My doctor thinks I have gout; I should get the uric acid blood result back next week.
Assuming it is gout, I have the option of trying to lower uric acid levels by 1) taking a prescription drug (allopurinol), or 2) by diet.
Old school diet advice is to limit animal protein (obviously not paleo). From my research here and elsewhere, I understand that fructose and alcohol are a bigger problem for uric acid levels.
I'd be happy to avoid fructose and alcohol, but not happy to avoid my grass fed beef.
So, with all that said:
Would you take take a prescription drug just so you could eat paleo, or would you go on a high carb, low protein diet to lower the uric acid levels.
Thanks for any thoughts,
asked byCaveMan_Mike (3275)
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on July 29, 2013
at 07:58 PM
I would recommend checking out this: http://perfecthealthdiet.com/category/disease/gout/
The post is about the dangers of being too low-carb.
From Paul Jaminet (link above):
"One difference between a ketogenic (or zero-carb) diet and a normal diet is the high rate of protein metabolism. If both glucose and ketones are generated from protein, then over 150 g protein per day is consumed in gluconeogenesis and ketogenesis. This releases a substantial amount of nitrogen. While urea is the main pathway for nitrogen disposal, uric acid is the excretion pathway for 1% to 3% of nitrogen. 
This suggests that ketogenic dieters produce an extra 1 to 3 g/day uric acid from protein metabolism. A normal person excretes about 0.6 g/day. 
In addition to kidney stones, excess uric acid production may lead to gout. Some Atkins and low-carb Paleo dieters have contracted gout."
elf again -sorry for the funky formatting, I can't put things in quotes like normal because of a browser issue.
Anyway, I also found this on their site, which is an interesting conversation about gout between Barry and Paul: http://perfecthealthdiet.com/2010/10/book-is-available-at-amazon-and-barnes-and-noble/
From PHD site: "Do you guys recommend anything in your diet to fight gout? I???m trying to keep from going on the drug for it, Uloric, since I???m worried about the side effects and what chain of events they might set off.
Many thanks, Barry"
Reply Paul Jaminet November 16, 2010 at 11:52 pm Hi Barry,
"Well, you have to try to eliminate fructose. Polyunsaturated fats should be strictly limited. I don???t think purines are as bad as the doctors do, but there???s nothing wrong with a low protein diet for a bit.
Safe starches and fats are good.
Alkalinizing foods like lemon juice might help. Drink lots of water. Avoid alcohol."
Reply Poisonguy November 17, 2010 at 5:42 am "Barry, you may also want to google:
Gout: The Missing Chapter from Good Calories, Bad Calories"
Reply bvanclief November 17, 2010 at 9:46 am
I read that ???Missing Chapter From Good Calories, Bad Calories. Very interesting and thanks for pointing it out. I was getting to be at my wit???s end.
I???m not obese, far from it, as a 62 year old guy at 5???9???, I weigh around 145 pounds.
I went on Mark Sisson???s ???Primal Blueprint??? diet in July, to help my allergies, not really to lose weight (I was about 157 pounds at the time) which meant cutting out my daily Coke, plus the couple of Pepperidge Farm Sausalito cookies a day I was eating, however I did replace those sweets with grapes and almonds, which may have increased my fructose levels???or not, since the daily Coke was gone. On the other hand, I did lose 5 pounds almost instantly and a couple weeks later, several more. It was about that time that I had a gout attack, the morning after a vodka and pomegranate juice.
Not sure what all this means regarding my insulin sensitivity, since I kind of think the weight loss means I may not be too sensitive.
Should also mention that gout runs in the family; Dad had it.
So, the rapid weight loss may have played a part in the recent attack and current elevated uric acid level, since it may have served to concentrate uric acid and/or dehydrate me a little. Also, alcohol clearly dehydrates, which would also concentrate uric acid.
I???m going to try cutting out most of the fruit I???ve been eating now and see if that helps, before going on Uloric, which is a drug and permanent regimen that I fear.
Again, thanks much for your help in this. I know it???s important one way or the other to lower uric acid levels, to prevent kidney damage.
I only hope that when I cut fruit out of my diet that I don???t lose even more weight, which might cause my uric acid levels to stay elevated. That???s actually kind of a concern. I???m going to start eating more rice and potatoes, for sure."
Reply Paul Jaminet November 17, 2010 at 10:31 am Hi Barry,
"Another thing I forgot to mention is vitamin C. High-dose vitamin C can reduce uric acid levels. Try 4 g/day or so.
Personally I would try vitamin C and alcohol/fructose removal before considering a permanent drug.
It should be possible to maintain 145 lb with safe starches and fats. Do you do any resistance exercise? That would help. Also, the C might help, since vitamin C deficiency induces weight loss."
Elf again: So--> try Vitamin C, stay away from fructose, and perhaps more PHD style levels of protein (between 0.5-1 lb per day) and see if that helps. also hydration like beef broth?
Are you Very low carb/Zero carb?
Also I wanted to add that Robb Wolf always says Paleo is macronutrient-agnostic, meaning you don't have to be lowcarb. (See posts from him around Dec 2012/Dec 2013 on his experiences, part 1,2,3 with Very low-carb)
With all the arguments around here about kitavans, !Kung, Inuit, etc. some people just do better on more carbs and less meat. I actually like eating beef broth/aspics/gelatin based protein more than muscle meat sometimes, and definitely prefer fatty cuts to muscle meat.
When I do eat muscle meat, I grind heart, which is an idea i got from chris masterjohn.
on July 29, 2013
at 06:24 PM
Well, if it was me, I would first just try the low fructose and alcohol thing, and then retest. No reason to go beyond what works. If that ends up not working though couldn't you just go lower protein and higher fat or higher starch, still with grassfed beef in your diet, just smaller portions of the lean cuts?
on July 29, 2013
at 06:27 PM
They also say that red meat and eggs are bad for cholesterol...I eat both daily (and a good amount) and my HDL is at 161. I would say try it WITH the beef and if there's still problems THEN rethink your diet
on July 29, 2013
at 07:46 PM
Animal protin, and especially liver have purine, but dietary purine makes up a very minor rise in serum urate (http://www.jrheum.org/content/29/7/1350.full.pdf).
Alcohol, Low levles of Vitamin C, and poor exercise habits can induce gout -- I would focus on fixing those first.
on July 29, 2013
at 06:50 PM
Diet (no alcohol/fructose, lessen load on liver) + medication is probably the best course of action. Gout, though, is a symptom of a larger problem, and prescriptions for gout do not treat the underlying problem.