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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first time commenting so sorry if I ramble a little. Anyway I am 47 and a diabetic for 12 years I have been experimenting with diets for years and have had success in curing all my metabolic syndrome issues except the blood sugar which is stubbornly high. Anyway to date I have lost a very slow 141 pounds in weight, now weigh 242 at 6 feet 1. OK to the point. The most effective diet for me is low carb high protein and good ie natural fats. The problem I have is everytime I begin to get good weight loss I get gout like symptoms! Not gout because no chrystals have ever been found but gout like. I think I have found the reason at long last as after a few months weight maintainance I went back on the low carb and tested both for blood sugar and keytones. It took a while but I went into keytosis finally and started to shed a few more pounds. After about 3 weeks the pains and feeling of inflammation began again. My blood sugar was now in a good range and I was in full keytosis. So after a lot of research I find that the excretion path for uric acid is the exact pathway shared by keytones! So I have an idea that when I get into keytosis this blocks my ability to clear uric acid from my body which eventually builds up and then triggers systemic inflamation to the point that I can no longer walk! The last time I had such an attack meds did not help but I eventually switched to high carb and it cleared up, but with high carbs stimulating the ensuing high blood glucose levels that I must avoid. Now I am testing this by blowing myself out of keytosis to clear the pathway in the hope that the signs will also clear. My plan is then to go back into keytosis for 2 weeks then back out for a few days to again free up the pathway. I hope this will enable me to continue to lose weight whilst balancing my uric acid and keytone excretion. Anyway I’ll see what happens. Any one else tried something like this and if so how did it work out? Is there an optimal number of days to clear out the uric acid? thanks
Hey Craig, When I got my urine tested at the doc’s, they said I had 2.0 ketones which meant that I may have been in ketosis. Urine is really not the best indicator, blood tests are. Anyway, my uric acid level was 7.6.
I have started adding some sweet potato a few times a week but not going overboard. I am trying to keep out of diabetes and I’m bummed that the LCHF diet may push up the UA levels.
I need to find out what ‘s going on with my thyroid as that could be responsible for high UA too.
All this ridiculous self diagnosis made in ignorance! Most of you need to stop your daft limited diets and consult a decent medical practitioner! What a load of self indulgent clap trap!
I recently came back to a Paleo diet last week. This week I have experienced my first ever bout of gout. The doctor has essentially ordered me to cut all animal protein until my symptoms subside and has all but said my body cannot tolerate animal protein. His belief is that I need to be on meds the rest of my life if I choose to continue eating meat. What I am wondering is whether or not I really need to be reducing my fruit intake?
I don’t want to be on meds and I want to continue to eat meat, but I definitely don’t want to live with gout.
TC..from what I hear, the meds for gout are deadly and have very dangerous side effects.
Do whatever you can to avoid them!
I’ve suffered from Gout for about 15 years. The frequency of my attacks has little to do with diet — that is to say that eating purine-rich foods do not, in and of themselves, cause an attack. What I HAVE seen is that following a period of major physical/mental stress — usually about a week — and low hydration, certain purine rich foods will act as a trigger to bring on an attack. So, the stress and dehydration are the precursors — probably dropping my resistance so that the purine is not being flushed from my system.
Staying hydrated and focusing on breath will usually ward off an attack.
Thanks for the advice. Kinda the conclusion I’ve been arriving at myself (first attack about 6 yeas ago now). I find having a couple of glasses of wine late at night is the surest way for me to get a stiff big toe the next morning, but I guess that’s probably just dehydration.
This totally makes sense to my first gout attack last week. I was very busy & stressed, drinking a couple glasses of water instead of my normal 6-8 cups, & I had 3 days of crazy eating of rich foods (I’m normally low carb). I gained 4 lbs that weekend & had my first gout attack. (before going to bed my toe felt like it needed to be cracked, next morning the toe was swollen & painful).
I just love the Paleo diet. It gives me exactly what I need to lose weight and maintain a healthy lifestyle. The high protein and fat keeps me full and really for the workouts while the low carb helps me not gain weight. It’s perfect for my not-so-active lifestyle. 🙂
my mom in her 70 has had gout & mildly high blood pressure. otherwise, she is in reasonable health.
she is slightly overweight (she looks more motherly than fat)
she is not a big meat eater nor does she eat too much sugary junk or packaged food (compared with SAD), except she probably eats too much wheat (bagels, bread, pasta/noodle) & peanuts. she does not drink soft drink. she has about 2 servings of fruits. so not much fructose.
every time she has thick chicken broth when eating out. it’s guaranteed she would have a severe attack.
she insists it’s chicken. but i suspect it’s something else MSG? flour? HFCS? (i have asked her to try home made clear chicken broth so make sure it’s not chicken. but she does not eat chicken soup anymore)
i suspect she is gluten intolerant & may have leaky gut. i have been trying to convince her to eat less wheat w/ little success.
Gout is not normally understood as autoimmune. More likely is she’s genetically susceptible to gout. How high is her uric acid? It may not be all that high; those who’re genetically vulnerable have a problem excreting uric acid so even normal or mildly elevated uric acid could instigate gout. Another possibility is the acidity of what she’s eating. Fructose is not an immediate instigator of gout. Fructose is a long-term cause of gout and it’s usually seen in high uric acid. Like I said, short term, gout is definitely driven by purines and alkaline and acid imbalance in those who’re genetically vulnerable. I’d get her uric acid and pH tested (through urinalysis). If her UA isn’t high, she has no choice but to restrict purines. If her pH is low, she could increase that by eating more fruits and vegetables and possibly supplementing with baking soda / sodium biocarbonate.
Great article. I had gout constantly for 7 years from my early 30’s. All the medication I was given by “health experts” only relieved the pain but never got rid of the problem. I have been paleo for 1 year and have had no trace of gout yet I eat more red meat and seafood than I ever have. Paleo Rocks.
My Husband just had a bad episode of Gout that took him to the ER. The Doctor asked if he had been under a lot of stress because that triggers Gout as well. Has anyone else heard this theory? By the way – yes, he had been under a ton of stress, but really?
I have suffered with month gout problems for a couple years. Pop a few indomethacin and go on with life. Since switching to a high protein primal/paleo diet I have not had a flare up in five months. Cheers
My brother in law has a uric acid problem ( gout) and struggled with it for a couple years with meat substitutes (all grains !!) and medication but finally tried paleo and now is gout free. It worked great for him and he’s still not even very omega 3/6 aware yet.
Very low-carb paleo (restricting all carbs) cured gout and other symptoms, not only in myself, but unrelated others. (Low-carb/high-fat diet, lots of meat and high fat dairy, otherwise all paleo.)
I suspect it may have something to do with insulin resistance, as it responds so well to lowering carbs (and omega 6 fats).
I’ve suffered gout attacks for 20 years, some bad, some minor. I’ve been “paleo” for about three years and have had minor flare-ups since but it was always due to falling off the wagon for a day or two. However, I had a seriously bad attack, the worst ever, during the summer of 2012; I was crippled for seven weeks. I actually had to buy a wheel chair plus I had to get my crutches out of storage. Man, it was bad.
Eating paleo was, I believe, tangential to this attack. I had lost about 20 pounds fairly rapidly, thanks to paleo. When I was doing my initial research into the diet I came across a couple of papers indicating weight loss, or “rapid weight loss” was linked to gout. One study was a group of men having served in WW2 that had been on starvation menus as POWs, and another study was of a mix of adult men. Both studies were halted after some of the subjects suffered gout attacks.
The theory is that rapid weight loss causes all the toxins in the fat cells to be dumped into the system too rapidly and too long for the body’s various filters to keep up with the onslaught. Why gout no one said but this theory makes sense until a better theory comes along.
I suspect things may be more complicated than “eat this, experience that”. It is know that uric acid levels will climb in hypothyroidism. If your diet is inducing a lowering of your metabolism (most common when we decrease caloric intake), whether paleo, gluten free, vegan, or whathaveyou, then gout is a distinct possibility. This helps to explain why some do great on paleo/etc. while others do not. The most critical thing is the effect on the metabolism. Real food IS good, but when people change their diets and then experience weight loss they are intentionally under eating. While good for weight loss there is risk of damage to the metabolism. The key is to make these changes while preserving metabolic rate (the $64K question). As with everything, YMMV, and the role of your body constitution is critical.
My husband’s first disabling gout attack with massive swelling and pain that left him hobbling was the year we started buying our beef in bulk from Costco. We were also eating a lot of corn and other GF grains, as we all also live with Celiac disease. I did a ton of online research because I knew that medications to get rid of the symptoms without finding the cause was NOT what either one of us wanted. Even though all his family was telling him to go to the doctor and get on the medications. I found out the connection between inflammation and gout, and so we switched to grass fed beef and went grain free. He has not had another gout attack that severe since then. If he accidentally eats something that has some gluten in it, too much sugar or some grains—he will start to get the beginning pain of another gout attack in his big toe. Inflammation is definitely the MAIN factor in gout, and if you can remove the inflammation triggers, then you remove the gout triggers. Interestingly, though, the chicken we eat in abundance is corn/soy fed and he has not problems whatsoever with gout from that.
I would frequently get gout a lot growing up as a teen. I rarely get it anymore. My diet definitely wasn’t paleo growing up but instead something along the lines of the typical American diet—high in vegetable oils, cereal grains, fast food/school lunches, etc. At the time I did eat a lot of meat though, and I also overate. Now I don’t strictly eat paleo as I consume a lot of dairy and other things like sweet potatoes and seldomly imported European breads that are pasteurized and don’t contain any wheat. I like lemons, and they reduce uric acid, so maybe that’s why I don’t get gout anymore? I’m betting my diet was just too acidic back then.
I wish I knew these things while my mom was still alive. She suffered from gout flare ups quite often and always blamed seafood which was probably one of the few healthy things she ate. She ate a lot of sweets and ended up dying from heart and lung failure although she NEVER smoked!
THANKS CHRIS for informing us of this often misunderstood condition! I will forward it to my husbands co-worker who also suffers from gout. Keep up the good work!
Kat, I wish I’d known a lot more when my dad was still alive who died from Parkinson, a disease almost as unnecessary as diabetes M2
Requesting recipie for gout flare ups. Thank you.
Great gout reference article Chris. Having just done some reading around gout another aspect to the puzzle I hadn’t considered was sleep apnea. If anyone is interested in the biochemistry link between sleep apnea triggering a gout attack I’d read this and this.
I have high uric acid, off the charts. It increased, nearly doubled, when I switched to low carb/LCHF, but decreased back to “normal” high levels in maybe six months. Never had gout.
However, I have high levels of c-peptid, but low blood sugar (even before low carb). I have no results from blood tests in childhood, but I think my problem with insulin originates from being stressed since childhood.
Sometimes I wonder what would happen to any study, if two or three paleo eaters were amongst the participants. Would probably blow up the results 😉
I suffered with gout from the age of 24. I had terrible attacks. I remember one left me unable to walk properly for around three months as it just wouldn’t go. Since I have been studying nutrition etc i refused to take a pill for the the rest of my life so set about trying to fix it myself. High sugar, especially fructose is bad, beans and lentils unfortunately seem to trigger gout, especially black beans! Cooked spinach, I seem fine juicing it, alcohol bad, although I still drink from time to time with no problem…. now…. gluten bad. Too much organ meat and is start to feel it, but I think this is because I’m already broken. The most important things for me is, keep well hydrated, taking up juicing is great, lower sugar, lower alcohol especially beer, lower cooked spinach, rhubarb and others hight oxalate foods, and get plenty of naturAl anti inflammatory foods. I also made a concoction that literally made my gout disappear and has never been felt fully since. You can email me for that if you want the recipe
Would you kindly email me this “miraculous” concoction? Thanks so much!
Hi John, i’m interested in having your concoction recipe. Please email me. Thanks, very grateful. – Linda
John — I’d like the recipe. Thanks. Limiting alcohol and drinking tons of water has helped me. As well as tart cherry juice. I also supplement with magnesium (for other reasons) and have heard that may break up uric acid crystals.
Ok, sorry for delay. The concoction. now remember that you need to increase fluids in general too (the most simple and important thing i believe helps).
the recipe was one i modified from a guy (Tony Pantalleresco) from Youtube here is the link (not sure i am allowed? but ill try http://www.youtube.com/watch?v=bvGD6IvS97E )
But this is what i done….
chopped one whole pineapple, (Tony uses papaya in the video) then covered it in Cinnamon powder, ginger powder and Turmeric (lots of each) in a glass jar and let it sit for 7 to 10 days in the fridge. I then blended it with some aloe juice and enough pure water to get it started (I would use more fresh juiced pineapple/grapefruit when i do it again)
I took it in small doses. I took 5 Serrapeptase tabs and a couple of ounces of this on a Friday night. I the same the next morning. I was unable to put smart shoes on to go out that night and i was going to get a taxi with the g/f because i could not walk. I knocked back my last 5 serrapeptase and the last two ounces or so of that concoction. A couple of hours later I felt a fizzing and and shortly after it was TOTALLY fine. I went out that night, in the tight shoes, walked a couple of miles to the bar and even had some beers to celebrate ( I know I know) and that was three years ago in July. Not had a bout since. Now I have learned some triggers (black beans in particular, and beans/lentils in general if consumed too much,) and the fact i don’t hardly ever eat bread or grains, or any fructose definitely all help. But I promise you I have never felt anything like this drink. I hope it helps even one other person. Now, I will have to make another batch and see if it works for Uveitis!!!! Good Luck
I too would appreciate you sending me your recipe.
I would love your gout concoction recipe! Thank-you, LeeAnn
I would be interested in that recipe that knocked out the gout if it is still available. I am a new introductee to the gout experience and can say I would really like to avoid it. Thanks
Adopting Paleo does not mean that we all somehow have the same genetic dispositions. Everyone will vary and have to navigate what works for them. Starchy rice and potatoes or dairy send me to the moon, but I can eat my weight in spinach. The real answer: pay attention!