3

votes

High Uric acid levels, Doctor told me to cut out red meat!

Answered on September 12, 2014
Created February 09, 2011 at 9:41 AM

Okay so I got my blood work done about 3 days into the diet (Maybe over three weeks ago now) so I could get a baseline. I just got the results back TODAY. My doctor called me in and told me that I had high uric acid levels.

URATE - 585 HI Reference Range: 230-480 umol/L Alanine Transaminase (ALT) 51 HI Reference Range: 12-49

So I was bummed. So apparantely you avoid red meat because of the high purine levels in them. Here are some foods that are high in purine: Sardines, Asparagus, Bacon, Beef, Cauliflower, Chicken, Crab, Duck, Pork, Rabbit, Salmon, Spinach, Tripe, Tuna.

Jesus. That's most of my foods that I eat on a daily basis right there.... With the exception of eggs.... Even sardines which I've been shoving down my throat, nose pinched, these past few weeks is on the red list.

What am I supposed to do? What am I supposed to eat now?

Also, since this was taken a little while ago in the beginning of the diet I was still drinking some pop and other sugary snacks. I'm hoping this high uric acid is due to my high intake of fructose in the past specifically of the HFCS variety. I have noticed that my eczema has started flaring up lately like crazy so maybe its a sign I'm developing gout or some sort of inflammation. Before I started paleo I had to put a topical cream on my face every night that would control my flareups. If I skipped it a night my face would be super red the next day. I actually enjoyed a week or two long period of not having to apply any cream on my face at night. Halleuljah, I know how you normal folks feel.

Unfortunately my eczema returned with a vengance. I did eat a slice of old cheese a the day before yesterday. Other than that my diet has been the same with the exception of taking magnesium and vitamin C supplements. The magnesium supplement (Natural Calm) contains no gluten, fructose, or anything like that. The vitamin C supplement (EmergenC) might contain like 6g of sugar but thats inconsequential.

So what do you guys recommend that I do?

I also migth have to postpone the leangains style intermittent fasting I was going to toy with. I don't know what sort of effects IF can have on my uric levels.

6ec8d30130a6fb274871314533b5536b

(581)

on September 14, 2011
at 03:59 AM

Thanks for this! More information to show my dad. :)

Medium avatar

(39831)

on August 25, 2011
at 06:17 PM

Technically, fructose metabolism results in the breakdown of purines as well. AMP->IMP->Inosine->Hypoxanthine->Xanthine->Uric Acid

11838116de44ae449df0563f09bd3d73

(655)

on August 25, 2011
at 01:15 PM

What controls my uric acid level Alpha Lipoic Acid. This supplement does not seem to work for everyone. Your uric acid level and other inflammatory conditions are almost certainly related.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 10, 2011
at 01:42 PM

Another downvote without comment or reason. Mature.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:46 PM

ramp up the Vitamin C slowly, excessive intake will not only cause a flush, but Vitamin C is rather uncomfortable when you release excess. Burns.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:45 PM

strongly disbelieve that it causes gout or excessive uric acid buildup.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:45 PM

@Gracken, totally depends on your definition of paleo, its a VERY broad spectrum... you dont have to eat high protein or high anything, its more about avoiding toxins IMO. Do what you like, just keep in mind that White Rice is nutritionally Void, if you want starch, shoot for something with Vitamins and Minerals. I highly recommend an Elimination diet, limiting all potential allergens, expecially Fructose in your case. then slowly introducing things back in to see how you react. Very very few people have a legitimate issue with Red Meat, but that doesnt mean no one does. I just strongly disbel

58987593d41d8a148c86690fd6a4ee67

(105)

on February 09, 2011
at 07:03 PM

With my already high ALT levels I suspect that I am overworking an unhealthy liver by going VLC. I will adjust my diet by including 300-400 calories of white race a day, and by eliminating all fruits, all together. I will also limit my red meat to about 25% of my protein intake. I will retest in a month and if my uric levels have normalized then I will start increasing my red meat intake once more.

58987593d41d8a148c86690fd6a4ee67

(105)

on February 09, 2011
at 07:02 PM

Stephen doesn't the paleo diet induce physiological insulin resistence? Also from "The Perfect Health Diet" 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. [7]

Cf5c9ba3c06cf300ae23c52778dfd317

(545)

on February 09, 2011
at 04:25 PM

Fructose is the cause, high-purine the exacerbater. Remove the cause, and there is nothing to exacerbate.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 03:08 PM

@Hernia, the references are there, and there are more that aren't there, meat as the culprit is ancient history(scientifically). It's not medical advice, it's education. Absolutely take it back to your doctor... Anyone with a doctor that they don't have difficult discussions with, needs a new doctor, that's MY advice!

100fd85230060e754fc13394eee6d6f1

(18696)

on February 09, 2011
at 02:50 PM

Did they actually test uric acid, or was it blood urea nitrogen (BUN)?

21084e275703e9a3909dafa28e5d29b5

(1103)

on February 09, 2011
at 02:16 PM

I see where you're coming from Uncle Herniation but I think Stephen-Aegis gave good advice/links for Gracken to take back to his doctor to have an open dialogue OR perhaps get a second opinion. Personally I think having blood tests done 3 days into being paleo would be come back crazy for anyone who has been eating SAD.

461281c9092d3cb306b46831064e2fc4

on February 09, 2011
at 12:10 PM

Or it could be a combination of meat and fructose. It's one thing to question your doctor and ensure you understand things properly. It's another thing to get heavy-handed medical advice from "Stephen-Aegis."

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7 Answers

15
4b97e3bb2ee4a9588783f5d56d687da1

on February 09, 2011
at 09:58 AM

S.A.D. Doctors... give S.A.D. Advice.

Its not Red Meat, its Fructose.

From Gary Taubes:

The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels. A nearly vegetarian diet, for instance, is likely to drop serum uric acid levels by 10 to 15% percent compared to a typical American diet, but that???s rarely sufficient to return high uric acid levels to normality, and there is little evidence that such diets reliably reduce the incidence of gouty attacks in those afflicted.(4) Thus, purine-free diets are no longer prescribed for the treatment of gout, as the gout specialist Irving Fox noted in 1984, ???because of their ineffectiveness??? and their ???minor influence??? on uric acid levels.(5) Moreover, the incident of gout in vegetarians, or mostly vegetarians, has always been significant and ???much higher than is generally assumed.??? (One mid-century estimate, for instance, put the incidence of gout in India among ???largely vegetarians and teetotalers??? at 7%.)(6) Finally, there???s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.

Insulin resistance relation

By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. ???It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,??? Reaven wrote, ???the more insulin-resistant an individual, the higher the serum uric acid concentration.???

and Fructose:

The second piece of evidence is much less circumstantial: simply put, fructose increases serum levels of uric acid. The ???striking increase??? in uric acid levels with an infusion of fructose was first reported in the Lancet in the late 1960s by clinicians from Helsinki, Finland, who referred to it as fructose-induced hyperuricemia.(20) This was followed by a series of studies through the late 1980s confirming the existence of the effect and reporting on the variety of mechanisms by which it came about. Fructose, for instance, accelerates the breakdown of a molecule known as ATP, which is the primary source of energy for cellular reactions and is loaded with purines. (ATP stands for adenosine triphosphate; adenosine is a form of adenine, and adenine is a purine.) And so this in turn increases formation of uric acid. Alcohol apparently raises uric acid levels through the same mechanism

The writeup and references are over on Tim Ferriss' blog: http://www.fourhourworkweek.com/blog/2009/10/05/gout/

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:45 PM

strongly disbelieve that it causes gout or excessive uric acid buildup.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 03:08 PM

@Hernia, the references are there, and there are more that aren't there, meat as the culprit is ancient history(scientifically). It's not medical advice, it's education. Absolutely take it back to your doctor... Anyone with a doctor that they don't have difficult discussions with, needs a new doctor, that's MY advice!

Cf5c9ba3c06cf300ae23c52778dfd317

(545)

on February 09, 2011
at 04:25 PM

Fructose is the cause, high-purine the exacerbater. Remove the cause, and there is nothing to exacerbate.

58987593d41d8a148c86690fd6a4ee67

(105)

on February 09, 2011
at 07:03 PM

With my already high ALT levels I suspect that I am overworking an unhealthy liver by going VLC. I will adjust my diet by including 300-400 calories of white race a day, and by eliminating all fruits, all together. I will also limit my red meat to about 25% of my protein intake. I will retest in a month and if my uric levels have normalized then I will start increasing my red meat intake once more.

461281c9092d3cb306b46831064e2fc4

on February 09, 2011
at 12:10 PM

Or it could be a combination of meat and fructose. It's one thing to question your doctor and ensure you understand things properly. It's another thing to get heavy-handed medical advice from "Stephen-Aegis."

21084e275703e9a3909dafa28e5d29b5

(1103)

on February 09, 2011
at 02:16 PM

I see where you're coming from Uncle Herniation but I think Stephen-Aegis gave good advice/links for Gracken to take back to his doctor to have an open dialogue OR perhaps get a second opinion. Personally I think having blood tests done 3 days into being paleo would be come back crazy for anyone who has been eating SAD.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:45 PM

@Gracken, totally depends on your definition of paleo, its a VERY broad spectrum... you dont have to eat high protein or high anything, its more about avoiding toxins IMO. Do what you like, just keep in mind that White Rice is nutritionally Void, if you want starch, shoot for something with Vitamins and Minerals. I highly recommend an Elimination diet, limiting all potential allergens, expecially Fructose in your case. then slowly introducing things back in to see how you react. Very very few people have a legitimate issue with Red Meat, but that doesnt mean no one does. I just strongly disbel

58987593d41d8a148c86690fd6a4ee67

(105)

on February 09, 2011
at 07:02 PM

Stephen doesn't the paleo diet induce physiological insulin resistence? Also from "The Perfect Health Diet" 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. [7]

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 10, 2011
at 01:42 PM

Another downvote without comment or reason. Mature.

3
Da4badc775f5cb8153476683b80877de

on February 09, 2011
at 05:20 PM

Quote from a 2002 article on gout and uric acid in the Journal of Rheumatology (http://www.jrheum.org/content/29/7/1350.full.pdf):

There is growing evidence that a low energy, calorie restricted, low carbohydrate (40% of energy), high protein (120 g/day, or 30% of energy) diet, with unsaturated fat (30% of energy) and high dietary fiber, is more beneficial...

...in reducing uric acid levels (as well as triglycerides, LDL, etc).

Uric acid is more soluble in an alkaline environment, so some people take sodium bicarbonate in water.

2
510bdda8988ed0d4b0ec0b738b4edb73

(20888)

on August 25, 2011
at 03:17 PM

Stephen-Aegis said it all, and I usually don't add another answer with the same information, but I really wanted to emphasize that he's right, my +1 on the answer isn't enough in this case. If you have high fructose, the liver-kidney signalling is all screwed up and you hoard uric acid which gets deposited in places like your toe and it hurts. The purines may be the source of the uric acid, but your kidneys will naturally clean it out right if they get the right signals. It's the same "salt = high blood pressure" story. Your kidneys will do a great job regulating sodium levels but only if they get the right signals. And those signals are screwed up by carbs (or more accurately fructose).

Medium avatar

(39831)

on August 25, 2011
at 06:17 PM

Technically, fructose metabolism results in the breakdown of purines as well. AMP->IMP->Inosine->Hypoxanthine->Xanthine->Uric Acid

6ec8d30130a6fb274871314533b5536b

(581)

on September 14, 2011
at 03:59 AM

Thanks for this! More information to show my dad. :)

1
Ef9f83cb4e1826261a44c173f733789e

on August 25, 2011
at 11:48 AM

My n=1.

I had terrible gout. My doctor gave the same typical advice. I decided to do the opposite: high meat, VLC. I've been almost flare-up-free the past year. I still had mild discomfort about twice in the past year, but nothing compared to what I've experienced in the past.

I had my uric acid checked a year ago, and I'll do it again sometime soon to compare.

1
6ec8d30130a6fb274871314533b5536b

(581)

on August 25, 2011
at 11:29 AM

This was very informative, thanks! I have been Paleo for about a month now, and get a lot of opposition from family members. My dad read an article yesterday in a magazine talking about Paleo and how "unsafe" it was, and cited a build-up of uric acid due to increased protein consumption as a side-effect of the Paleo diet. I highly doubted the legitimacy of the article, especially since it gave the impression that Paleo is a highly carnivorous diet, but clearly it's not. So, I decided to see what people at Paleohacks had to say, and I'm really glad I did. The references were especially helpful, and this will help me present another side of information to my dad.

1
Medium avatar

on February 09, 2011
at 06:20 PM

I'd cut out all fructose and replace the emergen-c with a sugar-free C supplement and take at least 3 grams of it a day. Vitamin C increases urate excretion. If you don't get the desired reduction, then increase the C supplementation further.

4b97e3bb2ee4a9588783f5d56d687da1

(22913)

on February 09, 2011
at 07:46 PM

ramp up the Vitamin C slowly, excessive intake will not only cause a flush, but Vitamin C is rather uncomfortable when you release excess. Burns.

1
C6395b675eb093a900055bc16eed2225

on February 09, 2011
at 09:58 AM

My first question to you would be. How do you feel? I stopped worrying too much about tests and started listening to my body unless you have some sort of condition you probably don't have to worry about it. Particularly so when you are just 3 days in on paleo....

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