5

votes

Do People Getting Gout on Paleo Diet Indicate It's a Bad Match for Us?

Answered on September 12, 2014
Created August 23, 2012 at 7:35 PM

I seem to keep hearing of people getting gout on both LC and Paleo diets. Of course some might seize upon this fact, and claim it as "proof" that we are not adapted to a very high purine/meat diet. (I think most paleo folks already know to avoid excess fructose which also causes gout) But the fact is that gout has been found in other animals besides humans, such as crocodiles and T-Rex skeletons. So if even a pure carnivore acting 100% within it's evolutionary niche can get gout, then perhaps no surprise some humans do as well, when eating lots of meat and seafoods high in purines?

- T-Rex Had Gout

- Crocs with Gout - PDF Doc

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 10:22 PM

thhq: And which "doctors, not the Wizard of Oz" are you quoting in support of your bizarre idea that fructose has nothing to do with gout, despite sharing a renal transporter with UA? (Note that Kruse is a doctor, no matter what you think of him...so you'll need a different criterium if you want to exclude his opinions.) +++ Note that I'm not blaming gout entirely on fructose, either...as I said explicitly in my other comment, fructose is just one contributor.

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 10:15 PM

mscott: Since gout risk is significantly increased by soft drink consumption (even at 5-6 per week, or less than one per day), it seems likely that the problem isn't being "hypercaloric" (whatever that means): it's ingesting a bolus of fructose more quickly than your liver can clear it. This makes sense, since fructose is extremely reactive in vivo and UA is an antioxidant. Result: anything that increases oxidative stress (and, therefore, causes the kidneys to hold onto UA) makes a gout attack more likely...including (but certainly not limited to) a large bolus of fructose.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on September 28, 2012
at 07:31 PM

http://jn.nutrition.org/content/142/5/916.long "These analyses do not support a uric acid-increasing effect of isocaloric fructose intake in nondiabetic and diabetic participants. Hypercaloric fructose intake may, however, increase uric acid concentrations"

Medium avatar

(10611)

on September 28, 2012
at 07:03 PM

Slanted hacks like this make paleos look like Luddites. I don't go to Taubes, Lustig and Kruse when I want useful medical advice. I go to a doctor not the Wizard of Oz.

Medium avatar

(10611)

on September 28, 2012
at 06:51 PM

Maybe fructose could trigger it in an obese alcoholic eating a high fat diet. But not for the rest of us on the planet.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on September 28, 2012
at 03:43 AM

This is right, regardless of specifics, its about an overly low clearance.

D7cc4049bef85d1979efbd853dc07c8e

(4029)

on September 28, 2012
at 02:58 AM

Lustig is rather firm on fructose having a role in gout. His viral YouTube video he stetches out the pathway in the where fructose leads to rise in uric acid pretty convincingly to a layman like me.

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 02:32 AM

Fructose raises serum uric acid (sUA) levels, at least in part because it shares transporters with uric acid. This is basic science and is not controversial. See, for instance: http://www.nature.com/ng/journal/v40/n4/full/ng.106.html For its role in gout, see, for instance: http://ajprenal.physiology.org/content/290/3/F625 http://jasn.asnjournals.org/content/17/12_suppl_3/S165.full http://edrv.endojournals.org/content/30/1/96.full +++ But thanks for the downvote, thhq!

Medium avatar

(10611)

on September 28, 2012
at 02:32 AM

Obesity, high fat diet, alcohol and inactivity set you up for gout. Paleo diet increases the risk of gout for those that live a sedentary lifestyle.

Medium avatar

(10611)

on September 28, 2012
at 02:08 AM

Keep hunting for devils...fructose causes gout???? Come on man.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on August 24, 2012
at 03:54 AM

Agreed. Purines are higher in fish anyway, and alcohol and fructose is the much bigger statistical influence on gout. Of course the lower carb may or may not lower your urine clearance according to some very short term studies (due to urine output of ketones), but as we all know, once your fat adapted, urinary ketones go down, making "room" for uric acid again.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on August 23, 2012
at 08:10 PM

And were they feeding those crocodiles anything except pig lungs, livers, and spleens? That's not eating head to tail! Totally un paleo, guys.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on August 23, 2012
at 07:52 PM

As for T-Rex, I've got no clue....

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3 Answers

10
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on August 23, 2012
at 07:51 PM

Dietary purine makes up a very minor rise in serum urate (http://www.jrheum.org/content/29/7/1350.full.pdf).

The diet is not to blame. Lack of exercise, and lack of vitamin C are typically the primary causes.

Where could humans possibly get get vitamin c? fresh herbs, dark leafy greens, cruciferous vegetables, citrus fruits, and berries are all very paleo. I know a lot of people on LC atkins style that get gout and blame the diet. The real reason is they dropped cereals that had been "fortified" with vitamin C, and didn't replace it with anything. simply eating a salad or some straw berries would have done the trick.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on August 23, 2012
at 07:52 PM

As for T-Rex, I've got no clue....

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on August 24, 2012
at 03:54 AM

Agreed. Purines are higher in fish anyway, and alcohol and fructose is the much bigger statistical influence on gout. Of course the lower carb may or may not lower your urine clearance according to some very short term studies (due to urine output of ketones), but as we all know, once your fat adapted, urinary ketones go down, making "room" for uric acid again.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on August 23, 2012
at 08:10 PM

And were they feeding those crocodiles anything except pig lungs, livers, and spleens? That's not eating head to tail! Totally un paleo, guys.

1
00c8eb3f6e6a1884216044ca29cf868a

on September 27, 2012
at 10:51 PM

Where are you getting the idea that "lots of people" are getting gout on Paleo? I know at least one person who has "cured" themselves of gout with a Paleo diet. (I use "cured" because you never know when it'll come back...but he hasn't had a single attack since starting.)

The literature is very clear: gout is a problem of underexcretion of urate, not overproduction of urate.

Bonifacio ??lvarez-Lario and Jes??s Macarr??n-Vicente
Rheumatology (2010) 49 (11): 2010-2015.
http://rheumatology.oxfordjournals.org/content/49/11/2010.full

"Uric acid (UA) is the end product of purine metabolism in humans due to the loss of uricase activity by various mutations of its gene during the Miocene epoch, which led to humans having higher UA levels than other mammals. Furthermore, 90% of UA filtered by the kidneys is reabsorbed, instead of being excreted. These facts suggest that evolution and physiology have not treated UA as a harmful waste product, but as something beneficial that has to be kept."

Pathogenesis of Gout
Ann Int Med October 4, 2005 vol. 143 no. 7 499-516
http://www.annals.org/content/143/7/499.full?ijkey=9d498ba985d9d77015d0e365eec67dd4be379803&keytype2=tf_ipsecsha

"Hyperuricemia results from the overproduction of urate (10%), from underexcretion of urate (90%), or often a combination of the two.

What causes the body to hold onto urate? The primary culprits are alcohol...and fructose. (There is also a role of systemic inflammation...as UA is an antioxidant, the body seems to want to hold into it in response to oxidative stress, including exercise. Therefore: exercise + energy bars/GU/drinks/Gatorade = gout problems.)

Reducing purine intake addresses the 10% issue of overproduction, not the 90% issue of underexcretion.

JS

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 10:15 PM

mscott: Since gout risk is significantly increased by soft drink consumption (even at 5-6 per week, or less than one per day), it seems likely that the problem isn't being "hypercaloric" (whatever that means): it's ingesting a bolus of fructose more quickly than your liver can clear it. This makes sense, since fructose is extremely reactive in vivo and UA is an antioxidant. Result: anything that increases oxidative stress (and, therefore, causes the kidneys to hold onto UA) makes a gout attack more likely...including (but certainly not limited to) a large bolus of fructose.

D7cc4049bef85d1979efbd853dc07c8e

(4029)

on September 28, 2012
at 02:58 AM

Lustig is rather firm on fructose having a role in gout. His viral YouTube video he stetches out the pathway in the where fructose leads to rise in uric acid pretty convincingly to a layman like me.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on September 28, 2012
at 07:31 PM

http://jn.nutrition.org/content/142/5/916.long "These analyses do not support a uric acid-increasing effect of isocaloric fructose intake in nondiabetic and diabetic participants. Hypercaloric fructose intake may, however, increase uric acid concentrations"

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on September 28, 2012
at 03:43 AM

This is right, regardless of specifics, its about an overly low clearance.

Medium avatar

(10611)

on September 28, 2012
at 02:08 AM

Keep hunting for devils...fructose causes gout???? Come on man.

Medium avatar

(10611)

on September 28, 2012
at 07:03 PM

Slanted hacks like this make paleos look like Luddites. I don't go to Taubes, Lustig and Kruse when I want useful medical advice. I go to a doctor not the Wizard of Oz.

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 02:32 AM

Fructose raises serum uric acid (sUA) levels, at least in part because it shares transporters with uric acid. This is basic science and is not controversial. See, for instance: http://www.nature.com/ng/journal/v40/n4/full/ng.106.html For its role in gout, see, for instance: http://ajprenal.physiology.org/content/290/3/F625 http://jasn.asnjournals.org/content/17/12_suppl_3/S165.full http://edrv.endojournals.org/content/30/1/96.full +++ But thanks for the downvote, thhq!

00c8eb3f6e6a1884216044ca29cf868a

on September 28, 2012
at 10:22 PM

thhq: And which "doctors, not the Wizard of Oz" are you quoting in support of your bizarre idea that fructose has nothing to do with gout, despite sharing a renal transporter with UA? (Note that Kruse is a doctor, no matter what you think of him...so you'll need a different criterium if you want to exclude his opinions.) +++ Note that I'm not blaming gout entirely on fructose, either...as I said explicitly in my other comment, fructose is just one contributor.

Medium avatar

(10611)

on September 28, 2012
at 06:51 PM

Maybe fructose could trigger it in an obese alcoholic eating a high fat diet. But not for the rest of us on the planet.

-1
1b80bdb00033caf5a49ebc7a6da4afc9

on September 27, 2012
at 02:43 PM

It s actually a great and useful piece of info. I am glad that you simply shared this helpful information with us. Please stay us up to date like this. Thank you for sharing.

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