlation seems weak or at least delayed though. Having a flare up right now and I have been drinking more than normal . . . time to cut the beer. :-(

    Brian Clasby wrote on April 24th, 2012
  23. Mark,

    I was recently reading The Miracle of Magnesium, and it mentions that uric acid can be reduced by magnesium. That sometimes uric acid related problems are directly related to magnesium deficiency.

    Something to consider, since primal diets *could* be short in magnesium if the dieter was not careful to consume nuts and dark green leafies, or if the dieter was consuming alot of foods high in calcium, which can affect the balance between calcium, magnesium, and potassium.

    Increasing Vitamin C and magnesium can have even better effects on uric acid troubles, whether it be gout, or frequent urination and kidney stones.

    Hope this is helpful.
    Mrs. Mom

    Mrs. Mom of 6 wrote on April 24th, 2012
  24. Excellent article Mr. Sisson and equally excellent comments from your highly informed and intelligent readers…I’m consistently impressed by how much I glean from the comment section alone.

    One question…if fructose is a culprit with regards to gout…why would consuming tart cherries or their juice be helpful?

    Donna wrote on April 24th, 2012
    • Cherries are very high in vitamin K, which has been shown to help with gout.

      Frank

      Uncle Frank wrote on April 24th, 2012
  25. Mark, I had Gout for years and years, flaring up every two months in the end! I resisted medication, and found the primal living in time – I have not had gout in 20 months! Also stop taking my 2 blood pressure tablets! Big thanks to you! Mark.

    Mark Simmonds wrote on April 24th, 2012
  26. The real problem is that all people lack a functional gene for the enzyme urate oxidase, which takes purine catabolism one step further.

    It oxidizes uric acid, poorly soluble and fairly toxic, to allantoin, 60 times as soluble and less than 1% as toxic.

    How to cure gout once and for all? Reinstall the missing gene!

    http://omim.org/entry/191540?search=urate%20oxidase&highlight=urate%20oxidase

    And, while we’re at it, cure scurvy too. It is also caused by a missing gene, preventing us from completing the glucose pathway to ascorbic acid:

    http://omim.org/entry/240400

    Tatiana Covington wrote on April 24th, 2012
  27. I have had gout for about 20 years. Diet will definitely affect occurrence, but until now I had not considered the effect of refined sugars. Alcohol is a major offender, but think about it – what is in alcohol? Sugar. Lots of sugar. I also experience flareups if I eat lots of sweets and deserts like around holidays. Extra water intake to help flush the offending intake will always help. If I have one beer, I have an equal amount of water to offset the effect.

    JohnP wrote on April 25th, 2012
  28. I have solved the problem with plain cinnamon and honey…google it and it what i want today, given I take enough water in

    Pierre van Niekerk wrote on April 26th, 2012
  29. I’m 51 and have had gout for 15 years. Going low carb and losing weight would trigger attacks. I started juicing a couple of months ago and my joints really improved. After a one week juice fast I incorporated 150-180 grams of whey and egg protein shakes. Within a couple of days I got gout again and stopped the shakes. I still juice and think I will supplement that with high fat, vegetables and minimum protein, say 60 grams. Has anyone tried this who is prone to gout?

    james proffitt wrote on April 26th, 2012
  30. I’m 56. I’ve had periodic gout attacks for about 10 or 11 years. I’ve eaten lowcarb/primal for about a year now. I’ve long seen a conection, at least in my case, between eating and drinking certain things, and gout flares. Beer and whiskey have been off the table for me for many years. I have continued to drink wine, about a half liter per day during this time, with no noticable connection to gout flares. In the past, eating scallops would invariably lead to a gout uotbreak. but that dosen’t seem to hold true anymore.

    anyway, about a couple of months back i started adding more organ meat to my diet. about 6 weeks ago i experienced the worst gout flare in years. was it the organ meat specifically? was it the change in diet in general? niether? i really don’t know.

    what i’ve done in responce is to cut out the organ meat, drink a lot more water, and take 500 mg of vitamine C/day. this protocal seems to be working.

    i may try to reintroduce organ meats at some very controled rate to see what happens.

    dave wrote on April 26th, 2012
  31. This is amazing! I suffered from gout for years and used to get 2 to 3 debilitating attacks a year. About 2 years ago, for compeltely unrelated reasons, I read “The Primal Blueprint” and eliminated grains, beans and refined sugar from my diet as an experiment to see how my life would change. Within 6 months, I lost 25 pounds and 2 inches from my waisline. I had increased energy, slept more soundly and felt better than i had in years. I made the dietary changes permanent and completely forgot that I was susceptible to gout. A few months ago, I was talking to a friend about gout and realized that I hadn’t had an attack since I changed my diet! This post completely validates that discovery and gives me yeet another reason why I will never go back to my old eating habits.

    Mark wrote on April 27th, 2012
  32. Gout runs in my family, but I never got it until after went Paleo, which for me was disappointing because until then it had been a miracle cure for me, alleviating my chronic stomach/throat inflammation and fibromyalgia symptoms. It may just be my age – I was 28 at my first flare up, so it may have happened regardless of my diet. I went Paleo in Feb 2011 and got my first episode in August, second flare up just started today (which is why I searched for this article)…and it hurts like a mother *$&! However, both times I’ve had it, I’ve overdone it on the red wine (ie drinking wine 4-5 days per week for a few weeks in a row, which is more than normal for me) and also I was dehydrated. When I got my first flare up, I didn’t do any meds. I just drank tons of water, soaked it in epsom salt, and took it easy (well, didn’t have much of a choice, it hurt to touch it on anything…I was walking like a penguin) and it went away in a few days. I’ll have to try the baking soda and vitamin C thing. I’ve also heard apple cider vinegar and coffee help. We’ll see…I do think water is a big thing though. I have been consciously thinking the last few days that I should drink more bc I’m feeling dehydrated, but I have been really busy and just didn’t take the time to drink enough. Regretting it now!

    Sarah Johnson wrote on April 29th, 2012
  33. The rich during the Middle Ages were the ones who could afford wine, pepper, oranges, apples, and other spicey ingredients in their food. They used the spicious to cover the taste of bad food.

    Gout is caused by spicy food when the spice is eaten in large quantities. Wine has an acid in it, alcohol has an acid in it. Oranges, grapes, cherries, apples have an acid in them. Eat too many and you will have gout.

    Sugar will cause gout if eaten with something that will ferment in the stomach making alcohol.

    My Dad had gout and he was a drinker of hard liquor. I avoid gout by minimizing the eating of all the foods listed above. I minimize the eating of spicy foods. This controls the gout. I know I will have an attack if I over eat any of the foods listed above.

    Val Losse wrote on April 30th, 2012
  34. Good read. I’m a fairly young physician (extremely relative term right…) that suffers from an awful case of gout. I’m also an aging athlete that has allowed my body to get out of control with poor eating and other poor habits. I have been on Uloric which is an uric acid reducing agent to prevent crystal build up in the joints and hopefully prevent subsequent flare ups… I have semi-attempted to change some lifestyle issues by trying to eat a little better (whatever subjective term that means), quit drinking alcohol about 3 years ago, and have increased my workouts attempting to get my 42yo body back in to shape. I believe (as a physician and patient) that the most pertinent part of your article was in the metabolic syndrome part.

    My wife did a Whole30 challenge a couple of months ago and introduced me to some of the premises of paleo in doing it. I’ve heard of paleo through our crossfit community but have always thought, “Yeah… whatever, give me my diet Sunkist and Sugar Babies please… I’ll just work out a bit more” and gained to 290+ pounds doing it. I have changed my eating with her during her Whole30 challenge and preparation and am 2 weeks into my own Whole30 and feel better now than I have in YEARS. My gout seems to have calmed down drastically… some other arthralgia issues (which could be gout related or not) have calmed down… I’m sleeping much better… I wake up in the morning refreshed and usually without an alarm clock.

    I’m sold. I speak to patients daily about it and can’t recommend it enough.

    E. Dale Christensen, M.D. wrote on May 24th, 2012
  35. why not just balance your ph to help your body deal with this acidic condition?

    Alvaro wrote on June 3rd, 2012
  36. I had an absolutely miserable experience with gout while going primal/paleo. My understanding is that while being at a healthy weight is good for gout, when overweight, the process of shedding the pounds can aggravate gout. My doctor thinks that may have been the case with me, and I wonder if that’s also the case with a lot of people who are having gout attacks on these diets. I’m back on the diet after having been scared off of it from the last attack (3 months long, going all over both feet and into my knees and ankle over that time), so I’m pretty damn scared. But I really must lose this weight (I lost about half of what I needed to during the first round).

    Dara wrote on June 25th, 2012
  37. Gout is congestion of the kidneys. Too much animal protein is the main cause, it will trap pretty anything you consume.
    A low protein consumption is important. Juice fasting can cure it for you do it long enough but it can come back if you eat too much animal protein and make it congested again.

    http://www.biomedx.com/zeta/page6.html

    Mike wrote on July 1st, 2012
  38. I am a personal trainer. I am fit. I started going paleo 4 months ago. At first I found more energy and dropped from 15% body fat to 11%. But lately my joints are aching and I had a gout attack for the first time. Don’t understand why

    Michael wrote on July 9th, 2012
  39. The first time I had gout was when I was on Atkins. Since then every time I’ve tried eating a lot of meat I’ve had gout. So before trying Paleo I got on allopurinol. I’ve been on Paleo for about 3 weeks, lost 8 pounds and have had no gout symptoms. I hope when I’ve lost most of the weight that I need to I’ll be able to go off the meds and continue this way of eating forever.

    Sheri Graham wrote on July 12th, 2012

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