Got Gout but Love Meat?

Gout cartoon

Gout, once called “the ailment of kings”, because it mainly afflicted those who could afford a “rich” diet, now affects more than 8 million nonroyal Americans. To what do we owe this dubious honor?  Is it because we are eating more meat than ever before?

 

 

 

What is gout?  Gout is a special type of arthritis in which certain joints fill up with microscopic shards of uric acid, becoming red, swollen, and exquisitely sensitive to the touch.  Most people with gout have too much uric acid in their blood—higher than 6 mg/dl in women and 7 mg/dl in men (levels can reach 12 mg/dl or more in some cases).  Uric acid crystals can also cause kidney stones and kidney damage.  More than 20% of Americans now have abnormally high uric acid levels.

What is uric acid?  Uric acid is a breakdown product of purines. What are purines?  Purines are molecules that help to make up some vitally important compounds present in the cells of all plants and animals, including DNA (genes), RNA (protein manufacturing) and ATP (energy source molecule).  The following are the most familiar purines:

  • Adenine
  • Guanine
  • Caffeine
  • Theobromine (cocoa beans, tea leaves, kola nuts, yerba mate)

Low purine diets (in combination with medication) have been prescribed for gout since the middle of the 20th Century.  This dietary advice is based on the belief that the cause of high uric acid in the blood is too many purines in the diet.  Now, since all plants and animals are made of cells, and all cells contain purines, asking someone to eat fewer purines is a tall order.  However, since most animal foods are higher in purines than most plant foods (animal foods are denser and contain more cells per unit weight), doctors advise people with gout to eat less meat. Now, you could also lower purines in your diet by simply eating fewer whole foods of all kinds.  [Actually, the best advice, if you follow this reasoning to its logical conclusion, would be to eat a 100% junk food diet of flour, sugar, candy, soda, ice cream, and fruit juice—foods that have had their cells destroyed or removed in the refining process—because these foods contain few if any purines at all—sound like a plan?]  The below list is adapted from Emmerton 1996:

HIGH-PURINE FOODS 

  • All meats, including organ meats, and seafood
  • Meat extracts and gravies
  • Yeast and yeast extracts
  • Beer, and other alcoholic beverages
  • Beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, and mushrooms

LOW-PURINE FOODS 

  • Refined cereals and cereal products, such as cornflakes, white bread, pasta, flour, tapioca, cakes
  • Milk, milk products, and eggs
  • Sugar, sweets, and gelatin
  • Butter, polyunsaturated margarine, and all other fats
  • Fruit, nuts, and peanut butter
  • Lettuce, tomatoes, and green vegetables (except spinach and asparagus)
  • Vegetarian cream soups made with low-purine vegetables
  • Water, fruit juice, cordials, and carbonated drinks

In actuality, scientists admit that it is impossible to know the true purine content of any food, but even if we did, purines are not the only problem.

Those kings of old must have known how to party.

It has been known for centuries that alcohol consumption can trigger gouty attacks.  This connection is now well supported by scientific studies.  Two 12 oz beers can raise uric acid levels in healthy men by about 10%, and drinking to intoxication doubles uric acid levels in alcoholics.  Most alcoholic drinks contain no purines, so how does alcohol raise uric acid levels?

  1. Alcohol cuts the kidney’s ability to rid the blood of excess purines by at least 50%.
  2. When the liver processes alcohol, lots of ATP (an energy molecule) is used up in the process; ATP contains purines that get broken down into uric acid.
  3. Beer is especially risky, because it contains alcohol AND purines (derived from brewer’s  yeast).

It has been known since the late 1960’s that fructose raises uric acid levels. 

Examples of foods which contain fructose are fresh fruit (max 10% fructose), dried fruit (max 40% fructose), table sugar (50% fructose) and corn syrup (55% fructose). Uric acid levels rise about 13% after eating meals containing fructose.  People with gout have more exaggerated responses to fructose than healthy controls.

 “…subjects prone to developing gout in the 1700s and 1800s tended to be wealthy and sedentary, often with the ability to afford sugar, the latter of which is known to raise uric acid. Indeed, today gout is increasing in all populations, and if anything is more common among the poor and less educated.” [Johnson 2011]

Yet, as you can see in this 2007 New York Times article, fructose is not even on the list of possible dietary factors in gout, which may be why celebrated NY Times food writer Frank Bruni continues to suffer with some symptoms of gout, despite following his doctors’ advice to limit meat and alcohol, and to take medication:

“I’ve noticed discernible changes in my health — or at least in the way I feel. How much of that is attributable to my reduced alcohol intake and how much to the exodus of red meat is impossible to say. I haven’t lost more than a pound or two, because carbs have rushed in where protein isn’t permitted to tread… the flare-ups [of gout] are subtle now that I’m medicated and reformed.” http://bruni.blogs.nytimes.com/2012/03/22/red-meat-blues/

Aye, there’s the rub!  Mr. Bruni has gotten right to the meat of the problem—low purine diets can be high in refined carbohydrates, such as sugar and flour, which raise insulin levels, and now not only do you have gout, but you have a hard time losing weight, and you’ve further increased your risk for all kinds of other chronic diseases:

“Fructose is unique among sugars in that it rapidly causes features of metabolic syndrome both in experimental animals and humans. Fructose ingestion also leads to fatty liver and elevated triglycerides in humans and can also raise blood pressure. Intriguingly, fructose is a sugar that has the unique ability to raise serum uric acid. Serum uric acid levels rise within minutes of fructose ingestion… the increase in fructose intake closely parallels the rise in gout, obesity and metabolic syndrome that has occurred over the last two centuries. Serum uric acid levels increased from <3.5 mg/dl in the early twentieth century to over 6 mg/dl today in adult males.” [Johnson 2009]

So, how does fructose, which is not a purine, raise uric acid levels?

“The specific reason why fructose is superior than glucose in increasing fat stores likely relates to the unique first steps in fructose metabolism. When fructose enters the hepatocyte, it is metabolized by a specific enzyme, fructokinase C. Unlike glucokinase, which has a negative feedback system to prevent excessive  phosphorylation, the phosphorylation of fructose by fructokinase will proceed uninterrupted, and as a consequence intracellular phosphate depletion and ATP depletion frequently occur. The fall in intracellular phosphate results in the stimulation of AMP deaminase that helps accelerate the degradation of AMP to IMP and later to uric acid. In turn, the intracellular generation of uric acid results in oxidative stress.” [Johnson 2011]

Translation:  Fructose is especially good at turning into fat.  The enzymes in the liver that turn fructose into fat use up lots of ATP in the process.  ATP contains purines that get broken down into uric acid.

Both alcohol and fructose burn through ATP like kindling.  Metabolically speaking, fructose and alcohol have a lot in common, which is why Dr. Robert Lustig mentions them both in the same breath as poisons.

But there’s more to the sugar story.  Rapidly digestible carbohydrates such as sugar, flour, starch, fruit juice, and white potato are notorious for causing insulin spikes.  Insulin tells the kidneys to reabsorb uric acid into the blood instead of excreting it into the urine.  Why?  Because insulin is, first and foremost, a growth hormone.  In order to grow you need to build more cells, and to build more cells, you need more purines.

So our dear meat-mourning Mr. Bruni is dutifully eating a low purine, high refined carb diet, which both lowers and raises uric acid.  As comedian Steven Wright would have said, that’s like putting a humidifier and a dehumidifier in the same room and letting them fight it out.

So what is he supposed to do?  What foods would he be left with if we told him he can’t eat carbs, meat, or alcohol?  Fat and low-purine vegetables?  Unfortunately that diet is dangerously devoid of nutrients.  Which is worse for gout–meat or carbs?

Here are the reasons for my beef with the meat-purine-gout hypothesis:

  • We are not eating any more meat now than we did 100 years ago.
  • Some cultures eating lots of meat, including 19th century Arctic peoples who lived on a diet of nearly 100% animal foods, did not develop gout.  “Gout is unknown in Eskimos and Northern Indians despite their purine-rich diet.” [Schaefer 1959]
  • Animal foods are higher in protein than plant foods.  Proteins increase the elimination of purines in the urine, which can actually lower uric acid levels.
  • Some plant foods are rich in purines, including legumes, spinach, asparagus, and mushrooms [dense or rapidly growing plants].
  • Purines in the diet do not have much of an effect on uric acid levels, because most of the uric acid in the blood comes from inside the body, as part of everyday cell turnover: “The purine content of the diet does not usually contribute more than 1 mg/dl to the serum urate concentration…” [Emmerson 1996].

Studies tying animal foods to gout have been epidemiological studies which have observed that people who eat more meat tend to have higher uric acid levels and/or a higher risk of gout.  These studies have not taken carbohydrate in general, nor fructose in particular, into consideration.  Therefore we have no idea whether people who reported eating more meat also happened to eat more fructose, which is, in my opinion, a critical omission, given that we have known since 1967 that fructose can raise uric acid levels.  Furthermore, there are some epidemiological studies that find no association whatsoever between meat and uric acid levels [Yu 2008, Villegas 2012].  Either way, as many of you know, epidemiological studies are not experiments and correlation does not equal causation.

So, what do clinical studies of diet and gout have to teach us? 

Unfortunately, as is the case with so many diseases, when the use of drugs to treat gout became popular in the 1950’s, interest in dietary strategies fizzled, so we only have a wee handful of small, flawed studies to guide us:

There are ZERO studies that have attempted to prevent gout with diet.

I could only locate a grand total of ONE study of the oft-recommended low-purine, alcohol-free diet that is relevant to our question (Peixoto 2001).  In this study, 55 Brazilian adults with both high blood pressure and high uric acid levels were divided into 3 groups— diet alone, low purine diet + medication, and medication alone—for 3 months.  Uric acid levels fell by about 2 mg/dl in all 3 groups by week 6.  However, people in this study were not gout patients, there was no control group, and the composition of the diet was not described (we are only told what was excluded from the diet), therefore we do not know if this diet contained less fructose and/or less refined carbohydrate than a standard diet.  Without that information, we can’t be sure that it was the lack of purines that may have been responsible for the decrease in uric acid.

I located only ONE small pilot study exploring the role of refined carbohydrate in gout [Dessein 2009].  13 South African men with gout were placed on a 1600 calorie diet containing 40% unrefined carbohydrate, 30% protein, and 30 % (unsaturated) fat, including 4 servings of fish per week.  Purines were unlimited and alcohol was not restricted.  Here are the results, on average, after 16 weeks:

  • uric acid levels fell by 18% , from 10.3 mg/dl to 8.5 mg/dl on average; 7 men had a normal uric acid level by the end of the study.
  • frequency of gout attacks was reduced by 72%
  • weight dropped by 17 lbs

This study is very promising, but unfortunately it is hard to know which of the interventions was the responsible for the positive benefits—was it the lack of refined carbohydrate, reduction in saturated fat, or the weight loss itself?  Even more confusing is that it is unclear whether these patients were eating much less meat than usual, given that they were told to avoid saturated fat. Uric acid levels fell by about 2 points, which is about the same as in the Peixoto low-purine diet study, although that group had much lower uric acid levels to begin with.

So, what should you do if you have gout?  The answer is that the research doesn’t have a clear answer for you yet.  Many questions remain unanswered.  We still don’t understand exactly why alcohol raises uric acid levels, why only a small percentage of people with high uric acid levels get gout, or even which carbohydrates might aggravate gout and why.  For example, a brand new analysis of all available fructose studies calls into question whether fructose raises uric acid any more than any other kind of sugar [Wang 2012].

But here’s what we do know.  When we combine the available science with common sense, we can say that:

  1. Human beings must be well-adapted, as all animals must be, to eating purines, which are found in all whole foods.
  2. It is highly likely that we are poorly adapted to be able to handle much refined carbohydrate or alcohol, which have never existed in nature in significant amounts.

DIETARY TIPS FOR MANAGING GOUT

  1. Stabilize and lower your blood sugar and insulin levels by reducing carbohydrate intake, especially refined carbohydrate intake.  A low glycemic index diet would be a good place to start.  Depending on your chemistry, you may even need to consider a very low carbohydrate diet.  Refined carbohydrate and high insulin levels have been strongly linked to metabolic syndrome and most diseases of Western civilization, and gout is probably just one more sugar-tipped arrow in the quiver of the Western diet. There is no evidence that lowering the amount of meat in your diet will protect you from these diseases, whereas there is plenty of evidence to suggest that lowering refined carbohydrate intake can.  Even if it doesn’t completely cure your gout, you’ll be a lot healthier for it.
  2. Minimize alcohol intake, especially beer. 
  3. Consider taking a vitamin C supplement.  A single randomized controlled trial found that taking 500 mg of vitamin C per day for 2 months reduced uric acid levels by 1.5 mg/dl.

If you focus on these goals, you may be able to have your meat and eat it too:)

For more reassuring facts about meat and health, including information about kidney disease, heart disease, and nitrates/nitrates, please see my meats page.

To read about the history of mostly-meat diets, including the diets of Arctic and African peoples, please click HERE.

To read a critique of the latest study trying to connect the carnitine in red meat to heart disease, click HERE.

What about you?  Have you tried any dietary strategies for gout that have worked?

Up next on DiagnosisDiet:  Foods that can cause Hypothyroidism.

To be notified of new blog posts as they become available, click here ↓

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REFERENCES

Choi HK et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NM 2004; 350:1093–1103.

Dessein PH et al.  Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539–543

Emmerson BT The management of gout. NEJM 1996; 334(7): 445-451.

Fam AG.  Gout, diet and the insulin resistance syndrome. J Rheumatol 2002;29(7): 1350-1355.

Fam AG. Gout: excess calories, purines, and alcohol intake and beyond. Response to a urate-lowering diet. J Rheumatol 2005; 32:773-777.

Garrel DR et al. Milk- and soy-protein ingestion: acute effect on serum uric acid concentration. Am J Clin Nutr 1991;53:665-9.

Ghadirian P et al. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol 1995;11:275-81.

Gibson T, Rodgers AV, Simmonds HA, Court-Brown F, Todd E, Meilton V. A controlled study of diet in patients with gout. Ann Rheum Dis 1983;42:123–7.

Huang H-Y et al.  The effects of vitamin C supplementation on serum
concentrations of uric acid: results of a randomized controlled trial. Arthritis and Rheumatism 2005; 52(6):1843-1847.

Johnson RJ et al.  Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? J  Comp Physiol B 2009; 179(1): 67–76.

Johnson RJ et al. Uric acid: a danger signal from the RNA world that may have a
role in the epidemic of obesity, metabolic syndrome and cardiorenal disease: evolutionary considerations. Semin Nephrol. 2011; 31(5): 394–399.

Lieber CS et al.  Interrelation of uric acid and ethanol metabolism in man. Journal of Clinical Investigation 1962;41(10).

Lieber CS.  Metabolism of alcohol.  Clin Liver Dis 2005; 9:1-35.

Lieber CS.  Hyperuricemia induced by alcohol.  Arthritis and Rheumatism 1965; 8 (5) Part I. 786-798.

Lyu LC et al.  A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr 2003; 78(4): 690-701.

Matzkies F et al. The uricosuric action of protein in man. Adv Exp Med Biol 1980; 122A:227–31.

Peixoto MR et al. Diet and medication in the treatment of hyperuricemia in hypertensive patients. Arq Bras Cardiol 2001; 76: 468–472.

Perheentupa J and Raivio K.  Fructose-induced hyperuricemia. Lancet 1967; 9(2):528-31.

Reiser S et al.  Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch. Am J Clin Nutr 1989; 49(5): 832-9.

Schaefer O. Medical observations and problems in the Canadian Arctic, Part II: nutrition and nutritional deficiencies. Canad. M. A. J. 1959; 81: 386-393.

Siener R and Hesse A. The effect of a vegetarian and different omnivorous diets on urinary risk factors for uric acid stone formation.  Eur J Nutr 2003;42(6):332-7.

Singh JA et al.  Risk factors for gout and prevention: a systematic review of
the literature. Current Opinion in Rheumatology 2011; 23:192–202.

Stirpe F et al. Fructose-induced hyperuricaemia. Lancet 1970; 19(2):1310-1.

Villegas R et al. Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men’s Health Study. Nutrition, Metabolism & Cardiovascular Diseases 2012; 22: 409-416.

Wang DD. The effects of fructose intake on serum uric acid vary among controlled Dietary trials. J. Nutr. 2012; 142: 916–923.

Yamamoto T et al.  Effect of ethanol on metabolism of purine bases (hypoxanthine, xanthine, and uric acid). Clinica Chimica Acta 356; 2005: 35-57.

Yu KH et al.  Dietary factors associated with hyperuricemia in adults.  Semin Arthritis Rheum 2008; 37(4): 243-250.

Zhu Y.  Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011; 63(10):3136-41.

 

 

 

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  • Des

    Dear Dr. Ede,

    What do you think about spices such as turmeric, saffron, cinnamon, ginger and the like? Studies show that spices are very beneficial to human health. For example, turmeric has been reported to reduce systemic inflammation and even cancer cells and tumors on both animals and humans.

    • http://diagnosisdiet.com/ Dr. Ede

      I haven’t looked at turmeric or spices yet but they are just plant compounds and my guess is that they will turn out to have the same double-edged sword properties that other anti-cancer plant compounds do.

      • Des

        Thank you very much

        Des Diamantopoulos,
        Certified Renaissance Exercise Instructor

        THE STRENGTH ROOM
        21 Camden St. #100
        Toronto ON M5V 1V5

        647-701-4017
        des.tsr.003@gmail.com

        Sent from my iPad

  • Des

    Hi Dr. Ede, what do you think about the ‘healing properties of astaxanthin?’

    • http://diagnosisdiet.com/ Dr. Ede

      I haven’t looked into it…

  • Pingback: Primal and gout | Mark's Daily Apple Health and Fitness Forum page

  • *LB

    This is a good article on gout,
    in fact, one of the best I’ve read on the subject. I suffered from gout for
    many years and it’s difficult to find much advice that doesn’t mirror the
    “conventional wisdom”. I am a healthy and fit 47 year-old male; my
    gout is most likely due to a hereditary predisposition (my mother also has
    gout). My gout symptoms were severe by most measures.
    I had tried all the pharmaceuticals and home
    remedies to no avail. I switched to
    a paleo diet a year and a half ago and that cleared up my gout symptoms, among
    other things, to a large degree. I still get flare-ups, but I can usually trace
    them to specific instances of falling off the paleo wagon. Sugar and alcohol
    are key triggers for me. For some reason, I seem to have even less tolerance for
    these things than I did when I was non-paleo. I have no symptoms of metabolic syndrome,
    but I do continue to have a high uric acid levels in my blood tests. So it
    seems like I can have high uric acid levels without gout, but if I over indulge
    I get uric acid crystals forming. I don’t have it completely figured out yet,
    but a paleo diet is a big step toward fixing the problem and I think I just
    have to be particularly vigilant about watching my fructose/alcohol intake
    because of my genetics. Although it’s a bit of a bummer,
    it’s nice to finally have some
    control over this, and in some ways
    it’s like my personal canary in the coal mine for the rest of my metabolic health.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi LB
      Thank you for your kind words about this article. I am really glad you liked it. However, it sounds as if you had already discovered your own excellent way to combat gout! I wonder how you discovered this approach, and am so glad to hear that it has worked so well for you–congratulations! I, too, discovered that a Paleo diet cured many of my own health problems a number of years ago. I wonder if you have every tried a lower-carbohydrate version of a Paleo diet?

      • *LB

        Hi Dr.
        Ede,

        I discovered my gout triggers by trial and error once I started eating paleo.
        If I cut out fructose and alcohol entirely I’m sure I would never get another
        flare-up. However, there are times
        when I’d like to have a cookie or a beer so it becomes
        a matter of seeing what I can get away with. I don’t have all of those
        variables quite figured out yet, so I’ll still cross over the gout
        “threshold” at times and
        regret it afterwards. One of the odd things I’ve noticed is that the cleaner my
        diet gets over time the less gout tolerance
        I seem to have when I do fall off the wagon. I would have guessed the opposite.
        Oh well.

        I’m not sure if my eating plan would be considered low carb or not as it
        relates to paleo diets in general. I tend to keep my carb intake around 50-100
        grams per day. I’m not too fussy about keeping track. I tend to eat a little
        more carbs when my activity level is high, and I think that’s just because I
        get a little hungrier as a result. I limit my fruit to one or two servings a
        day – I used to eat a lot more, but I became
        somewhat concerned about the added
        fructose and risk of a potential gout attack as a result. I generally eat two meals a day within an 8 hour window without much
        snacking. With occasional intermittent fasting I feel like I drift in and out
        of Ketosis pretty effortlessly. As an experiment
        this past summer I tried to see how
        much I could comfortably lean out and I was able to drop about 3 pounds in two
        weeks by keeping my carbs way down – maybe between 30-50 grams per day. I was
        surprised how reducing a relatively small amount of carbs in a diet that was
        already fairly low carb to begin with enabled me
        to carve off those last three pounds. My workout performance didn’t suffer at
        all from the carb reduction. I’ve since gained the three pounds back because I
        don’t see any practical benefit in being that fastidious about what I eat. I’m
        6’1 @ 170lbs – and I feel like my weight has settled into a zone that is easy
        to maintain and feels about right to me.

        I read with interest some of your experiments with ketosis. I hope you get some good insights from your efforts. My wife does the
        paleo thing with me and I find it
        interesting that our experiences, while both very positive, are also somewhat different. My guess is that you ladies have a
        much more complex hormonal system and that may have something
        to do with those differences.

        • http://diagnosisdiet.com/ Dr. Ede

          Very interesting details, LB–thank you for posting them here. It sounds as if you have deep insight into your own body’s rhythms and a very good feel for what your body can handle without having to go overboard monitoring everything. It’s incredible what you’ve been able to accomplish through trial and error and diligence. And I couldn’t agree with you more about the perplexing differences between boys and girls…!

  • Warren David

    I’ll be brief. I had candida and gout at the same time. The candida was
    more of a problem for me than the gout so I thought that I would deal
    with that first. I was already on a paleo diet but I switched to a very low carb version of paleo. After the cange in diet, the
    candida went away and I noticed that the gout also went away as well, which was an unexpected bonus.

    • http://diagnosisdiet.com/ Dr. Ede

      Excellent real-world story, Warren! Thanks for sharing it here, and congratulations on improving your health.

  • Sarel Van der Merwe

    Hi D. Ede. I have been experimenting with various permutations of dietary ketosis for about 2 years with excellent results. My results were so profound that people around me also became interested and I stated helping them with menus, calorie counting and blood ketone/sugar measurement responses and subsequent dietary tweaking. One of my co workers had very strange symptoms while in the keto induction phase. His diet consisted of 1100 Cal that was made up of 90% fat. This is to induce nutritional ketosis as quickly as possible while avoiding adaptation symptoms. He has suffered from gout in the past and 3 days into this diet had a major gout attack in multiple locations.It cleared up quickly once he went back to his normal high carb diet. I find it difficult to find the connection and your thoughts on the matter will be appreciated.

    • http://diagnosisdiet.com/ Dr. Ede

      Hello, Sarel
      I do not know what might have the gout attack in your coworker–I do know that the adaptation phase can be very stressful on the body and perhaps the induction he attempted was too abrupt and too severe for his system? Perhaps the sudden shift in fluid and electrolyte balance that can be caused by induction triggered the attack? His calorie total is quite low and he was probably not eating enough protein if less than 10% of his 1100 calories were coming from protein, because 10% of 1100=110 calories=28 g of protein. The issue may also have had to do with the composition of the diet (which foods he was eating). I honestly don’t know, unfortunately. I wish I could be more helpful.

      • Cynthsa

        From my experience with both gout & low-carb dieting, I found that switching from the carb to a high-protein metabolism causes a large increase in urination initially, as the body needs less H2O to process proteins (fats too? not sure). Anyhow, could the connection be as simple as dehydration? I’d be curious if tracking by UA showed correllation between high specific gravity in urine & this man’s gout symptoms….. I find that my daily water intake plays a vastly greater role in my level of gout symptoms than my protein intake (assuming I’m not going wild, of course.) Curious to learn if any conclusion are reached — hope you’ll post a followup if there’s anything new to add.

  • gkadar

    Dr. Ede, why don’t you also suggest that people with gout get a sleep study done. I recommend this to my gouty patients and so far they’ve all been diagnosed with severe sleep apnea. When they consistently use the APAP they are relieved of symptoms. If they come down with URI and can’t breathe properly, they get gout attacks.
    Of course not everyone with sleep apnea develops gout, but everyone with gout appears to have sleep apnea.
    Thanks, Dr. G. Kadar

    • http://diagnosisdiet.com/ Dr. Ede

      Thank you for this information, Dr. Kadar

  • dkay

    Hi Dr Ede, I too have enjoyed your article.
    The one thing missing or unclear is whether the dietry effects discussed (here and elsewhere) relate to people who are on medication (and which) or not. It seems that those not on medication gain little from diet alone.
    I can appreciate trying to decrease uric acid production in patients who are on uricosuric meds: in order to try reduce the uric acid in the urine and thereby decrease uric acid stones.
    In those on allopurinol, surely it doesn’t require any need to be concerned with diet, beyond having a healthy diet in all other respects. Excesses of anything is likely to be harmful in the long run: resp., cardiovascular, liver etc.
    Regards, Dov Kay MD

  • Susan Burns

    After eating mostly vegan for almost 3 years, in December, 2013 I decided I really needed to try eating gluten-free to see if it would help my narcolepsy. It helped a lot. Since then I have transitioned to a paleo diet, and in particular, am trying to follow Dr. Terry Wahls’ protocol as outlined in her book “The Wahls Protocol for all Autoimmune Disease.” I have been working into the Paleo Plus plan which is a ketogenic, low carb paleo which has me eating 6 cups of vegetables a day and liver every week.

    I had had gout attacks prior to beginning to eat vegan, but none at all during the time I lived on a plant-based diet, even though most of my calories came from carbs. Now that I am eating seafood, liver, and huge piles of vegetables, and only getting about 10-20% of my calories from carbs (and complex carbs are the bulk of that) the gout is back. My blood sugar is much improved from when I was eating a plant-based diet, I have lost a lot of weight, including around my waistline, I have a lot more energy, but my big toe is screaming.

    I found your article after looking up which foods can contribute to gout, and my diet for the last week includes many of the foods on that list: Liver, lamb, seafood, cruciferous vegetables. (Only an ounce or two of the meats, though, each day since I had gastric bypass surgery about 10 years ago and I can’t eat a lot of meat at a time.) So for me, it seems to be the high purine foods, not the fructose.

  • JB

    I was hoping for a list of safest meats but as far as what why alcohol effects gout.. Id say it goes to your theory on sugars. Alcohol=Sugar. Also beer is said to be worse this is likely because it is non distilled converted sugars and contains more yeast.

  • Akegolfrman

    Very good article Dr Ede,
    I would like to ask you ( I hope this blog is still live, no comments for 8 months)
    Is Colchicim pills the same as Colchicine, and what’s you view on this?
    I think, after reading a lot on the inet that if I had Allopurinol, and took a tablet a day then all my gout problems would be solved. Any comments?

  • JM

    I have been having constant gout flairs for about the last 2 years. I tried No meat along with lots of dairy, veggies and lots of carbs. Had no improvement. A few weeks ago I had a craving for steak. I had my fill along with veggies and a margarita two days in a row.
    Well guess what I have been in almost total remission from gout. The thing is when I eat to many carbs during the day I have pain that night. I simply eat less carbs the next day and feel much better.
    Who Knew. I will update my progress.

    JM

  • Pickle Eater

    My experience has been that neither plant purines nor fructose (from eating fruit) has caused me gout pain, but meat has.