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. While I would agree with much of the information provided concerning the relationship between some foods and a gout attack (we’re talking acute gouty arthritis here, as opposed to chronic gouty arthritis), one key factor that seems to be missed is that gouty arthritis is a genetic condition. It is inherited. So, while certain foods (especially those high in proteins) can cause an acute gout flare-up, they cannot cause you to suddenly inherit a genetic disorder. You are either prone to gout or you are not. If you are not, you would need to ingest an incredible amount of protein to overload your system and create a sufficient saturation of uric acid in the blood to cause uric acid crystals to form and settle in the joints. For those who are prone to gout, something as small as a stubbed toe can lead to a flare-up. The injury results in inflammation, which restricts blood flow, which reduces the body’s ability to flush uric acid crystals through the system. The crystals settle around the inflamed area and create the incredible pain and further inflammation. Bottom line: a paleo or other protein-rich diet will not cause you to “contract” gout. However, it may cause an acute gout flare-up if you are already prone to gout.

    • Thank you, your comments help to explain why my acute attacks have been triggered by an injury to my foot or ankle or by wearing a boot.. The boot restricted blood flow and the attacks happened within the hour. On a daily basis I wear Birk sandals and don’t have flare-ups. I remain on the Paleo diet but avoid organ meat and have added more dairy products to my diet. I have tried cherry juice during an acute attack, but it didn’t seem to make any difference fore me.

      I’m surprised not to see more mention of the importance of footwear that in no way restricts blood flow.

  2. I had my first gout attack in my big toe of left foot while healing from an achilles tendon injury; didn’t realize what it was at the time. A couple years later I went on the Paleo diet and have now been on the Paleo diet for almost 2 years. Strongly believe in the diet; it immediately resolved digestive issues for my husband and for me and we feel great. Over the last 6 months, however, I have had reoccurring gout flare-ups in my right toe and ankle and small tophi on my ankle. My triggers have not appeared to be caused by a certain food as much as external factors. Three of the four began after wearing a boot in rainy or cold weather (at home I live in Birkenstocks as the footbed seems perfect for me), and the fourth after a lightning strike that hit close to our kitchen. It was a powerful strike; immediately fried our router and TV power cord AND within an hour my gout erupted on my right toe. Weird!
    I did find a New Zealand study that said shoes can cause a gout flare-up by restricting circulation in the toe. My boots seem comfortable, but I won’t be wearing them again.

    I am going to try adding more dairy back to our diet and chicken and rice and cutting back on sardines, salmon, spinach, bacon even though it seems counter product nutrition wise. Have not tried recommended medications yet; really hoping to avoid them.
    Thank you Chris for the information you provide and the bloggers who share their stories. Please keep the info coming regarding gout – it is a nasty disease with many theories but not enough is understood.

  3. I had a gut feeling that gout isn’t caused by JUST uric acid.
    I’ve been on keto diet for quite sometime now and recently I realized that my uric acid level was high (9.0 to be exact) though it used to be around 5.0 before I went on this diet. I drink no alcohol, no smoke, just good fats and meat + veggies. I’ve heard the fructose plays a big role in this gout thing before, but I was always worrying about myself getting gout attack a bit because of my diet. But now when I came to this site and have read this article, I feel a lot better. Thank you. I knew keto diet isn’t the problem, the real problem is(and has been, also will be) SUGAR.

    • You are absolutely right about sugar being the culprit not uric acid levels. I was a chronic gout sufferer. I am also type 2 diabetic. I use a paleo style diet to reverse my diabetes. Even though my uric acid levels are high, since my glicose levels are now closer to normal I have had no joint pain, my arthritis is gone, back pain is gone and no sign of gout despite eating whatever I want in the way of red meats, fat and seafood. SUGAR IS THE ENEMY FOLKS! HI FRUCTOSE CORN SYROP SHOULD BE USED TO RUN CARS NOT PEOPLE.

  4. A few months ago I developed pain in the bunion area of my foot with some redness and swelling. I’m about 5′ 5″ and 110 lbs and wear orthotics. I retired 8 months ago and sleep great. I eat a mostly (80%) “Clean” and “Paleo” diet for gut health reasons – leaky gut (a lot of vegetables, vegan protein [hemp, rice, pea] shakes for breakfast everyday with nut milk or coconut milk, a splash of coconut water, greens, flax, antioxidants, and berries for sweetness – no other sweeteners). I eat mostly chicken, beef and fish protein, and few if any grains or refined carbohydrates or caffeine. I also drink alkaline water (for several years now). And yet I have osteoporosis, a slightly elevated HbA1c (5.7), high Cholesterol (222) with high HDL and LDL (both at 105). No uric acid test though. I do have some heavy metal toxicity which my Naturopathic Dr. is treating slowly with a Cilantro herbal tincture (for about two years now). I am at a loss for why this painful condition is starting now. I’ve heard that our feet and ears grow as we age, at 52 years young, could it be that the pain is simply from bone growth? BTW, I also recently purchased new shoes 1 whole size bigger than before.

    • Brenda, I can tell you from my personal experience that high protein (paleo/Atkins etc) absolutely cause my gout to flare. I was determined to go paleo and stuck with it for almost a year. I thought my body was simply trying to “adjust” as a lot of my friends suggested. I was plagued with gout almost the entire time. Within 2 weeks of changing my eating back to a plant based diet my gout let up. I did learn from that experience, however, that flour and sugar also caused my gout to flare.

      • Gout is an ailment brought on by nutritional deficiencies. Specifically, it is caused by deficiencies of Vitamin C, Folate (Vitamin B9), and potassium in some combination thereof. Vitamin C increases the rate at which uric acid is excreted through the kidney, resulting in less uric acid in the blood. Folate inhibits the enzyme that allows uric acid to be created from purines, resulting in less uric acid in the blood. Potassium is needed to neutralize (raise the pH of) the uric acid so it can be excreted through the kidney without damage to that organ.

        Vitamin C competes for the same metabolic pathways as glucose, so the higher one’s consumption of carbohydrates – the higher their need for Vitamin C. If it’s true that obesity is caused by consumption of excess carbohydrate, the heavier a person is – the more Vitamin C they will require. Vitamin C deficiency results in increased incidence of gout. Weight loss reduces the need for Vitamin C, making more available from the diet for purging uric acid out of the blood. Uric acid is an anti-oxidant, and as an electron doner it performs many of the same functions as Vitamin C. In a low carb diet, not as much Vitamin C is required since uric acid is increased with more animal protein being consumed.

        Folate is high in green leafy vegetables such as spinach and kale. These are usually part of a low carb or ketogenic diet, and will suppress the production of uric acid. Like biotin and choline, folate is also rich in egg yokes. Of course green, leafy vegetables are also high in potassium.

        In summary, people suffering from gout need to eat more green, leafy vegetables (raw) to increase their levels of Vitamin C, folate, and potassium. Or, take supplements. Important also is to abstain from drinking alcohol. It is curious that humans are among the few creatures on Earth which can’t produce their own Vitamin C and must get it from their food. Equally curious is that unlike most other creatures we lack the uricase enzyme which neutralizes uric acid. These two factors seem to indicate that nature has required that humans eat a low-carb, high-fat diet that includes a lot of green, leafy vegetables. And gout is one of the enforcement mechanisms.

  5. Great reading. For three years now I have been on the Modified Atkins Diet for seizure disorder (modified in that it’s high fat, moderate protein, low carb). I’m a 52 year old female, never had any real weight issues (currently 127 lbs), and I’m fairly active. Today I had my blood tested for Gout. Everything about my symptoms sounds exactly like Gout. I don’t think I’ve seen anyone mention that uric acid levels in women increase almost to the level of men’s after menopause (which as much as it pains me to say – I’m definitely in that category). I’ve probably been a little high in my meat consumption so I think I may have created the perfect storm by my meat consumption and the fact that I am currently entangled in the menopause mess.

    I have been feeling so healthy since being on this diet and then boom, out of the blue, I get this excruciating pain in my right ankle.

    But, just as I sit and write this I receive a text from my doctor saying it’s not Gout. Now I’m back to square one. Hmm, wonder if I should request a check of the fluid from that ankle?

    • Did you ever figure out what was going on? I’m in a similar boat, and was told the 2nd time I had a minor flare up that while it suggested gout, my uric acid levels weren’t elevated. Then I did the Whole30 paleo-like diet, cutting dairy and grains out of my diet for the first time ever (I’ve done low-fat, low-carb, high-protein in the past with P90X, but I’ve never eaten this clean before, and never so much fat – it’s been great! Aside from the joint pain that came on at the very end of my 30 days.) and I’ve read that dairy helps with the excretion of uric acid. On day 27 I had a massive attack and 3 weeks later I’m still suffering. This time my uric acid levels were elevated, so they’re just saying it’s gout but the only way to confirm or rule it out is to do a joint aspiration as you mentioned (checking the fluid from the joint for crystals). A co-worker struggled with a similar condition for years and was told he had gout even though his tests didn’t match the diagnosis. 2 years later a specialist finally realized he had Lyme’s disease!

      • Try two days on oatmeal,3 meals 3 bowls, flavored with stevia and margarine, cherry juice if you prefer. If all your symptoms “disappear” you know it IS Gout! and you must remove high purine foods completely from your diet.
        Forget painful aspirations and tests. Adjust your diet to rely on vegetables and grains with animal proteins as condiments. Many Gout related food lists can be obtained online. Good luck.

        • Oh dang, just saw your response. Thanks for the oats suggestion. I didn’t try it since I didn’t see it. Pain lasted for several months. Dr.s tried several “gout medications” which did nothing. Vegetarian whole grain diet also did not help. Finally I switched hospitals and the new team put me on a grain free/sugar free diet, with a focus on moderate servings of animal protein, lots of veggies, moderate starchy veg, ideally 1 serving fruit per day but I’m terrible at that, and lots of healthy fats. So far so good! I’ve had a couple very minor flare ups (more of the “uh oh…I feel it starting” variety and then it’s gone) and that has been associated with times I have cheated on added sugars. The new Drs don’t even think I have gout, but just generalized inflammation. Regardless, this is the diet they prescribe for gout too, based on more recent studies. So far so good for me, at least.

  6. Potassium deficiency is deeply involved in gout as an accentuating factor because uric acid is less soluble in acidic urine. Potassium bicarbonate supplements will reverse this. You may see this discussed in a book about potassium nutrition as it relates to heart disease, gout, rheumatoid arthritis diabetes, hypertension, diabetes, and metabolic shock (high blood potassium) available in http://charles_w.tripod.com/arthritis8.html along with the table of contents introduction, and first two chapters. 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..
    Sincerely, Charles Weber

  7. The reason people are more sensitive to purines Chris is because there acid load is too high to begin with. Its the overfilled bucket theory… Animal products are high in purines, as they are concentrated proteins. Too many purines like you mentioned that are in red meat, in addition to all the other acidifying foods that you mentioned is too much for the bodies buffers to handle so the acid gets deposited in the bodies tissues. Gout is the buildup of acids in the extremities like the big toe due to a high acidic load and the bodies inability to metabolize the acids. Thus, the bucket is full and as a protective mechanism the body needs to clear the acid to prevent extreme complications and even death. This one paragraph alone should give you a better explanation of how body pH works with the blood and definitive proof from gout alone that its not just blood pH that we need to focus on to be in balance and homeostasis. Too much meat and acid foods without the proper balance of alkaline foods will result in a positive acid tissue load. As disease sets sets in and kidneys begin to malfunction you may develop alkalosis in certain cases, but the underlying factor and origin of the disease is most always too much acid foods and an acidic lifestyle in general. I will be shedding a whole new light on pH balancing for you when my site is up so you can be better inform your followers and patients the the critical importance of balancing pH levels on a paleo diet. I also have a long list of pros and cons regarding paleo..

    • How is it possible for blood pH to be stable but for other tissues to be acidic when there is blood throughout your body?

  8. Sorry, despite my appreciation for what this blog provides overall, this article is misleading, and should be removed!!! Paleo, in the many ways practiced, does bring about mqny health benefits, BUT, please understand that red meat and especially organ meats are VERY strong trigers for a gout attack, even at low UA levels, achieved by high doses of allopurinol. As for high potasium being a cure…… it is highly unlikely given the fact that many gout patients have hypertension/metabolic syndrome and take antihypertensives (losartan, lisinopril etc….) that are known to raise potasium at dangerously high levels. I am a gout sufferer for over 9 years now, and although have reached a certain control over it after 5 years of 300/mg daily allopurinol, this is a very very hard disease to control. Organ meats make for a very humbling experience, as ot takes no more than 5-10 min to triger an attack. No theories or articles in order to glorify a certain diet, written by people with no gout experience would solve the fact that millions of gout patients know, and live with daily, that meat purines triger gout on them.

    • @ JohnD

      I have to disagree with you Sir. The incidence of gout amongst a largely vegetarian & teetotal society in India is as high as 7%.

      To suggest Gout is directly linked to Red Meat/High Purine intake is akin to suggesting Fat consumption is what makes us Fat (which as we are now learning is not actually the case at all. Good fats are hugely important and beneficial to us in the context of lowering HDL and increasing LDL for example and the rise in obesity is linked to the standard american ‘low-fat’ diet)

      This is a really informative read….

      http://fourhourworkweek.com/2009/10/05/gout/

      I am a gout sufferer and whilst I have modified my consumption of certain food types the single biggest contributor to controlling flare ups for me is the elimination of Fructose from my diet. I eat lots of protein and grass fed beef.

      I had suffered joint inflammation and have experimented with lots of food types (cutting some for 3-4 periods at a time) only to find that at time of high inflammation I was also more likely to suffer a gout attack. I consume fishoils with every main meal and my incidence of inflammation has reduced dramatically.

      Balancing the acidity in my body is key. Good hydration is important too. I have learned that my body produces a lot more uric acid through normal cell regeneration and body fat breakdown than anything I would ever consume in a given day.

      I am not a medical guy, just an ordinary Joe.

    • that long with such a curable disease like gout??? Wow.. If you want any advice in regards to pH balance and a definitive guideline that will allow ur body to heal itself I would love to help.

      • Brian- I have been struggling with my 83 year old mother and her chronic gout for years. Twice in 2 years she has called an ambulance in the middle of the night because she couldn’t even stand on her feet she was in so much pain from a gout flare-up. Drs are no help. Besides prescribing a pill (which she takes every day & still gets gout) they are useless. As very little has helped over the years, I took it upon myself to try to figure out why she’s so prone to gout. I believe the chemistry in her body is way to acidic. I actually had her Dr test her urinary ph & it was 5! I wasn’t truly shocked, but 5! Yiikes!! Can you provide me with information regarding alkalinity? I believe that if the chemistry in her body was more alkaline that gout couldn’t grow.

        • Gout is diet related. Change the diet, avoid the pain.
          We cannot change genetic propensities, just adapt to them to avoid the painful consequences, like diabetes. There are many online resources, lists of hi-purine foods to help you start the dietary elimination process and transition to a more vegetable and grain based diet away from hi uric acid animal proteins.
          Try a day of oatmeal, bkfst, lunch and dinner. No butter, margarine and Stevia only. It cured my acute gout attack in 24 hrs. May your gran be pain free soon.

    • Did you read the article? He said if you have gout it is best to reduce purine rich foods but they are not the main cause of the development of gout to begin with.

      “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.”

    • Hi, I must say I’m also very nervous to serve my 17 year-old daughter red meat (grass-fed). She suffers from severe gout within 12 hours in both her wrists, if she eats even on bite of beef.

      She doesn’t use any medication (it doesn’t help), she simply doesn’t eat beef or drink any fizzy drinks/alcohol.

    • If you are what I call Paleo deep organ meats will not give you a gout flare up. If you still eat sugars and grain of course it will. I had chronic gout (7 years), BP meds X 10 years and 4 months ago was informed I feel so poorly because I am now a diabetic. I went Paleo deep and after 4 months have lost 30 lbs., off the BP meds, off the gout meds, work out 6 days a week (couldn’t work out for about 8 years), don’t take naps and have a quality of life that I did not believe would ever be possible for me (67 years old). Amazingly I do not have any cravings. I eat all I want and do not count calories. I am just strict about Paleo, nothing else.

  9. 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

  10. Discovering that my acidity levels are through the roof. Not just gout but inflammation elsewhere also (eg. ankle tendons).

    One vice I haven’t ditched (aside from Alcohol, Dairy, Grains) is Coffee. Having read previously that coffee helped keep gout under control, I then read conflicting materials to day that too much coffee can trigger flare-ups.

    I have capped the various sources of my recent episode to either excess coffee consumption (and associated acidity) and increased metabozisation of body fat due to aggressive weight loss and BF% reduction.

    Considering doing a green cleanse to give my liver a much needed lifeline.

    Such is the life of a gout sufferer 🙂

    • The caffeine in coffee and much more so the aflatoxin biproducts from the mold that develops when the coffee beans are dried will make the coffee highly acidic and will override the anti-oxidant benefits. Green Cleanse great idea as you need to be pH balanced to control and eliminate problematic inflammation.

      • I HAVE GOUT, FATTY LIVER AND CELIAC AND I DON’T KNOW WHAT TO EAT ANYMORE, CAN YOU GIVE ME ANY INFO

        • Go what I call Paleo deep. No sugar, no grain, no processed food. Eat all you want. In four months I was off the BP meds and gout meds and feeling the best ever. You will notice changes quickly if you will just do it. I didn’t have any cravings and still don’t. Mind you now this is only 4 months of me doing this. I didn’t really know what it was until 4 months ago.

        • Gout is exacerbated by sugar and animal fats, which celiacs load up on in “gluten free” desserts. Get the hi-purine food elimination lists online as well as gluten free grains and vegetables lists, your liver health will get better with the two. Relax, there are plenty of new healthy, tasty,foods for you to incorporate in your diet.
          This crisis could prove a blessing to you long term. Experiment with all the gluten free grains, or better try raw vegan cooking.

  11. Delighted to find this thread.

    As a long term gout sufferer I have tried everything.

    I am currently (& have been for 3 months) sugar free, alcohol free, grain/wheat free and even dairy free. I chose an aggressive path to lose weight and ditch the meds.

    I reduced fruit to one piece a day or a handful of berries and most of my carbs come from fresh vegetables & leaves.

    I am training 4 times per week mainly using body weight and free weight circuits/intervals. I feel better than I have since my 20’s.
    All of a sudden I had a gout flare-up today. I always blamed it on alcohol/sugar/fructose etc. now what?

    In recent days I have been under a lot of work related stress. My water consumption is massively reduced and I am eating clean but not as often as usual. I have missed snacks and gone 6-7 hours without eating. My last workout session before the flare-up was particularly tough and possibly traumatic to my muscles (power squats). I slept terribly that night.

    I am trying to connect the dots and I am beginning to think the answer lies beyond diet alone.

    I hope this makes sense to anybody researching gout.

    • If you’re working out hard and don’t hydrate, you are very likely to have an attack. I’ve been through it more times than I can count. If you aren’t drinking plenty of water you are setting yourself up for an attack, regardless of how clean you are eating.

    • Hi Piper,

      I am facing the same problem you’ve described since yesterday. Have you found any solution to that? I’ve quit alcohol, carbs of all kind and I am eating meat, fish and vegetables since 9 days now. I am drinking a lot of coffee daily and since 2 days now I am suffering severe pain in my left ankle. I have had once gout but in that time it was caused mostly by alcohol consumption. This pain now reminds me of that one. Can you help? How did you get out of your problem? Thanks in advance.

    • Hi guys

      Good plan with the heavy restriction diet. However the reason for the flare ups during the transition is due to a sharp rise is uric acid that accompanies going low carb/ keto adaptation. My advice is get low, stay low and drop the weight. This may take a good 6 months in solid ketosis. With some bad flares on the way. But once you are adapted your insulin is down, gluconogenisis levels and your brain starts to love ketones you will be free. You uric acid will drop and level out. You will not experience rapid rise and falls in acid levels.

    • I would love some suggestions about gout. I was diagnosed with it almost two years ago and see so many conflicting articles about how to help it and whatnot that I feel like I’m running around like a chicken with my head cut off.

  12. Thanks for this article, Chris. Just want to point out to the team, an edit correction in paragraph 8:
    “you’ll be at a lower risk for gout that someone who’s washing their burger down with a can of coke.”

    It should be “than” someone. 🙂

  13. Hi. I have chronic gout for decades. 2 yrs. ago, I started on a low carb diet and have been eating red meat, organ meat, sardines-basically all foods rich in purine. Haven’t had any attacks except once when I had a severe seasonal pollen allergy last spring. It was maybe because I had inflammation in my body.

  14. Hi I have been directed to your article based on red meat.
    I have been very healthy up to know but was overweight
    I am now 66 and lost 10 kilos over the last 18 months on a low carb diet
    For the first time one of my health scores uric acid had reached 11
    Conventional doctors tell me to stop red meat etc
    One even said I will now be on a drug for the rest of my life
    No way so I have tried most natural supposed dies including cherry juice and bi carbonate of soda etc without success
    Is there anything I can do or is it even a ptoblem

  15. I switched to a Paleo diet almost three months ago. I have struggled with congestion, clearing my throat, foggy brain, insomnia and general malaise for several years. I would also experience flu-like symptoms following aggressive exercise so I have been moderating my level for several years. While I was eating a relatively healthy diet by western standards- organic, juicing, lots of fruit and veggies, reduced meat – I was not able to significantly improve. My integrative health doctor also had me take fluconazole 200mg for 6 weeks to eliminate bad yeast. All of my general health concerns have been virtually eliminated over these 3 months. I have not felt this good in years. However, I have been experiencing occasional pain in my right big toe and stiffness in my knees. These symptoms are new to me. Just wondering what I need to tweak in my diet or what supplements I should add/subtract to get rid of these symptoms. BTW, I have taken high levels of fish oil for several years.

    • One more important piece of the puzzle, all of my blood tests before Paleo were very good except my inflammation markers. All three markers came back pretty elevated. I will be taking a follow-up test in a month to see where my levels are post-Paleo.

  16. As I have been into a paleo lifestyle for one and half years, I fell into a trap of consuming refined grains (even gluten-free corn based cereal and gluten-free breads) and fructose rich foods when I visited my 88 years old uncle and 82 years old aunt. They do not understand my paleo lifestyle, and it’s like teach an old dog new treats. Right after I returned home from visiting my relatives, I ended up have an unbearable pain in my lower right abdomen. I went to E.R. I learned that I have a kidney stone. I also have a recent gout located in the bottom of my right foot. I later discovered that it’s due to high uric acid levels. I have never had this problem before. When I googled a list of uric acid rich foods to avoid, most of them said it’s red meat and fish. I then checked Dr. Kresser’s article in regards to high uric acid levels. That made sense since the way Dr. Kresser provided the information on what causes elevating a level of uric acid matched my food consumption when I recently was on a vacation. I often check out Dr. Kresser’s article while I do my homework in regards to any health issue associated to a food consumption.

  17. Found out I have gout five months ago while walking around Disney with my wife. Brutal pain. But it was a great wakeup call. I’m about to turn 40 and am in decent shape. I have a great metabolism that my doctor has always told me is a health risk because I eat what I feel like without visible repercussion. I imagine everyone’s specific body type, age and solution is different, and I imagine that most of these cures work in some way. I took a four-pronged approach that eliminated my attacks in a matter of 4 or 5 weeks for good after hearing every opinion I could find:
    1. ELIMINATE the widely-agreed causes of rapid UA buildup and excretion blocking: Organ meats (let’s face it, they’re not good for you no matter what), HFCS and Beer. the last two are the real killers because they both block excretion of UA into the urine and ADD purines to the blood. I love drinking, but I just gave up beer entirely. same for canned soda. I get the occasional Whole Foods cane sugar cola, but I basically dropped it all. I still love hard alcohol, but I’ve cut out mixed drinks. when I drink a bourbon on the rocks, I drink less bourbon and I drink WAY less coke. Sometimes I’ll cut it with club soda. And supposedly red wine in moderation has a similar effect to Cherry juice. can’t hurt!
    2. DRINK more water. seriously. not a little more, but so much that you actually feel a little bloaty at the end of the day. I drink about four liters of water durning the workday, then more when I get home. The end result is no gout, eating less and weight loss. Win win win!
    3. Eat in smaller portions. with all that water consumed, it’s pretty easy. overeating blocks the body’s ability to excrete UA as well… at least for a while
    4. Elevate activity. the more active you are, stretching, walking, running, lifting, the better your blood flow, the looser your joints and the easier it is for your body to break up those crystals and to flush the extra UA out.

    • And for reducing the pain DURING an attack, I’ve heard people say hydration, cherries or cherry juice, celery seed or apple cider vinegar. I’ve only done massive amounts of water and cherry juice to combat a flare up, but it worked within a few hours beautifully

      • Hi Den,

        Since it’s widely accepted that organ meats are among, if not the most, nutrient dense foods, what do you mean by, “let’s face it, they’re not good for you no matter what”?

  18. There is another form of gout called pseudo-gout. It is caused from too much calcium in the diet. Instead of uric acid crystals forming it is calcium crystals. This is also called chondrocalcinosis.

    • I am more “Primal” than pure paleo… but even then I probably eat too much dairly. This could be my issue. :-/

      I’m working on figuring out if there are other nutrients that I’m not eating in correct balance with calcium in order that my body properly utilizes calcium. I’ve always tried to make sure that I have magnesium, for instance.

      Very recently, however, I realized (from an article that Chris wrote about supplements) that I should try supplementing with K2 which is supposed to help shuttle calcium to where it is supposed to go.

      If I reduce my milk intake a bit and increase K2, maybe that will help.

      It’s all a big experiment! lol

  19. I’ve had gout for 7 months now. It believe it was precipitated by a ketogenic diet (3 months on keto).

    Does Paleo cause gout? In the pure sense, I don’t think so. Does Paleo push you into gout territory? Yes, I think it has that potential. I get the feeling if one already has a predisposition, ie metabolic syndrome, or other genetic factors, that high purine diets like Paleo are not going to help in the short term.

    It is a curious condition, as it is hard to resolve naturally. I cut purines drastically, got my Uric Acid down to 2.0, but it made my gout worse. The theory is that rapid increases or decreases in Uric Acid can trigger gout flares. Does this mean that a low purine diet doesn’t help? I am not sure, because I think your body still needs a stabilisation period.

    I tried a lot of stuff, ie different brands of Black Cherry Extract, Apple Cider Vinegar etc. You name it, I consistently tried most of the natural remedies and they were a waste of time.

    I finally succumbed to taking Allopurinol (very low dose of 100mg). That has fixed my gout. I only had 1 minor flare while on Allopurinol when I drank a pint of beer, but that resolve in 2-3 days.

    For what it’s worth I think gout is really related to metabolic issues. My bet is that most people with gout are (or have been) overweight, or have other metabolic problems like fatty liver, high triglycerides etc.

    Maybe it would help if we all shared our background with this condition or any other factors that we believe have contributed or caused gout.

    * I’m 36 yrs old
    * 186cm
    * 244 lbs
    * Muscular build but could definitely shed 25-30lbs
    * Fatty liver
    * High Triglycerides
    * First gout gout after being on a strict Ketogenic Diet
    * Second major flare-up was after I had surgery (I hear that is often a trigger)

    • Daren- I’m an American living in Taiwan currently, am obese, but have recently gone “reasonably” Paleo and have lost a lot of weight… quickly. And that BY ITSELF is REALLY likely to cause a gout attack. I just spoke to a very well-read doc on the subject, and he claims that when carbohydrates are drastically reduced and weight loss is rapid, it will nearly ALWAYS raise uric acid levels to the point of gout- i’m sure the fact that i live on a subtropical island and eat piles of shellfish and organ meat didn’t help, but i rarely drink alcohol at all, consume very little sugar, and drink a LOT of water daily. but i did have what i THINK was a very mild gout attack a week ago… ironically, i had had a blood panel done 6 days earlier, and my uric acid level came back at a 9.6 (pretty high!). Add to that the fact that i take a thiazide diuretic for blood pressure (my doc already informed me i’ll be coming off them this month) which has been proven to increase uric acid blood levels due to its inhibition on the kidney’s ability to excrete excess uric acid.. SO, don’t know if that helps tremendously, but hope it at least gives some insight.

      • Hi guys,

        I am facing the same problem you’ve described since yesterday. Have you found any solution to that? I’ve quit alcohol, carbs of all kind and I am eating meat, fish and vegetables since 9 days now. I am drinking a lot of coffee daily and since 2 days now I am suffering severe pain in my left ankle. I have had once gout but in that time it was caused mostly by alcohol consumption. This pain now reminds me of that one and of your problem. How did you get out of your problem? Thanks in advance.

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