Q&A: Gout and Paleo

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Q: Is the Paleo diet acceptable for someone who has diabetes and gout?

A: The short answer is yes. Here’s the long answer. Gout is a painful condition that occurs when uric acid crystals accumulate around a joint, often the big toe, ankle, or knee.  According to the Mayo Clinic, “gout has long been associated with diet, particularly overindulgence in meat, seafood, and alcohol.” Oh! So that’s why whenever I over-indulge in salmon, with all its good fats, antioxidants, and protein, my big toe usually starts throbbing…  (You’ll have to excuse my cynicism with this one; conventional medicine’s take on this topic is SO off base.)

Anyway, sometimes people (often men and women over the age of 40) will just have one “gouty attack” and some people suffer frequent, debilitating pain in several joints.  Either way, gout is due to high levels of uric acid in your body.

Conventional “Treatments”
The conventional treatment for gout is NSAIDs (like ibuprofen), strong pain killers, prescription meds for inflammation and swelling, corticosteroids, and of course, a pharmaceutical to reduce uric acid blood levels.

Doctors may also tell you to stop eating foods that are high in purines, since purines convert to uric acid in your body. High purine foods include anchovies, sardines, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, and baking or brewer’s yeast.  Comparatively, meats and seafood all have only moderate amounts of purines, but the diet that conventional medicine practitioners prescribe to gout sufferers is low in all meat.

In fact, the diet they prescribe goes something like this: limit animal protein intake, eat more plant-based protein, don’t drink much alcohol, eat low-fat or fat-free dairy products, and eat more grains. The truth is that I don’t know anyone who overeats calf’s neck as their main animal protein source (one of the highest purine foods at 1260mg per 100g), but they’re telling you to eat soy beans (190mg of purines per 100g), which have MORE purines in them than beef sirloin (110mg of purines per 100g) or salmon (170mg of purines per 100g). It just doesn’t make any sense.

According to the Mayo Clinic, the “severe dietary restrictions made the gout diet hard to stick to. Fortunately, newer medications to treat gout have reduced the need for a strict gout diet.” Thank goodness. I mean, we wouldn’t want to look at the real causes of those high uric acid levels and try to work on those — we should just treat the pain and stifle the levels of uric acid, regardless of the side effects…

What we need to look at here is why uric acid levels are high. Is it because of the amount of uric acid that’s coming into your bloodstream from your liver (a mere 1/3 from diet and 2/3 from your body’s turnover of cells)?  Or is it because your kidneys aren’t excreting the uric acid as they should?

Kidneys’ Role
The fact that the person writing in has diabetes AND gout is not uncommon. In fact, gout is often associated with diabetes, metabolic syndrome, and insulin resistance because all of the above decrease the kidneys’ ability to excrete uric acid from the body. Because the Paleo diet helps to reverse insulin resistance, metabolic syndrome and diabetes, it would therefore decrease the amount of uric acid that is in your body; your kidneys can’t do their job when they’re overloaded with an acid-forming, sugar-coated standard American diet.  Diabetes is caused by eating too many refined, high-glycemic foods. You know the type — sugary sodas, refined flours in pastas, pastries, “sports” drinks, candy bars — sugar, sugar, sugar. The Paleo diet doesn’t have too many of those items on the menu.

Liver’s Role
So we’ve covered the excretion of uric acid by the kidneys; what about the role of the liver in creating too much uric acid? Will the Paleo diet help that? Consumption of sweeteners, including the ubiquitous high fructose corn syrup, increases the liver’s production of uric acid. The Paleo diet, which is incredibly low in sweet foods, much less sweeteners, would help to decrease the amount of uric acid being produced by the liver.

So yes, go ahead and try out the Paleo diet if you have gout. Please. Since conventional medicine’s advice will be to eat foods like low-fat dairy products that may actually increase insulin resistance, and cut out meat, which actually helps to decrease insulin resistance, I think that Paleo is a far superior option.