Will Eating a Paleo Diet Cause Gout? | Chris Kresser
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Will Eating a Paleo Diet Cause Gout?

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Is there a link between a paleo diet and gout? iStock.com/nebari

 

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. (12)

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?

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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. (56)

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.

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.

Now I’d like to hear from you. Have you experienced concern from a physician or family member over your diet and your risk for gout? Has this article helped calm your fears about your diet-related risk factors for gout? Share in the comments below!

197 Comments

Join the conversation

  1. I believe that it can take more than 3 years to heal the damage. That’s my anecdotal experience.
    I seem to have suppressed my alopecia areata and osteo arthritis, but it did take time. I’ve been gluten/gliadin free for 7 years now. Also no industrial oils, only evoo and grass fed butter. My only carbs are basmati rice and potatoes. Never looked back.

  2. I eat Paleo but I do add grass fed and some raw dairy products.
    I never had a uric acid test, but I decided to get one a few months ago.
    The result was 5.5. I understand that the optimal level is 3-5.5, so I got concerned.
    I eased back on liver and sardines and just eat about once a month.
    I have no gout symptoms so I would appreciate if someone could put my mind at ease and let me know if these numbers are worrisome.
    Also, I don’t eat much fruit, just some berries or a little grapefruit a few times a month.

    • I would ignore the numbers and go with how you feel! As a NP in emergency dealing with many people presenting in severe distress, uric acid levels don’t often correlate to pain or clinical presentation. They can be normal. If you have inflammation, then avoid the foods that cause it. If you have no pain, never had, then why be bothered by a set of textbook values that have no relation to how you feel? Don’t worry, that just adds needless stress. Just keep eating clean and no sugar! 🙂

      • Thanks Michelle. Well..some time has passed and I took another UA test. Now, my number is 7.6!
        The doc’s people said to avoid red meat, but trust me, they are so undereducated it can make you cry.
        I came across Dr. Robert Su (www.carbohydratescankill.com). He also had a UA issue and he advised to use lemon and water, acv or cherries. He also found a correlation between coconut oil and this UA situation. He advised I dump the coconut oil and if I must cook with it..only tiny amounts. I am trying all of these and cutting severely back on my organ foods. I am trying to stave off prediabetes and I don’t want to just eat vegetarian now. I finally got my A1C to 5.2 and I’d love to go lower.

        I saw a video that uses Calcium Ion to ionize water. I may try that too.

        So far, no gout attacks, but I have read that even without an attack, high UA levels can cause stroke and heart attack. I also read that menopausal women and low thyroid (my profile) will also raise UA levels. Scary stuff!

  3. Thank you so much for putting this all together and giving the bigger picture…which you do so often and so well! It is much appreciated.

  4. Chris,
    I believe you are right on here with what you talk about but frankly I believe the culprit is even more deeply rooted in ALL the refined STUFF (beyond fructose) that we have in our diet. I am not a nutritionist nor doctor nor anyone with scientific credentials. I am in fact someone who has better credentials than that. I have been living with this condition for 40 years!! I get it in every lower Joint in my body! I never knew what it was, because one time I’d get it after eating too much Ham, then it was shell fish, then it was soup (ham stock) on and on. About 15 years ago (after I got intimate with Mr Atkins….) I didn’t get the gout in spite of all that purine based stuff. All the meats, all the organ meats, all the shell fish, spinach, mushrooms, none of that caused me ANY trouble. Then I decided to try out my assumption. I spent a week eating all sorts of the white things that are contrary to the (Atkins) Paleo way and by the fourth day I was limping and the 7th day I was in bed looking for something to remove my foot with. BTW this discussion also applies with many friends with Kidney stones…

    Since I have had a number of friends who have been on Allopurinol to manage the problem. Some of them have heeded my advice and Lo they have totally quite the drug and most of them have had few if any recurrences. Thanks for addressing this. Nice to know that my personal experience looks exactly what the clinicians suspect.

  5. I thought I had gout last month. I increased my walking and my big toe started hurting and the next day my foot swelled up. I cut way back on my walking and the condition went away in a week. I’m 63 now, so I cannot use the same gradient I use to when younger. Inches instead of yards now. Also I noticed my 3 year old (air-soled) sneakers were flat. So, no gout and just over doing it. I have to mention, I have read (online) the best of the best in alternative or natural health and nutrition over the past few years. There was too many different opinions, so I had to use my gut-instincts and pick a couple of what I thought were the leaders. Even so, there are still too many pieces of the puzzle that are not going together. I feel Chris, that you are starting to put the pieces together somehow, maybe through a mix of experience, intelligence and common sense. I appreciate this unique-perspective you show, so keep up the good work.

  6. Would the same logic apply to someone who gets oxalate-containing kidney stones? A good friend has chronic kidney problems and I keep telling him to cut fructose and added sugars while his doctors keep telling him to stay away from basically every nutrient-containing food due to purines.

    • There may be other relevant factors as well, but I suggest your friend transition slowly to a low oxalate diet. See my comment above for a source for very current info on oxalates.

  7. How does the many high oxalate PALEO foods, wherein the oxalates can form crystals and accumulate in tissue, affect this gout discussion?

  8. I must respectfully disagree with the conclusion of this article with my husband’s experience as my proof.

    This past January 2nd, we began a nutritional challenge (friendly competition @ our local crossfit) that followed the Whole 30 food plan.

    Within a week, my husband’s right toe began to swell and cause discomfort, but we still maintained eating and exercising.
    By week 2, he could hardly walk and I demanded that he go to the local quick care. He had severe gout and was given a shot to help reduce inflammation as well as pills to take.
    It took him over 2 weeks to completely recover.

    All of our meat (except seafood) was from a local farm and was grassfed. That first week, we ate eggs and bacon w/ guacamole and salsa for breakfast, lunch was a variety of crockpot meals ( pork and beef from the farm), and dinner was seafood (shallots, fish, shrimp), cauliflower in some form, asparagus, and other veggies.

    I share this with you to say that the meals I provided him literally created the perfect storm. Every item on the list to avoid or limit we ate, and ate them everyday that week. (I buy in bulk.)

    In addition to the foods to be careful, he started out overweight and a study led by Dr. Hyon K. Choi, reported in the March 11, 2004 issue mentioned that being overweight and doing a ‘severe diet’ can raise the uric levels in the blood.

    So what I’m trying to say is, people considering paleo need to be mindful when creating their meal plans. We have chosen to continue eating paleo and we BELIEVE in eating this way but we have modified what we eat and when. Obese readers need to be careful in their exercise and eating so that they can avoid this very painful affliction.

    • I would think that if it happened that quickly (w/i 1 week) after starting the Whole30, that your husband likely already had a higher level of uric acid in his blood and the change to a high purine diet triggered the acute gout attack. This would make sense in light of the study Chris referenced about high purine diets being associated with more frequent gout attacks in those with prior gout diagnosis.

      I think Chris’s point was that eating high purine foods should not directly CAUSE gout in an otherwise healthy person. But if you’re already at risk for gout symptoms from a past history of hyperuricemia, or have reduced kidney function for a variety of reasons, then a sudden and significant increase in purine containing foods could in fact raise your risk of gout symptoms.

      Definitely a good point to be aware of though, especially if you have a history of gout or other risk factors like obesity, metabolic syndrome, etc.

      • This is exactly correct.

        If you have gout, AND THEN, you get IBD, AID, Crohn’s, etc. etc. and begin a Paleo or SCD (Specific Carbohydrate Diet) your risk for a flare up is higher because those diets will make drastically shift your intake of purine. (SCD, is red meat, fish and chicken all day and night).

        I got a gout flare up battling Crohn’s with SCD.

        Really tough situation to be in, just gotta get more aggressive and careful with your intake, you have to… no other options or scenarios.

    • If you’re genetically vulnerable to gout, a Paleo diet high in purines will cause gout. I believe what Chris is saying is that the long-term cause of gout is over fructose consumption. But if you’ve already had gout attacks, are overweight, have high uric acid levelsand cannot excrete uric acid quickly enough, then you can get gout. But I don’t think a Paleo diet will cause gout in those who hasn’t developed it already. Check your uric acid but that’s not everything. I would also check my urine pH: make sure it’s above 6.5 or so. I drink a 1/2 tsp of baking soda everynight which causes my body to become alkaline at night when typically gout attacks occur. I rarely get gout attacks anymore. Two things are need to have gout attacks: (1) high uric acid and (2) acidity. There is plenty of people with one or the other who never get gout attacks. Only 1 in 10 of those with high uric acids have gout. 90% spend their lives not knowing what gout is.

  9. I started eating Paleo over a year ago to support my diabetic boyfriend. I haven’t had gluten or dairy for over a year, eat only organic veggies and grass fed beef, pork, free range, etc.
    I have had severe arthritis in my hands for over years. Cannot eat nightshade plants.
    By last summer, the gout flares in my hands and then feet were getting worse and worse. I was eating salmon 4-5 times/week, liver, tongue, tons of spinach and cauliflower as part of my diet. By December, I would cry because the pain was so severe in my hands. I finally went to a “Functional Medicine” doctor who picked up on it immediately. Have limited animal protein considerably and reduced eating other items that were on the list as contributors to “gout”. The severe pain is gone. I can eat the assorted aggrevators on occasion but stick more to chicken and white fish for animal protein. While I still eat beef, it’s once a month instead of once or twice a week. I rarely have major attacks unless I over do the foods that I shouldn’t. So while Paleo is still my eating style, have had to modify to deal with my gout issues.

  10. After three days of anomalous and excruciating scapular muscle back pain I found some relief through massage. It was so bad I had to sleep sitting up and even that didn’t really help my labored breathing. That was rough enough but on day four, just as the back pain was subsiding, I awoke to find that my ankle was painful and swollen. My kinesiologist immediately sent me to a podiatrist who popped the most surprising question, “do you have gout in your family?” I was shocked. Not only was I not genetically predisposed, I eat cleaner than most (non-neurotic paleo plus grass-fed butter/cheese and occasional corn and rice). Tests for uric acid levels in my blood are pending but all signs point to my first-ever gout flare up. Now I wish we’d checked CRP and IL-6 levels too.

    The week prior to the flare-up hadn’t been particularly typical as I never normally consume fruit smoothies, gluten-free goodies, or drink that much. Such was that week. While not off the rails, it wasn’t picture perfect either. Regardless, there’s nothing like the remarkable pain of gout to inspire better habits. I wish I could do that week over just to see how much diet played a role versus the very real stress of back pain.

    I’m deeply curious to find out what exactly was the cause and am wondering what might be done beyond my normal good habits to never ever feel that pain again. Does having a gout flare-up make me more vulnerable to having another or can I chalk this up as a one-time deal provided I stay on the paleo path? I’m on the hunt! Are there any stricter paleo folks who have seen gout flare-ups do to pain alone?

    Thanks for what you do Chris.

    • Check out the info from James and moi above, clay, on cherries, black and sour, fresh and tinned.

  11. I have been 100% paleo for 2 years. I do not drink alcohol, soda, smoke or eat sugary snacks.

    Over the Christmas holidays I have a severe case of gout that lasted for about a month. It was in my big toe on one foot and then would move to my ankle on my other foot and then back again. The pain was a 9 out of 10.

    What is causing this to happen?

    • I can sympathise with that 9 out 10 rating. Like walking on your eyeballs!
      Gout led me to Paleo, as I really didn’t want to go on meds. Persevered with fairly strict Paleo (with plenty of safe starches) for a year or so, but was still getting mysterious pains in my knees, and regular stiffness in my big toe. Finally gave in and went on the meds. That was about 6 months ago, and knees and toes better than they’ve been in years. I’m sure Paleo doesn’t cause gout, but I’m skeptical now that it alone cure it. Would really like to find a way to get off the meds though. Any suggestions?

      • I am tweaking my diet to stay off any meds. Reduced bacon intake and eating more chicken. I am beginning to believe that it may be a hormone issue and am pursuing that angle.

    • How about fructose intake? You didn’t mention this. Some people are very affected by fructose even the smallest amounts. Take a look at the FODMAP diet.

      • You might like to try alkalized water (you don’t need to buy a electronic water ionizer for this) there are alternatives to getting this kind of water.
        I have seen seriously good results from people just drinking this kind of water.

      • Very little. I only eat fruit occasionally and no sugary drinks of any kind.

        I will try out the alk water too. Anything to get my health and active lifestyle back.

        • Fructose subsets – Fructans & Galactans (Oligosaccharides) are in some vegetables too.
          High Content Foods are:
          Beetroot, Asparagus,Cabbage,Broccoli,Onion, Garlic, Jerusalem Artichoke
          Could be worthwhile taking them out of you diet temporarily and reintroducing them one by one to see if you have a flare up.

  12. My husband has a long history of gout which runs in his family. Since starting paleo two years ago he has not had an attack or needed to take his gout meds. He also had to decrease his blood pressure dosage though that is another post.

  13. I eat monster amounts of spinach on Paleo and have had no problem. I’ve seen it as a major contributor to gout.
    I also got off BP and statins after adopting Paleo, talk about a trade off for some incremental propensity for gout. I’ll take it.

    • On the topic of delicious spinach…met an oxalate expert yesterday – a prof at our local agricultural university. He said most of the oxalate in foods is destroyed by boiling. We have a weird little South American pink shiny potatoey thing here in New Zealand, which we call yams and they’re very high in oxalates in the skin. He said baking them unpeeled is the worst thing to do as we love to eat them in this concentrated form. Off-topic but thought I’d pass it on.

      Oxalates are found in spinach, swiss chard (very popular here in NZ), rhubarb and the yam thingies. They can cause kidney stones in some folks. All things in moderation and plenty of fluids he says. The worst offenders are the Saudi folk who don’t drink enough for their climate – they get annual practice in Ramadan of going without water in daylight hours after all.

      • According to another oxalate expert and researcher, Susan Owens, oxalate content in some foods is so high that it cannot be cooked or soaked or boiled out of it to a degree sufficient enough to not cause problems for people who cannot handle oxalates well. She manages a free and open Yahoo group called Trying Low Oxalates where you can find lots of current info on oxalates, including a continually updated searchable spreadsheet of the oxalate content in foods.

      • I have eaten strict Paleo for 8 yrs…..as well as CrossFit. Just had my first attack of gout that was miserable. I believe that in retrospect that what caused my attack was that I ate copius amounts of cooked spinach over a weeks time. This was due to me being sick of broc and asparagus. I eat tons of meat and I also drink beer. The only thing I changed was my intake of spinach. I think we are all different and we each have to find out what triggers it. My labs also came back as normal…. UA level was 5.5.

  14. My dad has a history of gout and, at 39, I have long felt very minor symptoms similar to gout in one of my big toes. My dad has cautioned me on the paleo diet, though I follow it contrary to him anyways. Having said that, I’ve always been a bit worried. Now I am less so, so thank you. 🙂

    It makes sense that it’s more the SAD to blame than the meat-component itself — seems like that’s mostly the case with other diet-related issues as well so why not gout?

  15. Couldn’t agree more Chris. I’d add that there is a reason why fructose in ”the complete package” is pretty harmless. Tart cherries will alleviate if not completely do away with the gout issue. Furthermore a paleo diet is not a meat heavy diet. One thing has always puzzled me though : why is it that gout so often happens to affect the big toe joints? Surely it cannot be gravity.

    • So true, James. Even the black cherries, fresh or from the tin or as pure juice work. For health I use a black cherry pure juice, not from concentrate but from 2.5 lbs cherries from Super Store. Also celery water (and seeds) and pineapple juice work in this regard. I remember 3 members of a men’s organisation who were suffering gout and told them about these helpful foods and the suggestion they drink enough water and cut back on sugars and high starches, all being relieved of their pain by next meeting. As Chris suggests it is the processed foods including junk and high starch products that may be at fault. I know that the smell and taste (UT advocates attest to this) of urine is far different when junk, starch and sugar are included in the diet in comparison to pure goods low in carbohydrates.

    • James to your comment about gravity, I have seen many docs about mine and all of them have told me that it IS gravity. If you look at other comments in the post you will see other folks talk about different areas, but the majority of affliction is in foot and ankle. Me.. I get it every where but MOST severely in my right great toe first knuckle..

      • I have eaten low carb paleo for almost 2 years. I occasionally have achiness in left bunion area, but never diagnosed with gout – uric acid levels are normal. It does not seem to be associated with any particular foods. However, I recently found that I have a structural misalignment on one side which puts more pressure on my left foot heel and great toe. You can test it by standing in bare feet and seeing where you feel the pressure on the bottom of your feet. Perhaps this plays a part in the “gravity” issues- especially if the “gout” is one-sided and that joint is constantly taking the hit for the body’s weight.

    • Actually, I’ve read that the crystals tend to form at lower body temperatures, and because the big toe is so far from the body where the temperatures are lowest, the crystals form there first.

      I actually have just self diagnosed with gout. I’ve been following paleo for some time but have only recently begun having symptoms.I’m thinking dehydration and inclusion of more seafood and sardines, along with stress, may be my triggers.

      Do you think drinking way more water and taking 500mg of vitamin C will be enough to keep it at bay? I’d really hate to cut sardines and seafood from my diet. =(

  16. Great article! I’m a Naturopathic and Chinese Medical student and I’ve had the best success with the paleo diet over everything I’ve learned in school. I was researching breast cancer this week and found that omega 3 has been found to be a causative factor in preventing breast cancer. Since that link has been made, it would be appropriate to get a study done on conventionally raised meat vs grassfed meat. What if we could change our agricultural practices through the link of omega 6: omega 3 ratios to breast cancer? We want a ratio of 4:1 or better – conventionally raised meat gets as high as 21:1 and grassfed between 1:1 and 3:1.

    • Good point about the difference in grass fed red meat and grain fed red meat. There are so many differences in these meats it wouldn’t be surprising if they did all sorts of strange things to the body.

  17. I had taken allopurinol for over a decade and still experienced occasional gout flares. In 2011, I eliminated sugar from my diet, stopped taking allopurinol and I stopped having gout symptoms. In 2012, I went full paleo and had no gout issues the entire year! January 2013, I did paleo auto-immune protocol to support my wife’s efforts to further figure out her sensitivities and in week 3 of strict AIP, I had my first gout flare in almost 2 years. I’m not sure why it flared during a more strict approach. I’d love to never have a flare again, but once in 2 years with no meds on a Paleo approach is much better than 6 times a year with meds on a standard American diet.

    • Rick,
      It’s very interesting that you experienced a gout flare during strict AIP. I’ve been “paleo” for over a year, and I just had a flare in January (after not having had one in several years). I was dealing with some stressful situations in January, and as a result I was lacking an appetite and not eating as much as I normally do. During the flare, I started reading as much as I could about the possible causes, and I came to the conclusion that I needed to start eating more, especially carbs. My stressful events have passed, I’ve been eating more regularly, and my gout has resolved. Now that I know what gout is, I realize that I’ve been having these attacks since I was 13 or 14 years old. At that age I was not eating any red meat, but I was anorexic and underweight. I’ve read that sudden weight loss can cause gout, so perhaps my body was metabolizing my own tissues due to lack of proper nourishment, and perhaps the increase in stress hormones was affecting my ability to excrete the excess uric acid. Or something like that. Anyway, that’s just my unsophisticated interpretation. Since the AIP is so restrictive, perhaps you were experiencing something similar?

      • Hard to say what my trigger was. In the past, my triggers were heavy sugar load, alcohol, shellfish, and asparagus. With AIP, I had none of those things. I definitely wasn’t under much stress and found AIP to be relatively easy to follow through on, although much less convenient than standard paleo. I did drop 9 pounds in the first 2 weeks, back to my pre-holiday weight, then leveled out. I tracked everything I ate over the month and I took in 53% fat, 25% protein, and 22% carbs. Normally, I’m probably running about 30% carbs.

      • I have been on the AIP diet for a couple of months, because I have a number of autoimmune diseases. I was a very clean gluten free, dairy free, organic eater before AIP. Since then, I have had extreme immune flares…worst I have ever had. I also have had a gout attack. Go figure! I am eating a lot of veggies, avocados, free range chicken, grass fed meats and wild seafood with a little added fruit. I am not sure why this is so. Perhaps I need to add something back in?

        • Hi Jan,

          Gout and AI issues can exist for different reasons.

          The gout would most certainly flare-up with increasing protein consumption as it sounds like you have done. So, decreasing purine intake is important for you.

          The AI issues could improve over time with both dietary approaches you have taken. However, even on the AIP your probable leaky gut may be allowing some invaders in to your body. The invaders might be okay in someone with a healthy gut and could be considered ‘normal human food’, but when the gut is leaky the rules change. If your newer dietary approach has in fact increased your AI symptoms, not just the gout, then something in the diet could still be causing a reaction. Certainly, emotional stressors may increase AI symptoms or gout by increasing systemic inflammation. Looking at sleep, comfortable exercise and relaxation techniques may be useful. It may take months for AI issues to subside, but be persistent with the lifestyle changes!

          • Thanks for the response. I have been tested for leaky gut and do have it along with damaged microvilli. I am also nutrient deficient. I have been gluten free and dairy free, egg free, corn free for years and eat a clean diet. I also take great vitamins (Pure Encapsulations), but still am deficient. I’ve been on a gut healing protocol for months, with no real improvement…increasing joint pain etc. I think I am going to try and lessen the red meat intake and eat more wild salmon and free range chicken to see if that helps the gout anyway. I have celiac, AS and Sjogren’s and Morphea (localized Scleroderma). I am the healthiest, non healthy person on earth!! Thanks again for your insight. I will continue on AIP for the next few months to see what happens.

            • Also, I am studying to get a Masters in Nutrition and Functional Medicine and have made this my life’s work. I hope to work with people with difficult immune problems, so I continue to scour the literature. Maybe it will help me in the end.

  18. I have been eating low carb for 10 months now and am very close to losing 120 lbs. I have been reading about Paleo and have based many of our meals on the recipes I have found on various Paleo eating blogs. I too have been told by my doctor that I have elevated uric acid levels and given a huge list of foods to avoid – including most everything I eat! 2 years ago I did have a debilitating “attack” of some sorts that left me with curled and painful hands and severe joint pain that lasted for almost 2 weeks. He now thinks this may have been gout, although at the time nobody ever tested for it or mentioned it. I was treated with steroid shots. I began eating cleaner last May and have been basically ignored my doctor’s request to decrease eating foods that are high in purines and I am doing well despite. He is pleased with my weight progress but I have to admit going totally paleo has really scared me since his :”advise”. I really do believe that the elimination of grains from my diet has helped with my inflammation and think I will continue on course for now.

    • For what it’s worth, I was being told the exact same thing. I ate vegetarian for almost a year and just got worse. Since then I’ve switched to a new clinic, with a DNP and a registered dietitian working on my “case.” They prescribed the exact opposite. Not quite a paleo diet (because they include dairy and legumes) but completely GRAIN FREE (not just gluten free) and no added sugars. I do cheat on the sugar now and then, and it seems to correspond with minor flare ups. But I have only experienced maybe 2 flares since April 2017 when they started me on this plan. They say this is exactly what they prescribe for gout and for any inflammation issues, but they also said this is fairly progressive medicine and that most clinics are still going by old studies that say to remove the meat and such from your diet (and eat lots of grains, go figure) I say do what works for you! I am not on any medication.

  19. I am 43 and have had two gout attacks. The doctor put me on Puricos until I discovered the paleo diet when I stopped taking it. I have been on the Paleo diet (albeit a little too loosely for my liking) for about six months now.

    In those six months I have almost cut gluten out, cut out chips and French fries and most other things that come in a packet or a box. I have substantially increased my intake of butter, cream and other healthy fats. Unfortunately I have very low cortisol so the results have not been as good as I had hoped, however both my bad cholesterol and my uric acid have dropped in the six month period. SO I would have to agree with your research through self analysis!

  20. I always love that you address that it isn’t the type of food but the quality of the food that is important. Another great article I can utilize the information for my own patients.

    • The facts for gout are what they are, however the cause of these conditions is a Significant Biological Special program of Nature (SBS = commonly referred to as cancer), called a “refugee or hospital biological conflict”. When there is an unexpected, isolating sudden shock experienced, called a DHS, a ‘lesion’ becomes visible on a brain CT scan in the brain stem. This indicates an active biological conflict in the collecting tubules of the kidneys, designed to diminish the excretion of urine for survival purposes. The uric acid in the blood is being recycled to form protein. So the body is kept from dehydration and starvation until the biological conflict is resolved, at which time the small tumors in the collecting tubules are removed by tuberculosis bacteria, if the individual was fortunate enough to harbor them at the time of the DHS. http://learninggnm.com .
      This condition, called a Syndrome, is quite serious, if any other biological conflict happens to be in the healing (resolved) phase.

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