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

Dear Mark: Risk of Gout?

Every 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?



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. 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.

    Mike wrote on July 1st, 2012
  2. 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
  3. 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
  4. There is a bit of anecdotal evidence, to which i can add, that nightshades — tomatoes, potatoes, peppers — can bring on a gout attack. I had never had a gout attack, doesn’t run in my family — and I once broke a long fast with glasses of V8 juice and suffered instant, excruciating gout that lasted for days. No doubt, for me the nightshades are deadly.

    mehitabel wrote on July 22nd, 2012
  5. A friend of my actually cure his gout through diet as recommended to him by some one. he was ask to be Drinking adequate water along with a diet low in alcohol and purine-rich foods and high in vitamin C. to my greatest surprise it work for him.

    emily jacob wrote on September 27th, 2012
  6. Have been on a purely primal diet, very little fruit, absolutely no grains or starches of any kind including potatoes, 2 green drinks a day fortified by whey protein, and one regular meal with meat or fish, and vegetables. Never had gout in my life, but whenever I travel and take meat or fish protein at breakfast and lunch in lieu of whey, or when I snack on any kind of jerky at home, I exceed some kind of purine threshold and within 2 hours I have a swollen and painful big toe, and puffy swelling under the ball of the foot i.e. gout. Takes about 2 days of eating low purine foods go away. I already drink cider vinegar once a day, take black cherry juice, use no sweetener except stevia, and have a strongly alkaline diet thanks to the greens, so anyone who says it’s not the high purine meats and fish that’s causing this is out to lunch. I know other people with similar diets and the same sensitivity, except their gout attacks are much worse, mine are only beginning. The trick seems to be to avoid exceeding the purine threshold, by sticking to low purine protein in general, or very limited quantities of the high purine foods.

    TJ wrote on November 2nd, 2012
    • Yes, you may have a genetic issue with this. No, really. The other big no no is alcohol. How’s that doing?

      Dr Jason wrote on November 2nd, 2012
  7. I have suffered from gout for 13 years. I have taken allupurinol, Uloric, mobic, ibuprophen, and prednisone along with Hydrocodone. I have not really found anything that has worked for me for a long term solution. Not even cherries or baking soda. Today is day 65 of paleo, with the first 30 days being Whole 30. In that time I have lost almost 40lbs (212-176). For the first time in 13 years, I have had a 30 consecutive day period with out pain. I have been able to start running again and I am healthier than I have been in years.

    I know gout can be a fickle thing and different things flair it in different people, I am a firm believer in Primal now. What a huge lifestyle change!

    Jason wrote on November 4th, 2012
  8. my husband has bad gout we are looking for some good recipes

    buffy wrote on February 2nd, 2013
  9. I suffer from gout. I was diagnosed 10 years ago and doctors immediately said to cut back on meat to only about 10-15% of my diet. No legumes of any kind, lower fat and higher carbs. After a month of very low protein, I found myself incredibly tired. Purine rich food has never been the problem for me. The problem has always been hydration. I drink entirely too much soda and sometimes virtually no water. That is the problem.

    I am just starting on a Paleo diet, week 2, in fact. So far, going good. My doctor doesn’t like it because of the gout and because I’m significantly overweight with a family history of heart problems. The proof of the benefits will come once I have lost weight and improve my cholesterol/blood pressure.

    Orion wrote on February 15th, 2013
  10. Really good article here. A lot of good and relevant info for gout sufferers, like me.

    I’ve suffered with it since 1995 and it wasn’t until a few years ago that I got serious, and fed up with the constant attacks and flare ups, that I took matters into my own hands and learned everything I could about the disease.

    Now, it’s been over a years that I’ve lived gout attack free. The answer is 100% related to diet and lifestyle.

    The one thing I’d add to your nice writeup is that gout triggers & gout remedies are different for every gout sufferer. My worst gout trigger (processed deli meats) may not affect the next gout patient at all, or very little.

    I’ve heard from lots of people that drinking apple cider vinegar mixed with baking soda is THE trick. Didn’t do a thing for me, however.

    Anyway, well done on the article.


    Ed wrote on March 27th, 2013
  11. boy this gout stuff can be really bad, when I get a flare up I can’t walk. It first started a few years ago with my ankles, only one joint at a time so far (which I guess I should be thankful for). The pain for me is excruciating and has finally pushed me over the edge in search of better health. The article, along with all the comments and personal experiences have been a great help.

    I’m having a flare up now on my right big toe, first joint at the ball of the foot. I believe my Uric acid has been pretty high for the past few months (constant but minor pain in my right big toe). My uric acid along with my triglycerides are always high at my annual medical exams. I believe what kicked it off this time around was eating way too much pork and beef and too many oranges within the past week. I also got a full body massage and the guy pulled and manipulated my foot and big toe which I think really helped kick things off too. I really want to stay off any long term meds and look forward to getting back to a healthier more active lifestyle. I will definitely watch what i eat more carefully, really limiting/eliminating sugar, fructose, HFCS, high purine meats along with regular exercise once this flare up has subsided. on the list of things to do will also be better hydration and regular Vitamin C supplements.

    A few questions I have are

    If gout is due to a deficiency in your kidneys eliminating uric acid why didn’t it affect me when I was younger and eating the same garbage but was way more active and in way better shape?

    why did it take so long for me to build up dangerous (to me, this pain is bad i tell you) uric acid levels that would trigger flare ups?

    Thank you all for this very informative article and helpful/motivating commentary. some of the best gout related stuff I’ve read by far, tons better than anything I’ve read from most medical sites.

    Medic J wrote on April 14th, 2013
  12. Great questions, Medic J.

    I’ll offer up my 2 cents.

    There’s two primary reasons that people have too much uric acid in their system.

    Either their body produces too much uric acid and the kidneys can’t process it fast enough or their kidneys simply can’t eliminate more normal levels of uric acid quickly enough.

    Eating a diet too rich in purines can affect either but for most people, their body produces too much for the kidneys to handle. The solution, is medication, or a more gout friendly diet.

    As far as the age goes, as we age, our bodies tend to become less efficient in the normal process we all take for granted when we’re young.

    In my early 40s I began to notice that my eye sight wasn’t as good as it once was. Then, at about 44 I finally went to see an eye doctor and got the full workup. He told me that I have a stigmatism and have had it all my life. I now needed glasses but when I was younger my muscles were strong enough to compensate and I had great vision. Had!

    I suspect it would be a similar situation for you, and me, when we were young and could eat anything we wanted and as much as we wanted. It catches up though.

    That can probably also be attributed to your question about taking so long to build up higher uric acid levels.

    The #1 thing that I recommend people do to start a good gout management diet is drink lots of water. 10-12 glasses per day.

    You’ve probably read all the lists of what not to eat. One thing that should be included on those lists but seldom is – and it was my main trigger, is processed deli or lunch meats. That stuff tore me up when I was having so many attacks. So, here’s my short list of foods to eliminate until you are out of “gout attack” mode.

    1. Processed deli meats
    2. Shellfish
    3. Organ meats
    4. Oily seafood (sardines, mackerel, etc.)
    5. Fatty red meats
    6. Gravy (especially from restaurants)

    Hope that all helps. Check out my blog if you want more specific info.

    Ed wrote on April 17th, 2013
  13. Great article. My father has gout and it is very painful. I will make him read this. Thanks

    Adam wrote on April 28th, 2013
  14. Thank you very much for this write-up, Mark!! We’ve gone primal for some weeks now and ordered your books last week. My husband (Mark) is almost halfway through The Primal Blueprint.

    Some of our vegetarian family members are not happy with our decision to go primal and have been harping on about gout and the dangers we’re putting ourselves in. As a result, I’ve been trying to read up about it and your article is fantastic and doesn’t really contradict anything of substance that I’ve read online. It actually gives more information with backup evidence.

    We are very happy to read this, as we’ve never felt better than in the last couple of months i.e. since going primal. We’ve always done lots of exercise too. It’s reassuring knowing I can ignore the ignorant.

    Thank you!

    PS your recipes are phenomenal!

    Simone Adler wrote on May 1st, 2013
  15. it seems like ages that i heve been searching for a website like this one? i am glad i found it,some great information here, i am new and just starting out, anyway thanks for some great tips..

    create a website wrote on May 8th, 2013
  16. Potassium deficiency is deeply involved in gout and high uric acid as an accentuating factor because uric acid is less soluble in acidic urine. Potassium bicarbonate supplements will reverse this. In view of the fact that this is not considered by current rheumatologists, it would be very valuable for you to bring it into your future writing. It is not only that potassium is not considered by physicians in regard to gout, many of them do not even believe that a potassium deficiency is likely. This even though many of them prescribe what are actually supplements, but prescribed under euphemistic terms such as salt substitutes, sodium free baking powder, ORT salts (oral rehydration therapy for diarrhea), polarizing solutions, GIK (glucose, insulin, potassium) salts, vegetables, or glucosamine. A deficiency is further defined out of existence by defining the blood serum content normal as 4.2 when the actual figure is 4.8. For gout, though, the chloride is not acceptable. But potassium bicarbonate powder dissolved in fruit juice or half teaspoon sprinkled on cereal will work very well. It may be obtained from businesses which add it to wine. You may see an article on this concept in . If you supplement potassium, be very certain that vitamin B-1 is adequate, because otherwise heart disease can be triggered (see ).
    Sincerely, Charles Weber

    Charles Weber wrote on July 15th, 2013
  17. i always had some joint pain before because of high level of uric acid, some of the reasons maybe because of my bad diet and heavy alcohol consumption when i was in college… everything improved about my uric acid when i started eating healthy and stopped drinking… my diet was mostly vegies, fish, fruits and sometimes red meat once or twice a week….

    when i hear about the paleo diet i was immediately interested, casue it sounds so logical to me and also want to sustain a lighter weight…so i gave it a try.. so at my 3rd week of paleo diet i tried intermittent fasting for 5 days, the 16/8 kind of intermittent fasting.. unfortunately i become sick on the 6th day when im about to eat normally..i got cough at first and on the next day i got a fever. so i went to the doctor and a had a blood test and i include uric acid test cause im getting pain again on my leg joints, and the result is a above average level of uric acid..the normal was 7 and i got 8.7…during my fever i was also suffering inflammation on my knee and toes…i wonder what could have raise my uric acid during my change of diet and eating pattern… :)

    jess wrote on August 13th, 2013
  18. I was diagnosed with gout about 4 months ago. I started eating primal 5 days ago and I was starting to feel better and then BAM I am having a horrible gout attack. So bad I want to cry. I have not had any alcohol in my system in over 10 years so I know it’s not that? I have been drinking cherry juice all week and it’s not helping.
    I was so excited that eating primal could help me…I hope the pain goes away.

    Heartichoke wrote on August 16th, 2013
  19. Gout is very serious as it is a signal something is wrong. You need to get a blood test and make sure your Uric Acid levels are under 5mg per dl otherwise your condition will get worse with age. Tophi will form and you can literally have your joints destroyed.

    As a second generation gout sufferer I know! (I am now cured)

    If you have gout I strongly recommend Keith’s site

    Yakpi wrote on November 3rd, 2013
  20. For many years, I’ve had chronic gout. Hospitalized many, many times. I drink a lot and usually have at least minor attacks every week. Since following this grok diet, while still drinking a lot, I haven’t had even a single mild attack. I was shocked when I realized, that it had been month since any gout issues.

    Joe Curley wrote on November 6th, 2013
  21. I’ve been primal for about 8 months with great results. A couple of nights ago, out of the blue for the first time in my life I had an attack of gout in my left foot near the big toe, which led me to this article the following morning. The article and comments were a big help. During the day, I drank much more water than I usually do (including a couple of glasses with some tart cherry juice extract and one with a teaspoon of baking soda), took supplementary Vitamin C, soaked the foot in some hot water with Epsom salts, and in a nod to CW took a dose of naproxen. I could literally feel it getting better by the hour. Within 24 hours, the symptoms had completely cleared up. Don’t know for sure which of the approaches was most effective, but my suspicion is that I just wasn’t properly hydrated. I’m going to pay more attention to my water intake going forward, and hopefully I won’t experience a recurrence.

    Kirk H. wrote on January 8th, 2014
  22. I have had terrible gout attacks in my toe, knee and most recently ankle. I have used Cherry & ACV which have helped at times. It’s the worst pain.

    I am now turning more to controlling the ph levels in my body with a more alkaline diet, a bottle of Evian in my hand most of the day 😉 and using an alkaline booster like Alkazone.

    JXS wrote on January 23rd, 2014
  23. Nooooo! This is so me. The base joint in my right big toe has been all red and achy, and at first I thought bunions or callouses or something/bad shoes (since tight shoes obviously cause pain on a swollen joint), but now I’m pretty sure it’s gout. I’ve been paleo for quite some time, but this has only been a problem for me recently.

    Lately I’ve been eating more sardines, scallops, paleo-friendly dark chocolate, and shrimp and a few 80/20 type sushi cheats (read: more fish!), and I’ve definitely been slacking on water, and I’ve been IFing, and stress has been high, so I think it’s been kind of a perfect storm brewing.

    I’m hoping if I slam water, take motrin and 500 mg of vitamin C and turmeric (allergic to cherries so can’t do those), and avoid these foods for a bit, maybe I can introduce them on a more limited basis? We have a lot of allergies in our house (beef, eggs, dairy to name a few), so I’d really hate to restrict my protein sources more than I have to. Thoughts?

    Also, if I behave, will the pain just go away, or will the redness and swelling also go down, or is that there to stay?

    Nichole K wrote on February 4th, 2014
    • As a person from the family with a lot of allergies I can relate to you troubles. I suggest, if you feel sub-optional in any way, drop chocolate – may be it is paleo-friendly, but it is very allergy unfriendly, like strawberries, citrus fruits, hot spices, tomato souses and some other things. Also important – avoid all alcohol.

      Galina L. wrote on February 5th, 2014
  24. Recently I thought I would give green smoothies a go. The general make up of my shake was 1 – 1.5 cups different greens each shake (lettuce, spinach, bok choy, or arugula), 1/2 a banana and either 1 cup pineapple or melon or 1/2 cup cherries. Fruit was bought fresh, cut into serving sizes and frozen. All this was blended with around 1 cup of whole milk. Within around 10 days I had a pretty bad gout attack. I hadn’t had one for around 5 years and nothing else in my diet had changed. Cherries featured in most of the shakes in the days before the attack. I have not started full primal yet but can only think it was related to the fructose content of the fruits as I am not usually a big fruit eater. I’m a 35 year old guy who doesn’t drink alcohol or eat much on the typical gout food lists. I generally used coconut oil and butter for cooking but read that saturated fat slows the release of uric acid from the blood stream?

    Dan wrote on February 8th, 2014
  25. I have been 95% Paleo for the past year. I have never had gout. But, I woke up one morning this week, and the pain in my knee was so intense I could hardly walk. It’s been almost a week and doesn’t seem to be getting any better. I have not injured my knee. It is swollen. As I was researching gout, and the gout dietary limitations, I wondered about Paleo. The recommendations are SO un-Paleo. Eeeek. I’m hoping what I have is not gout. I may go to a doctor next week and get it checked out. I’m hoping for the best. Reading these posts has helped me. Thanks!

    Susan wrote on February 27th, 2014
  26. So… I also have gout. Hits when I have a mix of dehydration, bad diet, and trauma. I’ve been paleo for 2 months, down 30 lbs, and no sign of it despite trauma, occasional workout dehydration. Then… Trip away with the wife where I went off diet. Had a few drinks, breaded foods, etc. 3 days later, got hit with a gout attack. I’m sold paleo helps my condition, and back to the straight and narrow lifestyle again. Lesson learned.

    SV wrote on March 6th, 2014
  27. I actually found MDA and this thread researching diet and gout as I often do when I am suffering a flare-up. It seems that there are many readers that have experienced the sensation of having an automobile parked on one or more joints of the lower extremities over a sleepless night. This thread has spanned two years and is still going so it is an important topic for those of us that suffer from this silent epidemic. In my 15 years as a gout sufferer I have experienced all of the flare-up triggers, and attempted most remedies mentioned within this thread.

    Triggers: Alcohol, dehydration, nightshades, gluten, organ meats, shell fish, fasting, sedentary periods, i.e. desk work/long flights. etc. The one thing that hit me for the first time was fructose. Ah Ha! I also believe excessive sodium can be one of the dominoes leading to an attack. The theory is kidneys concentrate on eliminating Na and uric acid takes a back seat. This may be why potassium supplements seems to work for some?

    Therapies: Cherry juice, ACV, avoidance of purine/acidifying foods, eating alkalising foods, Allopurinol, Colchicine, Indomethacin, increase fluid consumption, One of my favorites is Alka Seltzer Gold. The Gold has potassium bicarbonates and is buffered with 1 gram of citric acid. My flare ups seem to remain at bay when I drop a pouch before bed and seem to occur a month or so after the box runs out and I resume over indulgences.

    Judging from the lack of attention and knowledge in the medical community. The cure is most likely something that cannot be prescribed nor patented. One rheumatologist consulted me that once one starts allopurinol therapy one cannot stop it but could not tell me why. That same professional never asked me about alcohol consumption nor advised me to limit it.

    For those new to Paleo getting gout for the first time. I think it may be due to too much protein replacing the carb calories and not maintaining a balance with greens instead of two chicken breasts with broccoli, think two heads of broccoli with one chicken breast. Especially if one is more active at happy hour than the gym. You know who you are. Excess protein calories need to go somewhere if they are not used? I also don’t think Grok, feasted on a fresh kill three times a day. Also if one is rapidly losing weight, the toxins that occupy adipose tissue are being released so be wary of this process. I think there is a scientific name for that.

    The Tinge: Tinge is what I call the joint sensation precluding a flare-up. My therapy for the tinge is to begin lemon water rehydration immediately. Tighten up my diet with the known foods that reduce inflammation and limit animal protein to 4oz per day. Go out and buy a new box of Alka Seltzer Gold, take it before bed.

    Thank you Mark for such a through forum. Perhaps your passion for truth and knowledge will continue to help guide gout sufferers? Is it Mercury? Mycotoxins? bad genes? I found this in my quest for the cure and found it fascinating.

    Jason wrote on April 3rd, 2014
  28. Hi Mark, Thanks for this blog and this discussion. I have had gout for about 15 years and I have tried allot of diets (including paleo), supplements and medication. The disease has progressed and 2 years ago I quit eating meat. I got immediate results and the gout stopped. I added meat back into my diet and the gout returned. I tried to eat a meatless diet and was successful most of the time, but really wanted to have my streaks and chops, so I went on Allopurinol about 6 months ago. Not a good idea. I suffered for 3 months with continual gout in my feet, ankles, knees and even my wrist. I quit taking the meds 3 months ago and returned to a meat free diet with no sugar and no white flour. Gout is gone and I have lost 10 lbs. and feel great. About 2 weeks ago, in a moment of weakness, I had a cup of chilli with smoked pork butt. Delicious! Next day, I got gout. I don’t drink. My gout is caused by meat.

    Tommy Loyd wrote on April 20th, 2014
  29. I know some cases when people had an allergy on certain types of meat. The most problematic was fish, then to smaller degree beef and chicken. Lamb, rabbit and pork had the best record, especially rabbit. Meat was safer for allergics when it was fast frozen and defrost shortly before cooking. Boiled and stewed were the best ways to cook. Fried and grilled were the worst, smoked was the absolutely worst.

    Galina L. wrote on April 20th, 2014
  30. I had 3 gout attacks in 3 years, even though I drank very little alcohol but ate a moderate amount of meat and game (I’m a bow hunter). Of course, reading the literature out there I cut back on meat. I then had another flare up., a really bad one. What worked? I eliminated most sugar (I had been eating mostly fat free candy but it was still. . . candy and I ate it daily.) I replaced juices with low sugar whole fruit and diet pop with lots of water. I have a carb laden breakfast a couple days a month (pancakes with bacon) but with the dietary changes, which helped me lose 45 pounds, I haven’t had a flare up in three years eating Primal 90% of the time.

    Brigid wrote on July 18th, 2014
  31. It’s been almost two months since I went primal, and I’ve already lost circa 20 pounds. I was curious about other aspects of my health so I had my blood checked to see what was going on with my body.
    The cholesterol and triglycerides were really low (with a high LDL), and all other tests had really good results.
    But my uric acid has skyrocketed to 10,4 mg/dL, and that has really scared me. I’m eating religiously primal. What could I’ve been doing wrong?
    I eat circa one pound of fatty red meats daily, could that be it?

    Andre wrote on October 7th, 2014
    • Uric acid deposits in joints, tendons, and other tissues. You may have been asymptomatic. As you switched a primal diet – if uric acid deposits were dissolving, then possibly temporarily your blood levels would be high. Also, fructose is known to increase uric acid, so depending on what you ate the day of the test could effect the results. I would continue your current primal diet, and see what your results look like at the 6 month mark. Do you know what your uric acid levels use to be? I am not an expert, and gout and uric acid can be confusing and overwhelming with many varying elements and variables. I am curious what Mark’s uric acid level is. This is an interesting concept blaming yeast in your system. Maybe play around with advice to lower candida levels. Also you can take celery seed. 1tsp twice a day.
      Good luck

      Jon wrote on April 5th, 2015
  32. Great article, Mark. And I really appreciate everyone over the course of two years adding these comments. Yesterday was the culmination of three straight months of flare ups in both knees and feet. I spent the day nursing my left knee and hobbling around on crutches. Doing everything I could to relieve the pain. My job had been suffering as a result. I’m fortunate to have a very good boss that rolls with me on things like this but you still hate having to tell her that you need to rest another day, you feel like a burden to the company. Productivity just comes to a halt because all you can think about is relief. So I spent the day yesterday reading every single comment on this message board and amassing as much information as I could about what works for different individuals. I then read a fair amount of Mark’s info on PB as well as other sites. It is painfully (no pun intended) clear to me I have to choose to radically change what I put in put in my body or live my life in pain and be hobbled forever. I’m going to start easing myself into Paleo and dial back the hooch. I’ll be a regular here moving forward.

    Some things this last battle have taught me that I thought I’d share:
    I’ve heard that icing swollen joints during a flare is good. I’d rethink that based on my experience. Cool temps, I’ve read, multiply Uric Acid crystals. While the ice may relieve the pain the long term impact of icing may irritate the flare. I can confirm this based on my experience.

    Avoid fatty foods, Sweets, and alcohol in excess, completely during flares

    Thanks for the help yesterday everyone.

    Jeff H. wrote on January 23rd, 2015
  33. Also! Please excuse the crass avatar. Long story but it is inappropriate.

    Jeff H. wrote on January 23rd, 2015
  34. Dear Mark,
    Do you have any other studies that actually uric acid output to intermittent fasting? I looked at the one posted and it was for actual fasting between 8 and 21 days. The charts showed an excellent output of uric acid still remained after one day of fasting. Most people do intermittent fasting on alternate days or just overnight for 15-17 hours- isn’t that right? I would love to see more articles on this topic. Thanks Claudi

    Claudi wrote on August 16th, 2015

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