This article is part of a special report on Red Meat. To see the other articles in this series, click here.
A common question I get from readers is whether a Paleo-type diet will increase their risk for gout. Gout is a type of inflammatory arthritis caused by elevated levels of uric acid in the blood, forming crystal deposits in the joints, tendons, and surrounding tissue.
Gout typically affects the feet in general and big toe joint specifically, and causes severe pain and swelling. In the past, gout was referred to as a “rich man’s disease”, as it typically affected the upper class and royalty who could afford “rich” foods like meat, sugar, and alcohol.
Uric acid is a byproduct of the metabolism of purines, one of two types of nitrogenous bases that form the basic structure of DNA and RNA. While purines are present in all foods, they are typically higher in many of the foods emphasized on a nutrient-dense Paleo diet, such as red meat, turkey, organ meats, and certain types of fish and seafood. Patients with gout are often advised to reduce or eliminate these purine-rich foods with the goal of preventing excess uric acid production, thereby reducing the symptoms of gout. And research has confirmed the association between high purine intakes and acute gout attacks, suggesting that those diagnosed with gout would benefit from a reduction in purine-rich foods. (1, 2)
So, do we need reconsider recommendations to eat foods like liver, sardines, red meat, mussels, and other traditional foods? Do these nutrient-dense, purine-rich foods really cause gout? Are those of us following a Paleo-style diet putting ourselves at greater risk for this painful, debilitating condition?
Inflammation as a Cause of Gout Attacks
While high purine intake is associated with gout attacks in those who already have hyperuricemia, or high levels of uric acid in the blood, purine intake alone is not enough to trigger these attacks. (3) In fact, uric acid levels are frequently decreased during gout attacks, sometimes to within the normal range. Another factor associated with gout flares is an increase in C-reactive protein (CRP) and interleukin-6 (IL-6), cytokines produced during numerous inflammatory conditions. (4) These inflammatory cytokines are increased in the joint fluid and serum of patients with acute gouty arthritis. (5, 6)
Therefore, systemic inflammation is likely a key factor affecting the likelihood of developing gout flares, and as we know, diet plays a significant role in inflammation. While foods like grass-fed beef, sardines, and mackerel are high in purines, they are also higher in omega-3 fatty acids and low in omega-6 fatty acids. Since the omega-3 to omega-6 balance in your diet modulates the inflammatory response, a diet with sufficient long-chain omega-3 fats like EPA and DHA will reduce systemic inflammation and may reduce the risk of forming the uric acid crystals that cause joint pain.
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Fructose: An Important Player in the Development of Gout
While fructose in naturally occurring amounts is relatively benign, research has shown that higher intakes of fructose may mediate many of the abnormalities seen in the metabolic syndrome, including elevated triglycerides, due to increases in uric acid production. (7) A recent study confirmed the uric acid–elevating potential of fructose ingestion, both by producing excess uric acid and reducing its excretion in the urine. (8)
While some uric acid in the blood is normal, providing a level of antioxidant protection, excess uric acid is a pro-oxidant and the major causative factor for gout. Some researchers even suggest that this excess uric acid in the blood is a major factor in the development of insulin resistance and metabolic diseases. (9) So if you’re avoiding excess fructose consumption from high fructose corn syrup and excess sucrose (table sugar), you’ll be at a lower risk for gout that someone who’s washing their burger down with a can of coke.
A Word on the Epidemiological Correlation between Meat and Gout
A major reason that many conventional physicians and health professionals see red meat consumption as a significant risk factor for gout is that red meat is typically a component of an overall “Western diet pattern”, a pattern that is also high in sugar, vegetable oils, sweetened beverages, refined grains, and processed meats, while being low in fruits and vegetables. (10) It is nearly impossible for epidemiologists to separate meat consumption from this general pattern of eating when studying modern cultures — after all, most “health conscious” eaters in our generation believe that meat is unhealthy and typically eat less of it.
While most epidemiological studies attempt to control for these confounding factors, the truth is that most high consumers of meat are generally prone to other unhealthy habits such as smoking and drinking, and are typically more overweight than low meat consumers in these studies. Of course this doesn’t tell us anything about the active, health-conscious Paleo eater who avoids high fructose corn syrup and omega-6 fatty acids, as well as other inflammatory foods like refined grains, and doesn’t drink heavily or smoke.
Eating a Paleo Diet Won’t Cause Gout!
The next time your doctor or best friend says you’ll get gout from a Paleo diet, you can refer him or her to this article. Rest assured that a diet full of nutrient dense foods like grass-fed red meat, liver, shellfish, and fatty ocean fish is not putting you at risk for developing this painful condition. More likely to cause gout are the common American dietary staples such as sugar-sweetened beverages, industrial seed and vegetable oils, refined carbohydrates, and excessive alcohol (beer in particular). The Western diet pattern is a risk factor for gout; a nutrient-dense Paleo diet is not.
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I tried the atkins diet. I read dr. atkins book and followed the strict diet called for in the inception period he outlined. After 3 weeks my left thumb turned red and swelled to twice its normal size. it was also painful. i went to a doctor and he diagnosed it as gout! what is even scarier is that even after i went off the diet, i feel it in my thumb if i eat alot of protein. I recommend that you stay away from the atkins diet. Just follow something normal and healthy with exercise. I am afraid i may have long term battles with gout after just 3 weeks of his diet.
Paul – I had a similar experience when I followed the Zone Diet several years ago. I am not a fitness or nutrition expert, so my advice is only based on my own experience.
I follow the Dave Diet (ok – that’s me) which is moderation in any high purine type of the foods. I eat 6 smaller meals a day. I follow several Paleo principles such as grass fed beef, reduced white starch foods. But I follow elements of an alkaline diet – lots of greens, moderation with meats, more avocado and coconut/mct oil for my oils, lots of lemon water.
I try to eat the foods I enjoy, but in smaller quantities.
Exercise a lot – sweat out the toxins.
Hey all, I was happy to find this thread, lots of good info.
I had a spike of gout 6 months ago. Battled it with allopurinol, uric acid down to 2.x, all better. Then contracted EBV and ended up with RA promptly after! Now I’m on autoimmune paleo for 4 months and just ended up with…GOUT. Full circle! I eat zero sugar and little fruit. I do eat meat at every meal (no organs) and sweet potatoes. Going to try the oat diet for a day that was mentioned here but I’m really nervous because there’s already very little I can eat. I’ve lost 40 lbs off 160 in the last 6 months (most of it in the first 3) there’s not much left of me and I’m eating 100% healthy so there’s something in my body that’s malfunctioning but no docs can tell me what it is. All blood tests have been fine. I exercise daily but not strenuous and am now very toned. I’m 45. Please advise if anyone knows anything else I can try!
HI Lowella, Try looking at oxalates in the diet. Sweet potatoes/yams are very high in it. It is known to form stones/crystals similar to uric acid. Do some research on it and you will find oxalate can be a problem too. Also, moderation in the quantity of meat may help. Add unsweetened sour cherry juice too. The cherry juice is usually highly recommended by gout sufferers.
I have been dealing with gout flare ups for 15 years using colchicine which brings it down over 3-5 days. Finally tried concentrated cherry extract and was surprised how quickly it helped to reduce swelling and pain by neutralizing uric acid. I plan to use the cherry extract on a regular low dose daily to keep UA levels down. Decided to use the extract instead of the concentrated juice to avoid the sugar. Good luck!
I know this is a super old post, but Im curious where you stand today.
After lots and lots of reading I have found out that the crystals, when dissolved, causes flares/swelling.
This is why you here, allopurinol can cause an attack… because it’s working.
So I’m theorizing that it is entire possible that you may have been, at the time, dissolving these crystals. A very good thing.
lowella – I realize this is 18 mo or so past your posting of this and I hope you are faring better. As soon as you make mention of Epstein Barr my thoughts turn to Lyme. Weight loss is a common occurrence with Lyme. Lab tests mirss it all the time as the Lyme parasite burrows into tissue anda – and they are taking BLOOD samples. My recommendation is to find a certified technician using either the Asyra or Qest4 bio-resonance system. Another brand used by an ND missed advanced Lyme in my husband (much weight loss) and we found a DC using the Asyra (Qest is newer version) – this is the most advanced and sensitive system out there. Hard to digest proteins will feed the Lyme parasite when active.
I pray you are doing much better.
I found the fungal etiology of gout and have been following a ZC meat diet with 109% results , fungus loves sugars http://press.mu-varna.bg/ojs/index.php/bmr/article/download/221/221
I’ve been on the LCHF for almost 4 years. I lost about 30 pounds during few first months. My cholesterol is normal, and the weight is stable. The liver has returned to normal size. And the kidney stones have disappeared!!! The gout attacks first became less acute and occasional.
But recently attacks renewed . I have no idea whats wrong..
I am a 67 year old white male that had gout for 6 years before it was diagnosed. I am a VA failure. Chronic gout with all the typical horror stories. Four months ago they told me I was a also a diabetic and that was another reason I felt so horrible. My conversations with my children got me to investigate grains and that led to Paleo. It hasn’t just saved my life, which was miserable, it has given me quality of life I never imagined I could ever have again. I have lost 30 lbs and went from a 40 inch waist to 33 inch. I work out 6 days a week and do not need naps. I have mental clarity once again. I don’t have any cravings, which has been the problems with diets of the past. My lab work is normal for the first time in my life. I am off the BP meds and the gout med. (allipurinal). I am grateful beyond words.
I have repeatedly experienced gout associated with keto, and often these are the worst cases of gout I’ve ever experienced in the 15 years I’ve exhibited gout. I have high uric acid levels while fasting as well, thanks genetics. It wasn’t until a few years ago that I began to clearly see the link however.
I’ve been back on whole grains for almost two years now, and haven’t had a gout attack the entire time. I’m also down 15 pounds, but that was mostly counting calories and reducing overall intake.
Need some clarity please?!
Mostly paleo for a year now. Not excessive over weight (maybe 5-10 pounds, 5’6 weight 153). Active (weights and running). Now suddenly (?) I’ve got gout. Eliminate fruit entirely? Reduce meat to 1xday? Any thoughts would be most appreciated. Thanks. Want to get a handle on this ASAP.
8 days into a low carb diet I developed gout for the first time in my life. Uric acid was slightly elevated. What was strange was it was ongoing low-level joint pains migrating round my body and not like normal gout. 3 years later the problem is still there! Both knees and ankles particularly bad. No history of gout in my family. I feel that something shocked my system with this diet which has not righted itself since so I regret my low-carb diet very much.
I have had a first gaut attack 5 weeks after starting the Whole 30 diet, which is a Paleo type program. I think the key is to do what I did not do, actually eat a lot of vegetables as all diets say to do and drink 80 to 100 ounces of water a day. You can’t just eat a lot of meat and expect good things to happen. Also, I have the usual risk factors, age, gender, over weight. In short, be very careful with diet change and weight loss, especially after 60.
I was reading through the comments. I have been studying on gout non-stop. For three weeks my left wrist was unable to function. I went from a job to moving on average 70 000 lbs of tires by hand per shift and then training 6 days a week in muay thai kickboxing/weight training to zilch. I just woke up with it. I was so distraught, as I thought that my training-days were over and I would have to go on short-term disability.
Prior to this I had consumed large quantities of liver; I calculated that within a 6 week time-span I had consumed over 40 lbs of liver.
I experimented with various supplements, diet changes etc. to help my wrist. I was uncertain what it was at first. I presumed it was a fracture or a tendon tear. Then I decided to consider the hypothesis regarding if it could be gout related. I researched and read everywhere that cherry juice was effective, so I decided to give it a try.
Within 1 hour of consuming about 60 ml of pure cherry juice I was able to go from only moving 10 lbs with my left hand to over 100 lbs. No more severe pain. Minor flare ups here and there, especially if I consume any fruit (fructose is the culprit) However these flares are nothing to the original severe pain, that essentially locked my wrist into one position, pain so bad it would induce a maddening rage.
Thus cherry juice is consumed whenever there is flare ups and they are immediately countered. I am researching this extensively, and although I did not read every comment, I read most of them.
The common factor in paleo diets is iron-rich foods. There is a strong link between excessive iron levels and uric acid. I have also been taking a chelator called ip-6, which is isolated phytic acid to lower iron levels and have found this to greatly help with the flare ups. Generally the standard assumption of iron usage per day is 1mg in the body. Iron is the only mineral your body cannot get rid of on its own. You can either donate blood or chelate it. Many estimate that especially in men their potential iron stores could reach over 50 grams in the body as they age. Contributing towards joint ailments(as it deposits in the joints, organ problems, as it deposits in the organs, especially the liver and so on.) Thus perhaps excessive iron is associated with uric acid issues.
I am so convinced of the effect of cherry juice that I strongly urge everyone struggling with gout to try it. I believe it to be almost miraculous in effect. Coffee is also effective too. Studies show that the more coffee is consumed the less uric acid is in the blood. The presumed link is not the caffeine, but rather the chlorogenic acid. However it should be noted that coffee is also a potent iron inhibitor. Some estimate up to 90% of iron is prevented from being absorbed as a result.
Thus this may contribute to the excessive iron/uric acid theory.
Thus when consuming your healthy meats and fats (the weston price foundation states that the high levels of vitamin a and proper fat to protein ratio (80% fat, 20% protein) prevented gout in cultures of old who flourished on paleo-type diets) Consume your meats with coffee and cherry juice and this should counter any uric acid build up.
Dairy products, especially milk also help in decreasing uric acid. I am studying this endlessly. As I cannot allow anything to get in my way to become the strongest. My life is nothing but training and studying.
Although herbs/foods I am trying are celery, celery seeds, nutmeg (sprinkled) and ceylon cinnamon. Although I have not researched them enough or done enough experiments to prove their usage. Nevertheless I beg of you to try the cherry juice (tart or black) as it could make a miraculous difference. I tried both expensive organic ones and a standard grocery store one and found them both equally effective. I swish it around in my mouth to increase absorption via the mucus membranes.
Since I am so active (moving tires, muay thai kickboxing, etc.) all very hard on the joints, I can feel a flare up rather quickly and cherry juice works the best, coffee being the secondary usage. Although potential uric acid inhibitors are psyllium fiber and cordyceps.
I plan to research this endlessly until I found the perfect solution. Also noting that taking any alcohol based tincture herb causes a flare up as well.
wow Sean, this information was extremely appreciated! I have been on the keto/paleo diet for about 5 months now ( my 12 year old daughter as well ). I’m 53 and noticed that a grain based diet kept me so bloated over the years, I couldnt figure it out. My daughter was a tipical 12 year old that ate whatever junk they can put into their body ( birthday parties, sleepovers, sports day, it’s the tipical diet for kids) she clearly didn’t process sugar like normal kids, however, cause she’s much chubbier than her peers. She asked me to help her so were on this diet together. We eat alot of meats -beef, pork, chicken, and fish like white & Salmon ( although she doesn’t like it ) shellfish, eggs etc. and an abuntace of vegetables, and fruit. She and I both feel so awesomely great!! But I must admitt, I am fearful of gout. I’ve had gout, about 5 years ago. Sooo painful, then got put on dangerously stronge antinflamitory med from a Doctor. I resently started feel a bit of pain in my toe but can’t see anything – it comes and goes, but nothing severe. I will look into cherry juice ( although, it’s probably high in sugar ). I was told, back when I developed gout once, that cranberry juice helped. I didn’t know why, but drank copious amounts and I did seem to do the trick ( cause I only took the antinflamitory once ). Thanks again. Rosa
Try 3 meals in one day with three large bowls of oatmeal alone, using stevia and margarine for flavoring (ok cherry juice too) to eliminate gout symptoms in 24 hrs.
Then followup with rice/grains and vegetables and non acid fruits for a few days, adding white flesh fish, eggs in moderation and tofu when you are pain free.(lowfat dairy may or may not cause a flare up for you depending on fat content.
Organ meats, beef , oily fish and turkey were gout inducers for me. Avoid all bullions except vegetable.
A more vegetarian style diet will prevent future flare-ups.
Try tumeric too
I began a Paleo/Low carb diet about 3 months ago. I eat no fruit or fruit juices, no sugar of any kind, including artifical sweetners.
I DO eat liver, grass fed beef, organic chicken, shellfish, butter, coconut oil, eggs (from a friend’s farm) cheese, and tons and tons of vegetables.
First gout attack this week… now what do I do?
I have about 30 pounds to lose, but more imporantly on this diet my blood sugars were so incredibly stable and I feel better than I have in years. No hunger, huge energy, just awesome.
But this pain is bad.
Any suggestions I’d love to hear them. Thanks
if you loose weight drastically , it lowers your uric acid thus releasing lodged crystals from tissue and joints . hence the attack . Try cherry tablets as they do help and have lots of water.