April 23 2012

Dear Mark: Risk of Gout?

By Mark Sisson
173 Comments

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?

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 ?mol/l (1–2 mg/dl).”

“Conversely, an isocaloric purine-free diet for 7–10 days will slightly lower serum urate by about 60–120 ?mol/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!

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173 thoughts on “Dear Mark: Risk of Gout?”

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  1. I had a co-worker of mine cure his gout through a 2 week fast. His case was really bad as I saw him limping in the hall for months, eventually he got tired of taking drugs and fasted. His fasting also made him think of his diet and he greatly reduced all fried foods. Not fast food fried, but traditional Chinese fried.

    As far as I know he is generally light on the meat and high on the salad/fruit. I have to check back in with him now to see how his gout is doing, but the long fast did the trick.

    I also fasted for 6 days after his episode to see if my persistent inflammation would go away, but it did not and I like the idea of IF a bit better.

    1. I’ve also heard anecdotes of fasting helping gout, and will try my darndest to find some peer-reviewed papers that explore this issue.

      On a related note:

      One reason why “juice fasts” may help things is a minor uptick in blood alkalinity, from all the alkaline plant matter without any acid-producing grains/meats/etc.

      Fasting my also help with pain perception via sympathetic nervous system effects. If your body thinks it’s shutting down, sometimes it starts not caring about pain so much!

      1. I’m in my 40’s – I was first diagnosed with gout at age 20. The first time I had a major outbreak was from weight loss. Be careful fasting if you have gout – weight loss is essentially the body digesting itself.

        1. Mr. Brown, would you mind elaborating a bit more? About 3 months ago I began a keto diet (pretty strict) and began intermittent fasting once or twice a week (16:8) and have lost about 20 pounds. I started at 200 and am now about 180. I was also diagnosed with gout about 10 years ago, but never experienced a flare up until now. I never fast beyond 16 or 18 hours, but also don’t want to put my body at risk in the long term. What was your experience like for your initial weight loss? Did you choose NOT to fast because it triggered gout, or did you find that your gout was triggered by something else?

    2. Careful throwing around terms like “cured”. Gout is a fairly odd disease in that acute flare ups are not always consistent with the body’s current Uric Acid levels. An acute flare up may dissipate (and possibly even be helped by his fast). That doesn’t mean at all that his uric acid levels had improved .

  2. I’ve had three flareups of Gout in my lifetime. All three times were related to intake of brown liquor (whiskey in specific)

    After cutting out the whiskey I’ve had no further issues. Beer is fine, and clear liquor is also fine. I’m not sure why whiskey specifically caused me problems.

    1. Because nothing good ever comes out of consuming brown liquor ;).

      1. The difference between brown liquor and clear liquor is aging– unless you’re drinking mass-produced brands, in which case caramel color is frequently added. Your best bet is to avoid alcohol altogether if you suffer from gout.

    2. It really is amazing how similar fructose and ethanol are treated by the body.

      Fatty liver disease, high triglycerides, metabolic syndrome, impaired glucose tolerance, and now gout.

      I always knew, through intuition, that the “conventional wisdom” was wrong about gout, and I have always felt completely safe eating the foods I eat, knowing that it must be some modern source of food causing this problem.

      Thanks for cracking this one open, and exposing the truth again Mark.

      1. I have found dry wines, strong ale and yeastly whole-wheat breads have made me a cripple overnight. I also find that I am more likely to get an attack if my kidneys are not firing on all cylinders.

  3. I’m pleased this subject has been tackled, as feels like it’s deliberately avoided by primal folk at times.

    Unfortunately, I do suffer from gout periodically, although the trigger seems to be exercise (impact exercise like running) rather than diet.
    I’ve been ‘primal’ for 17 months now. I think I did see an increase in the number (and severity) of attacks when I first started – I nearly stopped for this reason, however after about 7 or 8 months, they slowed and, touch wood, I haven’t had a visit from the gout fairy for nearly 6 months.

    High doses of Vitamin C (1400mg / day is optimum apparently) seems to help, and the other thing many people swear by is tart cherries. I buy concentrated cherry syrup, which is expensive but anybody who has experienced gout will attest that it’s worth trying anything!

    I like to conveniently skip the link with alcohol, but it’s probably true 🙁

    1. My uncle had really bad gout. He started eating a 6-12 dried tart cherries a day and his gout disappeared. This was many years ago and he still eats his cherries faithfully every day. (As he lives so far away, I have no idea if the gout returned. Haven’t heard any mention of it for years so I just assume it’s been fine.)

    2. Tart or BlckCherry juice works! So does applecider vinegar. I had my first episode in April and could barely walk. Had to use a cane. Then, becuase of improper lifting, had a back injury and becuase of the icing it triggered another episode in me hip joint. But in both cases the cherry and vinegar gave almost immediate relief. I have started taking daily doses of black cherry pills and applecider vinegar pills. It is so worth the money, as I never want to feel that pain again.
      On a side note, I think my first attack happened becuase I was loosing weight too quickly and mainly eating meat with limited vegetables and still consuming sode (high fructose) on a regular basis.

    3. I’ve just started eating Primal and am totally sold, I’ve dropped 14 pounds in 10 weeks. I’m exercising regularly, lifting weights and running.
      However I have had intermittent flare ups of pain in my feet which has made it very hard to run.

      I previously had 2 bouts of gout in my ankles but this pain is around the metatarsal bone in my foot. I have been to see a Cardio who checked the bone and said it was fine and pain is muscular or gout.

      I’ve read multiple discussions about gout on the forum – eat red cherries etc, but would appreciate any other advice on how to manage uric acid levels?

    4. Tart Cherry and clear tequila over ice. Yummm. (for your convenience)

    5. Can you share the brand of cherry juice you purchase &/or tell us where we can purchase it or what website you recommend?

  4. This makes so much sense. My dad had terrible gout when I was a kid and he loved chicken livers and gizzards, and he also drank a lot of beer. When he cut back on both, his gout cleared up dramatically. We always assumed it was dropping the organ meats, not so much the alcohol. I am new to Paleo and not ready for organ meats yet, but good to know gout shouldn’t be a problem when I do start them.

    1. Half of my meat intake consists of organ meats now. I started to experience trouble with swollen painful joints after I tried limit meat and increase whole grain consumption 5 years ago. Going to low-carb diet eliminated that issue together with pre-menopause symptoms, allergies, infections and much more. I have been avoiding alcohol for last 15 years because it interfered with my asthma and migraines. On LC diet sometimes I could have a glass of wine without a problem.

  5. Eating primal is a gout suppressor for me.

    I was diagnosed with gout a year and a half ago at 32 years old. I was pretty bummed, and the information about it is so varied that it was tough to know what to do. I decided I wasn’t going to go on meds for the rest of my life. I changed my diet and lost a lot of weight. I started out doing the Slow Carb diet, but eventually transitioned to primal. My doctor advised against a “high protein” diet, but we agreed that I’d try it and quit at the first sign of gout symptoms recurring.

    I never had problems. The primal diet doesn’t trigger gout symptoms for me at all, quite the opposite. I’ve lost weight, and feel better every day.

    I’ve had over a year to play with this, and the only thing that will for sure trigger a gout twinge is excessive beer consumption. Beer is a weakness for me, and I can’t say I never give in to temptation, but I probably consume 1% of what I previously did.

    1. Absolutely, Beer is unfortunately a trigger for my gout as well. Not typically simply on its own. I can usually track attacks to moments when my beer intake increases for a several day period in combination with poor eating and times when I’m out of shape (think sugar snacks and hot dogs). And there is usually a lag. So like when get home from vacation or right after holidays. If I eat right (Whole9life has worked well for me in the past), exercise right (intense like Crossfit or Tacfit have worked for me), and moderate any drinking, I have yet to have an attack and my asthma improves dramatically.

  6. I haven’t had a flare-up since going primal, circa 2010, that’s eating at least a pound of salmon a week, which is supposedly one of the highest contributors to an attack (purines).
    I think the biggest cause (anecdotal-based)is foods that cause inflammation – as gout is nothing more than an auto-immune disease. And we all know how to fight inflammation on this diet.

  7. I constantly hear about how I’ll get skin cancer from not using sunscreen and being in the sun all the time. Everyone seems to have a story about a friend or relative who used to lay out tanning and/or spend lots of time outside without “protection” but ended up with melanoma. Anyone else get this? I don’t have much to respond with other than “I’m not really worried about it.”

    1. my son’s high school class got a recent guest lecture by an oncologist-about skin cancer. apparently, sunscreen does not protect from melanoma,but only “milder” forms of skin cancer. the conculusion was to spend some time outdoors for vitamin D, but not long periods in the sun from 10 am -2 pm or whatever the “danger” times are.

      1. I tend to agree that we should stay out of the sun at it’s highest point.

        First of all most indigenous people avoid the sun during this time. Secondly, our circadian rhythm naturally provides more natural protection from the oxidative damage caused by UV rays during the morning hours, when we are also most active (or should be) because of increased cortisol levels. We usually get sleepy in the afternoon, and we would tend to seek shelter to nap or rest, out of the sun. Cortisol rises briefly later in the afternoon when the sun is lower and less intense.

        It seems to me that our circadian rhythm would have us be active in the sun when it is less intense, and to avoid it when it is most intense. UV rays can be very intense in the noon of summer.

        1. They have found that UVB is the only kind of UV that makes vitamin D. The amount of UVB depends on the angle of the sun. Between 10 and 2 are the best times for UVB.

      2. Bad news. It doesn’t protect against that either. I haven’t attempted laying out since high school in the 80s. Pretty much have spent the rest of the time AVOIDING the sun. It’s too bright and I burn anyway. I don’t even swim in my pool until evening. Beach? Not until the sun is setting (and I’ve burned then too, WITH sunscreen 70 SPF).
        Last week? Squamous removed from my nose-a nose that has been smeared in sunscreen religiously since I had a precancerous lesion removed 7 years ago. And a melanoma off my leg. Nice. I might die from a stupid mole. On top of that, I’ve exercised every day for over a year, been on the SCD for almost 2 years. Did it help? Nope. Neither did avoiding the sun and wearing sunscreen.

        1. K, my understanding is that sun damage is cumulative (think of your skin as akin to litmus paper), and the time we spent lying out in the sun when we were younger cannot be reversed by applying sunscreen now. I too have avoided the sun religiously for at least the last 15 years or so, wearing hats whenever possible and wearing sunblock whenever a hat was not possible, but I have had squamous cell cancer removed from my temple and the dermatologist had to go so deep the last time (it kept recurring) that I no longer have any pigment cells in that location, meaning I have a permanent white spot on my temple. We can, however, prevent more damage from accumulating by the steps you mention, so please don’t think your efforts are wasted.

  8. My coworker suffers from gout, and ever since I converted him to Primal he’s had far fewer flare ups. I don’t know if everyone would have the same success with it, but Primal definitely helps!

  9. Altering purine intake has made no difference for me. Fructose and alchohol do so very much, though.

  10. Almost five years ago, I was 231 lb (I’m 6’1″), eating mainly junk food, candy, soda, and an average of about 12 ounces of sugary alcoholic drinks with about 7% alcohol per night.
    And was diagnosed with gout. I didn’t like the doctor’s advice regarding dietary restrictions, so decided on my own to cut out sugar and alcohol immediately and go on a macrobiotic diet. The gout disappeared quickly and never returned.
    A year or so later I moved away from the macrobiotics, into Primal.
    Now at 175 lb (thinking about going down another 10 or so…), feeling good.

  11. Thanks for the writeup, Mark. I’ve heard many people pan primal/paleo due to “protein crystallizing your joints.” It’s uninformed and silly, but all too common.

    One other factor not mentioned in the article that can aggravate gout is rapid weight loss, believe it or not. Key things — keep hydrated, and talk to your doctor about something like allopurinol if your uric acid levels are elevated. I’d tried doing primal weight loss with a high uric acid level a few times, and it always kicked off gout flares. After getting on allopurinol, I’ve been able to lose weight primal style and not encounter flareups.

    Gout can be very frustrating, as many doctors adhere to the purine dogma and will advocate a diet of garbage to accompany any medicine.

    Sometimes a rapid change in some portion of your diet can trigger a gout attack even if you’ve never had one before — starting or stopping regular alcohol consumption, losing weight, changing diet makeup, etc. If this happens to you, I’d strongly encourage getting your uric acid level measured. Gout flareups are a warning sign that you’re getting crystallization, and that won’t happen in just your big toe. Fingers, elbows, knees.. most any joint can get gout. Be informed, and eat well! 🙂

    1. I’ve been on a ketogenic diet for about 3 and a half months and lost 30 lbs. Recently I had a massive gout flare with pain in nearly all of my joints. uric acid was 7,7 a few days after the flare came up.

      My train of thought now is that I should slow down my weightloss with a higher carb intake (not being in ketosis all the time). Of Course I don’t want to eat pasta etc. again but instead fruit like bananas and apples. But if fructose also has a bad influence on uric acid levels, would you advise to stick to keto and take meds until I lost enough fat?

      I am a little lost right now. I know this way of eating is the right way for me to lose weight and live the rest of my life, but I never had problems with gout and it really sucks.

      Sadly my doctor advised me to eat less meat. She believes the higher meat intake is the cause of the gout flare and is not fond of the idea of giving me meds to lower the uric acid.

      I could need a little advice 🙂

      1. Suggest you include ‘safe’ carbs (sweet potatoes, white rice) rather than fruit – per Jaminet’s Perfect Health Diet.

      2. To be honest, you may want to re-evaluate whether you want to be keto all the time. Being in ketosis has it’s benefits, but always being in ketosis has downsides.

        One being insulin resistance.

        http://jpet.aspetjournals.org/content/304/3/994.short

        I don’t bring this up to bash on anyone’s lifestyle, but I’m concerned that people making a lifestyle out of ketosis will one day regret that decision.

        Also, I don’t mean to confuse you more, but you don’t need ketosis to lose weight fast. In fact, I just helped a client lose ten pounds in ten days (not a program, just a coincidence). She was a low-carber, aka keto, but weight loss was stalling for her. We added some carb refeeds, and higher protein intake all around, and the weight started falling off. I’ve got to say she is my star client right now though.

        1. yeah, I know you don’t have to be in ketosis to do that. Actually I already made the decision to not be in ketosis all the time and see how it affects the gout flares. but adding fruit to my diet to get out of ketosis might be a bad idea if fructose can mess with the uric acid level as well.

          so the suggestion of some sweet potatoes and white rice by Sharyn is something I will look into.

      3. This is what I do to avoid gout, from which I suffer. First, be aware that any soreness/stiffness in the mornings, in the absence of pre-existing pathology in a relatively young person, is probably low level gout. Therefore do not exercise on those days of walk a lot because that will aggravate it.

        Go to bed well hydrated and stay well hydrated during the day. It is nearly always overnight that crystals grow, due to lack of movement and circulation.

        When I think it may be coming on I take cystitis remedy (urine alkalinizer) before bed. This works a treat, and, in combination with naproxen before bed will limit an acute attack to 3 days absolute max in my case, and will prevent an acute attack when it feels like it’s threatening.

        Most gout is due to problems with excretion, which is why the alkalinizer works. In my experience high fructose and alcohol are to be avoided if an acute attack threatens, but managing myself as I do currently (and (I eat a relatively large amount of meat) has meant not having to avoid alcohol.

        Result!!

    2. Thanks for posting this comment Lynch. I though I was the only one who would get gout attacks whenever I lost weight (always happened after I would lose 30lbs quickly). I mentioned this to a few of my primary care doctors over the last 20 yrs and they all had the same reaction…that I was making it up and that losing weight would prevent gout not cause it!!!

  12. Does me good to hear this info finally getting out. I still feel terrible for one of my first hospital patients as a newly minted RD. He was a truck driver suffering with gout and trying to eat as low purine and possible and getting no relief. I didn’t have any answers for him then.

  13. Interesting! Overally, I’d say going primal has helped with my gout & my health in general. Gout runs strongly in my family & I got it at about age 25 (after an injury in my big toe joint). I did not fit the bill as a typical sufferer as I was young, in good shape physically, didn’t drink much alcohol, etc. The hereditary link with gout can be pretty strong though.

    I have to admit my last gout attack was the morning after eating beef liver. 😉 However, overall since eating primal I’ve had very few attacks. And I have eaten liver since then with no issues (although, it’s been chicken liver not beef).

    Great article! I’ve heard of the fructose connection before but never seen it explained so well!

  14. As a long time sufferer of gout, this was a concern of mine when I started going primal about 8 to 10 months ago. Turned out I had nothing to be worried about. I have had not attacks since, not even a peep. In addition I have dropped from 245 to 179 lbs (and counting), reduced my blood pressure and feel healthier than ever. Still fixing all the damage that the SAD diet caused, but I’ll be primal forever. Thanks Mark for the post and this site.

    1. Going primal and hiit training caused too many gout attacks!! Currently had attack for the past 4 weeks and still limping around despite following docs meds…. think you got to listen to what works for you. The best diet for me was “eat right for your blood type” no attacks in 3 years…. changed to a high protein low carb diet and been back on the crutches. Don’t get me wrong my energy levels been great, fitter and leaner than ever but uric acid thru the roof

  15. My brother has gout and he doesn’t even come close to following a primal diet. If I had to guess I’d say alcohol is the biggest culprit– though he loves his dessert too…

  16. Went from vegan to primal a year and a half ago. Everything has gotten better —– EXCEPT for gout. Gout has flared up tenfold.

  17. My first gout was in my knee, and it was so bad that I got referred to an orthoscopic surgeon who did some imaging. When it came back and he told me “go away, you just have gout”, he seemed almost disappointed that he didn’t get to cut my knee open.

    I had several more attacks, and I tried all the CW about cutting back on “good protein sources”. I tried less conventional wisdom about adding berries, dark cherries, and (to treat acute attacks) baking soda.

    At least the baking soda helped, some. The cherries and cherry extract, maybe. The fish oil, maybe.

    Over time, I came to discover an interesting correlation.

    Stress at work –> drinking more sugary soda –> Gout attack

    Some literature was connecting the fructose to gout, but I am not sure that the carbonation might not also be a factor. So I tried cutting out the soda, and that helped when I was consistent, but eventually I ended up on 300mg of Allopurinol. That really helped.

    Since going primal, (December 2011) I have not been as consistent about taking the allopurinol, and I have had none since returning from an international trip in early March. (I did take it on the trip because I knew that I was going to be eating more non-primal foods than normal, and a gout attack overseas would have been particularly bothersome.)

    Anyway, so far so good. At the first sign of trouble, I won’t hesitate to run back to the allopurinol, but I am not convinced that my body still needs it to get by.

    1. PS: I also wanted to mention that I am also down 34.5 pounds since December 8, 2011 — my Primal birthday.

    2. be careful going back and forth on/off allopurinol because I’ve heard that is a known gout trigger too.

      I agree with an earlier post saying that the change in stress, diet and alcohol can trigger an attack.

      I researched this about a year ago when I first went primal and was having more gout outbreaks. I ended up increasing my allopurinol to 200ml and no more outbreaks.

  18. I have found Primal to help. I suffered from gout regular. I also did NOT drink alchol ever. I was oveweight and out of shape. I have been in shape before and still had an attack from time to time. The more out of shape and the more SAD I ate the more often the attacks came. I decided to get back in shape and I wanted a quick weight loss plan, so I started Atkins. That worked great as I read on I descovered MDA. Long story short, I have lost about 80lbs am in pretty good shape and have been gout free for several months now. I started Atkins-to-Primal Dec 26 2010. I still eat a junk meal a couple times a month, I think now my body can a piece of cake or a cookie twice a month. I do believe it was the fructose in store bought bread that was the culprit. Also Braggs Apple Cider Vinegar helps. It blocks some of the acid from forming, when I have something bad I always follow it with a 2tbsp/8oz of ACV and water.

  19. Hey, Mark:

    Nice column. I’ve had gout for 15 years — at least — and over the last 18 months, it’s gotten to the point where I just can’t shake it. I have some joint affected by gout almost daily. When I first started having chronic gout, I thought losing weight my help and that’s how I found MDA. I lost about 60 pounds and stay on the paleo/primal diet at least 80 percent of the time. The diet hasn’t helped my gout, but it hasn’t gotten any worse.

    I am seeing a holistic doctor now and I’m taking supplements to treat a liver infection, which my specialist (a chiropractor who also does Nutrition Response Testing) said I had. He has me on a ton of supplements. In addition, he recommends a paleo diet, so I thought that was encouraging. The doctor said it could take three to four months to clear the infection naturally and get my liver back to 100 percent, which he believes will get the uric acid out of my system.

    My symptoms are lessening and there are days when I feel like I could almost sprint without too much pain.

    Bottom line – I believe the paleo/primal lifestyle will work once my body gets healthy on its own and starts doing what it should do.

    Thanks for everything you have done for me.

    I’m out.

    1. If I may be so bold why not go 100 percent Paleo for 1-2 months? The 80/20 rule doesn’t apply to people with auto-immune issues. Seems like it would be worth it to me if I had gout. You are saying that 20 percent of your diet is not Paleo so it seems like maybe going a 100 percent would give you a better baseline to see what if anything in your diet flares the gout.

      1. I don’t think gout is classified as an auto-immune disease. It’s caused either the over production of uric acid or the body’s inability to get rid of it fast enough. The body attacks the crystals during an outbreak but this is a normal reaction.

    2. Paleo/Primal may not be sufficient for someone with an existing auto-immune disorder. I’ve read posts here and on other paleo bloggers websites such as Robb Wolf and Chris Kresser about an Auto-immune Protocol diet to eliminate certain foods like nightshades that would otherwise be okay on a typical paleo diet.

  20. I used to suffer extremely painful gout flare-ups every summer (probably triggered by mild dehydration).

    Though I don’t drink alcohol, I was a moderate non-diet-soda drinker. I quit soda about 4 years ago have not had a recurrence.

    I never did give up red meat (even during symptoms), and this article makes me worry less about revisiting those days while living and eating primally.

    Thanks, Mark!

  21. I have had gout and was on medicine to control it until just a few months ago. In September of last year I decided my way of losing weight wasn’t working and went primal. Since then I have lost 58 pounds and not surprisingly I don’t need the gout medicine any longer and have had no flare ups at all. Gout is related to arthritis and I can’t say my arthritis is totally gone, but it is a little better as well. Unless you are really gorging on the meat I can’t see that this diet is going to do anything but help a gout situation.

  22. I have hereditary gout. My first symptoms of it being in my early 40s after I injured the joint in one big toe. That seemed to trigger it. I suffered excruciating pain until I gave up alcohol and all forms of sugar, including grains. I basically went Primal before I knew what Primal was. I still like the occasional glass of red wine, but can only have it once or twice a month as I’m just too sensitive to it, in relation to gout.

    I would have to agree with a previous post that the 80/20 Primal rule doesn’t work for me. I need to be pretty much at 100% Primal to keep the gout at bay. Other than a little bit of arthritic stiffness in both big toe joints, I have no symptoms now that I’ve gone Primal. I also don’t need any medications.

  23. Hi Mark – “How do we reconcile without destroying our brains with cognitive dissonance?”

    This sentence alone was reason enough to read this article. I had to laugh out loud! Excellent!

  24. I’ve suffered gout for nearly 30 years. I actually thought it was turf-toe from football when it first reared its ugly head.

    While not fully primal, I have found gout to increase in two circumstances: While experimenting with IF and should I fall way off the wagon and subject myself to process foods – namely breads/buns multiple days in a row.

    I’ve not found any correlation with alcohol or meats.

    I limit breads/buns and have not done any IF and, knock on wood rapidly, I’ve not had any flairs in nearly a year.

    Dave

  25. I had a couple of big toe issues before I went Primal. Funniest thing but cutting out grains, sugar and starchy stuff fixed many things, not just the gout problem. I have totally eliminated any gastric distress and ‘heartburn’ and my dry itchy skin patches cleared up. I even have not had any more problem with dry eye. Go figure !!

  26. Mark,
    Interesting article but on what basis are you saying the average person does not need to megadose on vitamin C? what is megadosing? and on what basis are you saying 1-2 grammes should be ok?

  27. I suffered for about 5 years before I experimented on myself through diet.

    I cut protein to no effect, I never drink anyways, I cut high purine vegetables to no effect and cut table sugar to no effect.

    I cut fruit from my diet and haven’t had a flare up since (two years).

  28. My gout definitely flared up after doing a primal diet. However, as mentioned earlier, its quite well known that weight loss can lead to acute gout attacks as the process for burning fat releases uric acid.

    I’m so far just depending on prescription drugs, i.e. allopurinol to prevent further attacks. I’m a little nervous to even attempt to go off of this as everybody that has gout knows how terrible the attacks can be.

  29. I believe that my gout was caused by the diuretic Maxzide. Although their are postings online suggesting that it can cause gout, it’s not mentioned as a side effect. I suggested to my MD that I needed a change of meds to treat hypertension, which he did. Since then not gout and it’s been four years. This was pre-paleo.

  30. How can you write a whole post about gout and not mention the chapter on gout that Gary Taubes deleted from his book GOOD CALORIES, BAD CALORIES? there’s a huge amount of info there as one would expect from Taubes, for instance the fact that dietary approaches to control of gout have largely been abandoned as ineffective.

    You can find & read the whole thing on Tim Ferriss’ fourhourworkweek dot com/blog/2009/10/05/gout/

    You’re welcome.

  31. Any time I went off my low carb primal diet, I would get gout in my right big toe, which tart cherry juice helped with a lot, but as soon as I was off the sugar/alcohol, the gout was gone. Can’t be purines in my case.

  32. I only ever got gout when I went off my low carb primal diet; tart cherry juice/supplements would help a lot, but the gout went away when I got off the carbs and wine. It can’t be purines in my case.

  33. Since being diagnosed with Gout, I’ve lost over 80 pounds going primal which I imagine has helped a lot. I do take a daily dose of Allopurinol with my vitamins and havent had any issues in over two years. Interestingly enough I had my first flareup of gout after increasing my fruit intake several weeks ago but was able to stop it with 100mg of indomethacin at the first signs.

    I am guilty of drinking a glass of red wine on most evenings. I certainly appreciate the article and will monitor my alcohol and fructose intake. I have not avoided any primal foods and thus far have had a lot of success on the primal diet. 🙂

  34. Excellent post on a difficult subject. It does seem to always boil down to “Eat a healthy, real food diet!”

  35. Would drinking kombucha trigger gout? I have never had gout before. But had a recent bout of it about a month ago. I stopped all fruit and decided not to eat good grass fed bacon everyday. It’s better, but still some numbness on my big toe. I also haven’t drank kombucha everyday for the past month.

  36. Man, make no mistake about it…going primal/paleo changed my life. Since having stopped eating fructose, whether fruit or High Fructose Corn Syrup, I have not had a gout attack. After having suffered three or four attacks per year for 20 years, life is pain-free. All the advice I followed over the years were for naught because I would continue to get attacks. (Hell, did you know caffeine is a purine?)

    Upon reading Sisson’s “Primal Blueprint,” gout has been a thing of the past. I’ve been eating a lot of meat with no problems.

    Got gout? Stop eating junk food but getting away from fructose is the biggest step one can take.

  37. I just read most of the comments before my post. Some mention gout attacks after startin a fast. A fasting/low calorie study was done after WW11 on returning soldiers. Many in the study had a gout attack after the study began. Several other low-calorie studies have also resulted in gout attacks. At the time, the researchers postulated the gout was caused by various chemicals reentering the system as the body drew upon the fat reserves in such abundance the body was unable to handle the influx.

    True? I don’t know but my first three fasts resulted in soreness in my thumb joints and big-toe joints. Not actual attacks but I knew from the discomfort that gout was definitely present.

    The last few fasts have been trouble-free.

  38. A scientific expert on uric acid told me that a mechanism of precipitating uric acid crystals (which is what causes the inflammatory arthritis of Gout) is dehydration. He thinks this is why gout is associated with alcohol use, especially beer, because people who chronicly consumption alcohol tend to not take care of their fluid needs.

    Thoughts on this anyone?

    1. My grandfather suffered gout, and my father has had a few gout attacks in the past 5-10 years. He drinks 4 liters of water a day (in addition to his 3 huge glasses of milky tea), and swears that he feels an attack coming on whenever he slacks off on the water intake. He doesn’t eat the best diet, however, so who knows how less water would affect him if he were eating Primal?

    2. I was thinking the same thing. Both alcohol and sodas often lead to dehydration. Caffeine too for that matter. I wonder if dehydration might be a problem? The people I have known with gout are usually chronically dehydrated as well…it is a possibility…

      1. I have a case of continuous minor gout, with tingling and stabbing sensations in many various joints and body parts. It started out with a high uric acid count which is now normal but I still have the tingling.

        I have found after 4 years of research and experience that gout is a problem of ph of the body. The purine theory has never improved my gout. What has and does improve it is decreasing the acid level of my body by eating a lot of vegetables and salads with my meat.

        I eat tons of meat – chicken, beef, bison, salmon, pork, all free range and/or organic. As long as I also take in lots of organic veggies I am fine. If I have eaten too much meat or “crap” with no veggies, the stabbing pains start up. I have found this to be alleviated almost immediately with a tall glass of good water with 1/2 to 1 whole fresh lemon squeezed in it. This is a testimony to the ph being involved because lemon water is extremely alkaline.

        My belief is take out junk food or any useless foods and drinks for the body and gout will improve or go away. Eat free range meats/wild salmon and tons of salads and veggies and healthy oils. Oh and eggs.

  39. 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

  40. Never had another case of gout after I increased my water hydration daily to 8 glasses per day. The water flushes everything away.

  41. 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!

    1. 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.

  42. For me, alcohol=gout. I have had no gout issues while eating primal (and keeping my alcohol in check).

    1. Hi there,

      I do think that sugar is the culprit as well. Can you tell me just how far you went with fructose? Did you lose all fruits and vegies with high sugar content as well? i.e. sweet potatoes, tomatoes, squash? I would be very interested to hear what finally got your gout under control. Thanks Claudia

  43. 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

  44. 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.

  45. 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.

  46. 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.

  47. 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.

    1. Don,

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

  48. 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!!

  49. 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 🙂

  50. 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.

  51. 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!

  52. 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.

  53. Try a couple capsules 3x/day of quercetin with bromelain. Knocks down gout quickly for me.

  54. 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.

    1. 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?

      1. 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.

  55. 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. 🙁

  56. 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.

  57. 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.

  58. 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.

  59. 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. 🙁

  60. 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

  61. 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?

    1. Cherries are very high in vitamin K, which has been shown to help with gout.

      Frank

  62. 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.

  63. 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

  64. 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.

  65. 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?

  66. 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.

  67. 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.

  68. 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!

  69. 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.

  70. 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.

  71. why not just balance your ph to help your body deal with this acidic condition?

  72. 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).

  73. 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

  74. 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

  75. 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.

  76. 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.

  77. 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.

  78. 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.

    1. Yes, you may have a genetic issue with this. No, really. The other big no no is alcohol. How’s that doing?

  79. 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!

  80. 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.

  81. 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

  82. 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.

  83. 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.

  84. Great article. My father has gout and it is very painful. I will make him read this. Thanks

  85. 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!

  86. 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..

  87. 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 http://www.webmedcentral.com/article_view/4217 . If you supplement potassium, be very certain that vitamin B-1 is adequate, because otherwise heart disease can be triggered (see http://charles_w.tripod.com/kandthiamin.html ).
    Sincerely, Charles Weber

  88. 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… 🙂

  89. 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.

  90. 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 goutpal.com

  91. 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.

  92. 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.

  93. 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.

  94. 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?

    1. 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.

  95. 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?

  96. 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!

  97. 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.

  98. 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.

    https://archive.org/details/uricacidasafact05haiggoog

  99. 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.

  100. 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.

  101. 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.

  102. 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?
    Thanks!

    1. 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. http://www.yeastinfectionadvisor.com/arthritis.html Maybe play around with advice to lower candida levels. Also you can take celery seed. 1tsp twice a day.
      Good luck

  103. 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.

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

    Thanks for the help yesterday everyone.

  104. Also! Please excuse the crass avatar. Long story but it is inappropriate.

  105. 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

  106. 6’4″ 225 and can bench 200 lbs15 times and have a 34″ waist. Former athlete and avid skier, hiker, and hunter. A my big toe will knock me flat on my back once a year. It always happens to me during a change of seasons. I am talking a week at a time unable to wear a shoe. I am 41. I don’t drink. Body chemistry. First, never fast! Second, cook your meat well done. When you start burning fat instead of sugar (ketosis), the ketones prevent you from expelling uric acid. Once you get here, it is too late. There is nothing you can do but hydrate and let it run its course. Naproxen (anti-inflammatory) sometimes cures it for me but is never prescribed by doctors. I found it quite by accident as it was the only thing we had in the house and my wife used it for her back. Your daily maintenance is HIGHLY important. Potassium and Vitamin C and multi-vitamins, combined with magnesium (blood flow) are crucial. No processed fructose. Organic raw cherry juice (shudder) helps. Then, if it ever hits, you MUST give in and have dairy. Yogurt, smoothies, and broccoli, Brussel sprouts all are good. Even then, be prepared because if like me, it is hereditary, grit your teeth, ice your foot, and cuss a lot, because it hurts like hell.

  107. I have an occasional flare up in the big toe, usually after wine and or junk meats like hot dogs. I have excellent results with tart cherry capsules. A couple for 2-3 days takes care of it, plus staying away from alcohol. Beer and wine seem to cause my flareups, not spirits.

  108. Gout like symptoms can also be caused, from personal experience, by Leaky Gut Syndrome in turn caused by inflamed stomach lining which allows toxins to be dumped into ones bloodstream. Be that as it may be, the cure is essentially the same. Cut down on grains, particularly wheat, sugars and refined products (worst offender is HFCS, which in turn is made from GMO corn), and all GMO products.

    When one changes diet don’t expect a magic bullet response, but watch the trend. Be satisfied with a gradual improvement in health and reduced occurrences of gout like symptoms. You will have ups and downs as you refine yr diet thru trial and error – stick with the trend!! My personal improvement over 6 months can only be described as amazing – from not being able to walk to running 2-3 miles in 12 months, now almost completely pain free and without taking any medication or a single pill.

    The other point here is that the medical and pharmaceutical industries are not your friends. They want to treat symptoms not causes, so you keep coming back for more medications. In fact the medications in almost all cases are toxic to you.

    Gotta take personal responsibility for your own health and not outsource it!

  109. Gout like symptoms may be caused by Leaky Gut Syndrome where certain foods irritate the stomach lining so toxins leak thru to the bloodstream. In my case I cured my gout completely by cutting down on bread and boosting veggie intake. Never had high uric acid but would be crippled with pain in knees or ankles or toes. 12 month of revised diet got rid of it all and have gone from not being able to walk to running 2-3 miles – all in 12 months.

    One has to take personal responsibility for ones health – the medical and pharmaceutical industries are not one’s friends. Watch the trend for improvement as diet changes are not magic bullets or feel good solutions. Go with the trend and experiment.

  110. I had about 4 gout attacks in my life (at the rate of once a year). Going through all the websites to find the cure was very frustrating since I tried to avoid beer, tart cheery juice and organ meat but the gout flareups revisited once a year or so. After the last attack, I realized that the diet soda could be the trigger of my attacks. Looking back, I had very little knowledge about how diet soda contained the sweeteners that were bad for your body. Ever since cutting down carbs and eliminating sugary drinks (regular and diet) I have been gout free for about 2 years.

    As far as I know, everyone’s trigger is different. Generally I learned that Fructose, Alcohol and insulin resistance contributes to gout attacks. Diet soda doesn’t contain Fructose but I don’t know what sweetener like Aspartame can do to my body.

    I suggest:

    -Avoid sugar at all cost including artificial sweeteners (Eat low carb/primal etc)

    -Avoid fruit juices because of their Fructose content (Whole fruit may be okay because you are having fibers also)

    -Try intermittent fasting to reduce insulin resistance

    -Reduce your alcohol intake

    These are nothing that you haven’t learned from this site but researching the cure for gout can be very frustrating.

    Please note that I heard you may get “healing” gout attack during rapid weight loss or fasting. I don’t have knowledge on this subject. It may be due to your body trying to get rid of toxins from the breakdown of your fat cells.

  111. Hi Mark. I’ve been mostly Paleo for a year now, drink some wine and fruit smoothies every morning. Is there a link between paleo for a sustained period of time and now fruit and wine now becoming inflammatory for me? I’m considering reintroducing white rice and totally eliminating fruit and wine for a period of a month to see if that helps? Thoughts?

  112. “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.”

    Basic misunderstanding of gout. The problem is caused by the immune system attacking microscopic crystals, not the crystals themselves.

  113. As a post menopausal female with gout, diagnosis and treatment took almost two years. I was misdiagnosed by 3 doctors, and suffered to the point of near suicide from the pain that I can’t even put into words. The number one comment I got from doctors? “But women don’t usually get gout….” <<>> For myself real relief came with a combination of some medication and radially changing my diet to a near vegitarian level….after following paleo for several years and loving it. Now that I feel like I’m under control I’m easing back into more protein and feeling better, but there isn’t just one answer to gout.

  114. “But perhaps the best way to avoid gout? Get healthy. Eat well. Exercise intensely from time to time”.
    Best, most full-picture advice I’ve found. Avoiding a few, otherwise healthy, foods really doesn’t stack up as a cure.

  115. When I cut out fruit and went high high fat low carb I got gout. I tried twice last year – basic keto diet and terrible gout followed. When I reintroduced carbs and fruit no gout. I have NEVER heard of fructose causing gout – high fat/high protein and alcohol causes gout (in people presupposed to it). Did the “upper class” that got gout 300 years ago eat mostly fruit and grains…haha, no, they ate meat and drank wine.

  116. Dear Mark, I have been on an AIP diet for about 80 days in the hopes of eliminating my problem with HS. This is showing great success and also my ibs has completely cleared up. In the last few days I noticed a gout like ache coming on and now have full blown gout in my left foot. The pain is of course nearly unbearable. Since my current diet consists of non starchy veggies, coconut in many forms and meat (and usually a small glass of red wine with dinner) my conclusion is that for me, the wine and the red meat have to go for the time being. Sad. But I do think in people like me, red meat is probably exacerbating the problem. On AIP, perhaps I am missing some nutrients that would mitigate it. Any suggestions out there would be helpful. I am trying vinegar in water and have also stopped drinking coffee.

  117. Yep. Two weeks to the day from starting the diet. I am encouraged by the studies that show uric acid levels fall over time, and I know that losing weight will help, too. Right now, my toe hurts.

  118. I have a history of kidney stones, but did not suffer from gout until the first time I was on a CR/paleo diet. Unfortunately, I was not living in the US at the time, medical care was inconvenient, and I thought I had a persistent foot injury due to weight. Limped around for 3 months in severe pain. Eventually I figured it out.

    Time passes, and once again I’m on an IF/CR/paleo diet. Hello gout and a regular supply of colchicine.

    One article I read suggests that IF causes a lactic acid build-up which, in some way or another, reduces excretion of uric acid. Details were not available.

    Drinking significantly more water seems to help. On the other hand, there goes more magnesium, etc.

    I’m wondering how much of it has to do with autophagy scavenging amino acids and such when in a fasting state.

  119. I was given a gout diagnosis at the age of 20 years old. I was fit and dealing with what I thought was a sports injury – the first physician that examined me gave me a diagnosis of plantarficitis. It was not until six weeks later that my uric acid levels were tested, that I was correctly diagnosed with gout. This was 25 years ago. I have been involved with just about every treatment available to Western medicine. For me, the best way to manage gout is to have a healthy body weight, keep hydrated and abstain from alcohol. If these things are in check – then I do not have issues with gout, regardless of the purine content of my diet.

  120. I just saw my naturopathe and he told me cause he saw cristal in my urine and blood, to reduce red meat, salt, cacao, and”sugar, process meat ( I dont eat them)” what do you think Dave Feldman and Ken D Berry, MD and he said to eat more celeri, celeri rave, cucomber, water, yellow apples, noix de grenobles, and went to buy supplements thymus and manganese cobat, and the lady told my keto is not good for long turm 😛 I read alotand I think i know what im doing and keto is about eating real food. 18 mounts that I cut sugars
    Lyne

    1. sorry for the last post here is the good one thank you xx I just saw my naturopathe and he told me cause he saw cristal in my urine and blood to reduce red meat, salt, cacao, and’ sugar, process meat ( I dont eat them)” what do you think? and he said to eat more celeri, celeri rave, cucomber, water, yellow apples, noix de grenobles, so wy would I have cristals if I dont eat frustose or sugar, I eat meat, keto veggies, keto fruits good fats and he also said that I still have low llymphocyte so he prescribed supplements thymus and manganese cobat for my anxiety, pvc, tremors and digestion, I add it in januray also from blood test, he checked my cholesterol and sugar all is good, thanks if you can help xox