Got Gout but Love Meat?

Gout cartoonGout, 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

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.”

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.

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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.

    • 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

        21 Camden St. #100
        Toronto ON M5V 1V5


        Sent from my iPad

  • Des

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

    • 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.

    • 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.

        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.

        • 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.

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

    • Janine Cortinas

      I used to suffer from gout for about 12 years so I can very much relate to people who suffer from it. No medications or treatments ever really did anything for me (i tried them all haha) but I was actually able to cure my gout symptoms naturally after countless hours of online research. What worked for me is as follows:

      1. Apple Cider Vinegar. Put 1 to 2 tsp of it in a glass of water and drink 3 times a day. This tackles the acute pain.

      2. Follow every step in the guide seen at the following link:
      solvehealthproblem*com/gout (obviously change the * for a dot) This will get to the root of the problem in a NATURAL way. This is very important!

      3. Add Epsom Salt to your bath. Add two cups of Epsom salt to warm bath water and soak your body in it until the water starts losing heat. Do this once a week. If you have more severe gout, you can try it two or three times a week.

      Try all those three steps together and hopefully you will get as much luck with getting rid of gout as i did. Just stay confident as this condition does not have to be permanent as long as you have it in you to fight it. Good luck

  • 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.

    • 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

    • Thank you for this information, Dr. Kadar

    • Todd Jamison

      I have gout, and have had a sleep study, I do not have sleep apnea

  • 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.

    • Auggiedoggy

      The safest meats would be no meats at all. Ok, some meat in moderation is allowed but you shouldn’t be looking at any high protein/fat diet if you have gout problems. Stick to dairy and eggs as your primary animal protein sources as these foods are actually shown to be beneficial to gout sufferers. Dairy should be low fat. There’s actually a study where participants were given soy milk and after 3 hours their serum uric acid was tested. Soy milk caused a 10% increase above baseline. The same test was done but with skim milk. The skim milk caused a 10% drop in serum uric acid levels from the baseline.

      • Maybe?

        Soy milk, 15 grams of carbs ( 10 of which directly from sugar or more specifically, 45 to 55% fructose)

        Milk, 11 grams for whole milk, but this is lactose, it does not spike your insulin.

        The soy milk has fructose which causes the spikes and insulin resistance.

        It’s right back to fructose, as stated in this article.

  • 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?

    • Auggiedoggy

      Allopurinol doesn’t allow you to eat whatever foods you like. It lowers uric acid production by about 30% but you still have to follow a prudent diet. There’s no magic pill in life. The dietary advice here is the worst advice possible for someone who is predisposed to gout/high serum uric acid.

      • Dear Auggiedoggy
        Thank you for sharing here what you are learning about your gout symptoms and their connection to your diet so that others can benefit. I would never disagree with any individual’s personal experience with diet and health, since that is exactly what this site is all about. I would like to clarify that my article does not advise people with gout to eat a high meat diet and I do not mean to suggest that people who remove refined carbohydrates and alcohol from their diet will then be able to get away with eating high purine foods such as sardines and organ meats nor that their gout will be cured, simply that it may be possible for people to be able to tolerate healthy animal foods if they reduce intake of other problematic unhealthy foods. I am in general in favor of diets that include sufficient (as opposed to excessive) animal protein, but people only need between 8 and 16 oz of animal protein per day, depending on their weight, activity level and health status. Unfortunately I don’t know of any gout studies that adequately test healthy low-carbohydrate diets that include meat, so people with gout are left to their own devices to a large extent to figure out what works best for them.

        • Maybe?

          I went from 230 lbs to 165 during my struggle to control my gout. I completed countless experiments with much pain as my reward. It took a while and mine was losing the weight, which made things worse for a while, but when you drop sugars and carbs (what I suspected was the cause), you can’t help but lose weight.

          I eat about 60 to 70% fresh or steamed veggies daily and meats as the secondary. I also consume a lot of whole milk, homemade yogurt and a variety of cheeses.

          This is what stopped my gout in it’s tracks. I figured it out when I went to juicing and a more vegan type of experiment and it made it worse, from all of the fructose in fruits. Juicing made mine worse.

          I removed the fruits and it slowly started improving. so I started on mostly veggies and meats and things kept getting better.

          I had 3 years of a swollen knee and my knee was pretty messed up from being stuck dozens of times to remove fluid, plus the stretching from the swelling.

          The more I dug into food sciences, the more I came to the conclusion that even if we eat right, we still lack minerals and nutrients because of the loss of miners in our soils. Our produce has a fraction of the nutrition it had in the 1950’s, so i started supplementing with minerals and vitamins. Organic, not synthetic or chemical reaction stuff in a lab and my knees healed up within a month.

          I used to be on blood pressure meds too, but now that is gone.

          This leads me to a couple of questions for you if you don’t mind.

          Why doesn’t main stream medical look at veterinary medicine and look at how they handled domestic and wild animals via nutrition?

          When you start looking at what they have accomplished vs main stream medical, it’s really sad. They have eliminated most of the disease and conditions common to the populace of the US and western diets.

          From the research I have done, this is accurate information. So am I misunderstanding them when they say they have virtually eliminated diabetes in dogs, cats and other domestic animals via nutrition? In fact, they claim the number of these conditions/diseases that have been eliminated somewhere in the range of 600 to 900. All controlled by diet.

          Is this true?

          If it is, then would not humans (animals by scientific definition) have similar results via nutrition?

          I am not a doctor and did not get rid of mine on my own, my doctor helped me as we went along. I guess I was the first to ask for that kind of help and guidance from him.

          I asked him these same questions, just curious about your opinion. I am no professional, so it’s in no way a loaded question, just asking your opinion on these.

          Thanks for your time and such a great post. I know you must be very busy.

    • Dear Akegolfman
      My apologies for the delay in responding to you. I agree with Auggiedoggy (below) about Allopurinol, and this applies to medicines in general, meaning that medicines can be helpful with many medical problems but they rarely completely remove all symptoms of any condition and almost never solve the underlying problem. I do not know what you might be able to eat if you took Allopurinol; you would have to find out for yourself. My general philosophy is that a healthier diet can be helpful with many conditions. Some people can completely solve their health problem with diet but others may need a combination of dietary changes and medications.

  • 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.


  • Pickle Eater

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

    • Ken Foster

      I recommend you put a bit more study into it and measure out and record what your are eating. Even better, try going completely paleo for a couple weeks!

  • Duane

    Lots of plain water help the most

    • duane

      I started out with Gout about 20 years ago. I have never drank any Alcohol at any time. Doctor said limit proteins eat Brussel sprouts.Within a short time my fasting sugar were high so I discover that HFCS raised my test the most. I could get the sugar test down below 110 if I had No high fructose corn syrup the full week before fasting test. Doctor said no frutose. Now they may be saying the blood sugar carbs & insulin may cause the body the fail to digest protein. So don’t eat carbs & meat in same meal. So much for American diet. Water & allopurinol do more for the gout than any diet. My A1C is normal 5.8 but they sill give me metformin. Then doctor said don’t eat; I then gain weight. Bad advice.

  • Auggiedoggy

    I have had high uric acid for the last 5 years. Never had a gout attack until two months ago when, coincidentally, I increased my animal protein intake, in particular, sardines. It was definitely not refined carbs or fructose as I consume only small amounts of each. I drink one glass of red wine per week so it wasn’t alcohol either.

    • Auggiedoggy

      UPDATE: Just getting over my 2nd gout attack in 6 months. This was brought on by the fact that I had an increased intake of animal foods, especially seafood. It is now pretty clear to me that animal foods and seafood in particular is the cause. Looks like low-fat dairy is going to figure prominently in my diet from now on and other animal foods will be restricted. I now drink 8-10 glasses of water daily and include 1 cup of tart cherry juice.

  • Ken Foster

    Dr. Ede,

    I can’t begin to tell you what your article has done for me. I have suffered with gout attacks for the last 10 to 12 years, always lamenting and trying to figure out where I exceeded my “meat quotient”. It was demoralizing because the pain that kept me from work was direct evidence of my poor food choices. Any medical advice I received supported the notion that too much meat was the culprit. I was advised to take alopurinol and colchizine and eat more refined starches.

    I am six weeks into a diet that has gradually increased the amount of animal fats and severely lowered my carbohydrates with success in lowering blood sugar, losing weight and incidentally no gout attacks!

    I was living on chicken and fish with occasional meals of beef and never, ever any pork. This Independence day weekend I smoked racks of ribs and for the first time in years enjoyed pork without any twinges of gout. Seeing in your article that it has been understood since 1960 that fructose increased uric acid level sort of angers me.

    I blame my doctors who in the early 90’s put me on statins for high cholesterol, subsequently checked my glucose and put me on metformin and insulin injection for diabetes with my glucose at 140. All along they either knew or could have easily discovered that a carohydrate-rich diet was the problem. Liver and muscle damage ensued with the statins and I finally rejected them wholesale after learning that they don’t even know what cholesterol numbers mean and that high cholesterol does not contribute to heart disease.

    With my history with carbs, blood sugar, cholesterol all being linked to the foods I was eating, I should have known that sugar, (fructose) was the contributing problem to my gout. The pain of gout is not only demoralizing but excruciatingly unbearable.
    To explain the kind of pain to people who never had gout, I simply said, “Open the first joint of your big toe, pour in sand and stuff it with broken glass. Then close it up and put it in a vise. For me, this approximates the sensation and debilitation of an episode of gout.

    Thanks to you Dr. and others named in your article, I don’t have to suffer that kind of pain again. Bless you!


    • Dear Ken

      Your story is heartbreaking. I am hopeful that more and more physicians will become aware of the major role that sugars and starches play in common health problems such as gout so that fewer people will suffer due to misinformation. Most medical schools teach students next to nothing about nutrition, sadly, but I’m hopeful that this, too, will change. I am so glad that you took matters into your own hands and finally found a path to healing. May your health continue to improve every day!

  • ktrosper

    Awesome. Thanks for this.
    I was battling gout every couple of months.. hard-core and debilitating 🙁
    my research brought me about where this summary of yours did. Hard to say exactly which intervention made the difference, maybe a combo of all of them.. But I haven’t had to deal with gout in years. And if it never happens again, it’ll be too soon!
    1. cut out beer – drink 1/2 glass of wine every night now.
    2. low-carb diet (keep insulin very low most of the time)
    3. moderated protein intake (red meat meals down to about 3 per week) to about 1g/kg lean body mass per day
    4. got ALL the fructose out (this crap is everywhere…)
    5. increased water consumption
    6. vitamin C – 2g per day
    Test my uric acid every once in a while.. my levels are consistently lower than they used to be.

    • Fantastic recommendations, ktrosper, thanks for sharing your hard-earned wisdom with all of us here!

    • Chris

      How did you get all the fructose and sugar out of your diet? (you do mean fruits as well, right?) What kind of carbs do you eat if you do not eat any fruits and still go low carb?

      • ktrosper

        I limit fruit, yes. My meals are typically a fatty meat and 2 veggies.

        Their are hidden sugars in darn near everything processed, so to get it all out takes a commitment to make everything from whole foods (including ketchup, etc).

        Over time, I’ve taught my body to run on fat by limiting sugar (which includes things that turn to sugar: starches, breads, etc) and I seem healthier for it all the way around.

        Gout is one nasty SOB and I never want it again. I still feel some pain in my big toe joint when I stress it – probably residual damage from my gouty years. I’m hoping it’ll continue to heal.

  • AJ57Eagle

    Dr. Ede, is there a connection between gout and statins? My doctor prescribed Atorvastatin Calcium 40mg TA to be taken once a day. I have just gone back on a low-carb diet (Atkins) to help me lose weight, and was not pleased to read on the Mayo Clinic website that I was going to have to limit the red meat (which I love!).

    • Dear AJ

      According to this article:, Atorvastatin can reduce uric acid levels. However, if your doctor prescribed the statin drug to lower your cholesterol levels, you will be pleased to know that the most effective way to naturally lower your cholesterol levels, as well as your uric acid levels, is to stay on the low-carb diet you just went back on. Excess carbohydrate turns on the enzyme that builds new cholesterol molecules in the liver…the very same enzyme that statins turn off! So you can achieve the same effect, without side effects or copays, by eating a low-carb diet, just as you are doing. As for gout and red meat, many people find that eating a low-carb diet takes care of gout attacks without needing to give up foods like red meat, but not all people. So if you still have gout attacks on a low-carb diet, you may need to also limit your protein intake, because excess protein turns into sugar in the liver and gets released into the bloodstream. If a low-carb diet doesn’t help you enough, you may want to look into a ketogenic diet, which limits protein as well. Good luck!

  • Alex

    I’ve been getting random lower back pain flare ups, and today found out I have high levels of gout (never had problem with feet). However I don’t drink (at all) I’m not obese, I hit the gym 6 times a week ish and eat well. The only thing I would say I eat a lot of is beef, and over Christmas (when the flare up occurred) I ate a lot of junk (sugary carbs).

    Is anyone else in a similar position? I have to change my diet and get retested in a month at the moment. I’m cutting out garabey carbs for January already anyway and now I’m going to reduce red meat too.

    Would you suggest carbs only and keep the meat in? Asi do eat ate last 5 portions of beef a week I think


    • Hello Alex

      Do you mean that your testing showed a high level of uric acid or that you were diagnosed with actual gout and told that your back pain was due to gout?

      Regardless, the food group most likely to be problematic is the carbohydrate group (particularly the rapidly-digested carbs like sugar, flour, fruit juice, white potato, refined cereals), so it’s great that you’re doing that already! Some people must also be careful with protein intake, as excess protein can be turned into sugar by the liver. If you focus only on the carbs for this month and leave the meat in, it could help you to figure out whether the meat needs to also be reduced or not…

      • Alex

        Thanks Dr. Ede. The upper threshold is 420 and i was at 440 (my bloods were taken during the end of a flare up if that makes a difference?)

        I have supplemented my diet with protein shakes for years now, well before the pain came and i was actually taking less protein over Christmas when the pain started.

        as i just showed high signs of gout, this doesnt mean that i have gout? the back pain could be something else? as from what ive read it doesnt seem to appear in the back very often, and when it does its normally found in the feet first? and my feet are fine and always have been


  • Donald MacLeay

    Adelle Davis has a good discussion of vitamin therapy for gout in Lets Get Well. Page 190.

  • Karen Noback

    I have had great success with a low purine diet as I am not allowed to take the meds for gout, I eat no meat except for chicken, I dont eat fish or shellfish and I dont drink alcohol i dont eat green veg like spinach or asparagus nor mushrooms beans or peas and i steer clear of yeast extract and I have been gout free for 3 years i have also been eating 10 cherries a day and upped my water intake. Before that I was pregnant with my son when I had my last attack 3 years ago but then a pregnant women are prone to attacks, before that i would have attacks just by looking at a steak or eating a spoonful of tuna so dont rule out diet by any means because that is all some people have to control it xxx

    • Mary

      Where do you get the cherries from when they are out of season?

      • Karen Noback

        Hi Mary I keep bags of frozen ones in my freezer and if i cant get frozen then tinned ones in light syrup not the heavy or in water when i can find it or when health food shops have the cherry juice on sale but cherries freeze well just remember to take the stone out before you freeze them or if store bought frozen ones i like to seperate them out in to daily portions then just take them out in the morning and let them defrost and them just eat them good luck hun xxx

  • I’m only 35 and I’ve been getting gout since I was 25. When I committed to a no meat diet and didn’t drink alcohol for 3 years I never suffer from bouts. (well I might eat meat 5 days out of 365 and have alcohol 1-2 days a year. But I’m not sure why this diet worked for me? I just don’t want to take the medicines prescribed for it. Interesting this article didn’t address the ideas of foods the help with Gout because everything I read seems to say Tart Cherry juice is good for people with Gout.

    • knuckles2007

      i too have gout… and i have had it now 5 years… i found it really hard to enjoy just the serving size of tart cherry juice and it may be good for us with gout but too much and it is a stocahache battle…

  • Bruce Blessinger

    Hi Dr Ede,
    What is worse for me alcohol or the grains and sugars used to make alcohol? Which is worse a high proof grain alcohol or beer? Are potatos considered a refined carbohydrate?

    • Hi Bruce

      Great questions!!!!

      1. Alcohol vs grains/sugars: hmmm…you have to choose your poison…neither is healthy, but most people tend to consume a lot less alcohol per day than sugars/grains. For gout, you’d have to experiment to see how each of these food groups affects you personally.

      2. Grain alcohol vs beer: this depends in part on whether you are sensitive to gluten or not, because beer contains gluten and grain alcohol does not. Beer is high in carbohydrate, which grain alcohol is not. So, I suppose, serving for serving, beer may theoretically be a bit safer? Just a guess…

      3. Potatoes are not technically refined (unless you’re talking about processed potato products like Pringles or instant mashed potatoes). However, potatoes are pure sugar in disguise, so they can raise blood sugar almost as much as pure glucose does, making them just as risky to people with gout and other diseases associated with insulin resistance as refined carbs.

    • subsistent1

      I have been able to overcome gout by eliminating fructose and carbs. I can drink distilled liquors without any attacks. i drink Gin….and a lot of it.

  • knuckles2007

    dear, dr. ede

    currently i am 29, i weigh 433 and i can’t seem to lose any weight… not only that i have been suffering from gout since 24 years old… today i am finally on the cooldown period of a double flareup (both feet)… is it ok to enjoy fresh [golden delicious] apples and tangelos (hybrid of tangerine and red grapefruit). on a very rare occasion i would eat warm/heated italian garlic bread… my dad, before he passed away, had us eating just about every bad food for a gout victim [whole dark wheat bread, heavy amounts of spinach{YUCK} and other high purine foods… and now i might be having to pass a kidney stone…


    i just can’t win can i…

    during a previous gout flare-up i couldn’t get to my dr., so my older sister got me some pure black cherry concentrate juice, but forgot to mention that a serving is VERY LITTLE amounts… and i was stuck having the runs… ruining several pairs of shorts… will i ever get well again…

    • Dear Knuckles2007,

      I am sorry to hear of your frustrating battle with gout and weight. You are not alone! I am curious to know if you have ever tried a low-carbohydrate diet and if so, what your experience was with it?

    • Malaena Medford

      Go Paleo or Ketogenic. I guarantee you will start to see results. I can provide nutrition guides for you as I am a nutritionist undergraduate in advanced nutrition and health studies. You can contact me on my Facebook, as well. I’m a published author so finding me shouldn’t be hard.

  • IMV

    do you have any recommendations for “serum uric acid” home testing kits, similar to glucose meters?

  • Chun Locke

    My colleagues were searching for DS-5002 earlier today and discovered a web service that hosts a huge forms library . If others are searching for DS-5002 too , here’s

  • Tim Heineman

    It has been know for more than 100 years that starvation and ketosis raise uric acid levels. There are many studies in PubMed. If ketones increase uric acid, there’s probably a healthy reason for it.

    Many studies suggest that in humans and primates, uric acid is a more important antioxidant than vitamin C. Primates have an order of magnitude higher uric acid levels than most mammals.

    Your comments on this would be welcome.

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