Q&A: Gout and Paleo

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.


  1. My Gout pain has been so bad in the past and I have been looking for information on relief for sometime. This post is just what I needed…Great information

  2. I have been doing 80% paleo for about 5 months, and I’ve lost about 35 lbs since beginning (weight loss, and overall improvement in general health, were the main reasons I went on the diet). Unfortunately, I have a history of gout, and while I had few problems with gout during this diet, a couple of weeks ago I had a short-term flare-up, and now I am having the worst flare-up of my life. It’s really bad. I’m in no way ready to abandon paleo (particularly because this flare-up came after a weekend of not being on the diet – if anything, I’m ready to commit to 100% paleo), but I do wonder if I should take it easy on the meat consumption while I’m actually in the midst of an acute attack. I’m just trying to get through this, as the NSAIDs are only making the pain (barely) tolerable. I’ve switched to a diet where I’m getting my protein from aged cheese, cottage cheese, high-fat greek yogurt, eggs, and some meat (not a lot), I’ve added some sweet potato into the mix, more nuts than before, lots of salad and veggies – still trying to avoid processed sugars and grains and legumes. Anyway, do you think I should just stay on a traditional paleo diet while in the midst of an acute attack? I mean, I’d do just about anything to get rid of this pain right now.

    1. Hi Dara,

      I’d say go as strict Paleo as you possibly can, especially take out that dairy and see if you improve. Stay away from those high glycemic foods like grains, legumes and too many starchy veggies for now during this flare up. Please keep us posted.

  3. Thank you for the comment, Neely. I have been staying away from most high-glycemic foods, same as before the attack, though I have added sweet potatoes (which I understand not to be high-glycemic, though not low either). The dairy is something I just started having instead of meat a few days ago when the attack struck me, so it certainly is not a cause (though high-fat yogurt is a common cheat for me). I doubt it’s making it worse, but who knows? I’ll try to stick with strict Paleo during the acute attack, but wow, these gout attacks pretty much make me fear afraid to eat any of the higher-purine foods. My foot still hurts like a @$#@%$@#. Ugh.

  4. The gout attack is slowly improving, but lingering. I’m on NSAIDs for the pain, and I thought I could go off a few days ago, but bad mistake, so I’m back on them. I’ve been mostly paleo compliant (with some plain yogurt), and I’m continuing to lose weight, which is good, I guess, but also something that is known to aggravate gout (being slim is good, the process of losing the weight, however, is known to aggravate gout). I must say, this is the longest acute attack I’ve had (and unusually, it hit both feet, though one much less than the other, thankfully). Anyway, any advice from a fellow paleo/primal enthusiast on what s/he did DURING an acute attack would be much appreciated. Thank you!

  5. To Dara:

    Google up: gout and citric acid.

    I started putting citric acid into my pot of tea every day to keep cups from getting stained, and my gout attacks stopped. I was puzzled. Then I googled it up. But nobody makes any money on citric acid. So much of our body chemistry is still to be discovered.

  6. After about three months of hell on my feet, the gout is gone. It’s fair to say I’ve reached a state of acute gout, and it’s fair to say that primary care physicians seem to know little about this condition other than what was taught 30 years ago and which has pretty much been disproven (e.g., don’t eat too much meat, eat a lot of whole grains, etc.). One common home remedy that seemed to help me a lot is to drink water with baking soda (bicarbonate). The theory is that this alkalinizes the body, allowing the uric acid crystals to dissolve, removing the cause of the inflammatory attack that causes pain in an acute gout attack. I didn’t try this until the end of my gout attack, when little attacks kept coming back every few days in different joints. This finally stopped the attacks for the most part. Of course, one should be careful not to try to glean too much from a non-controlled study with a sample size of one, but I’ll try it next time I get an attack. I was aware of citric acid being another home remedy, and this doesn’t surprise me. Occasionally you see advice out there saying not to take citric acid or citrus fruits with gout because they are acidic, and acidity facilitates gout. This is extremely poor advice and a good example of how a little knowledge can be a dangerous thing, because citric acid, when metabolized, actually produces byproducts that have an alkalinizing effect on the body. To this end, citric acid may be good for gout in the same way baking soda may be good. I’m not sure. Anyway, I’m back on a more fully paleo-compliant diet, and it’s working well. I’m trying to be careful not to lose too much weight quickly, because my doctor thinks that rapid weight loss triggered the gout, which seems like a reasonable conclusion to me. (Being slim and healthy is very good for gout, but the process of losing weight can certainly aggravate the condition.) Also, it seems that insulin sensitivity has been linked to gout, which would suggest that a paleo diet is a good way to go in dealing with the condition.

  7. Dara –
    Thank you for your great comments and following up. I am researching this diet plan for my husband and I. I have Celiac (thus gluten free) and he has gout. We are trying to see if the paleo diet will work for our family together. Honestly, the pain from gout attacks is SO bad (I can see it) and debilitating that I am afraid for him if we do this. Could you let me know how things are going for you after what appears to be almost a year since the initial posting?


  8. My husband has severe gout and doesn’t seem to believe me when I explain that Paleo is a total possibility. He seems to think having a salad, big steak and then cooked veggies for dinner is a worse option for himself than pasta with a little chicken and bread with a small salad. (this is what we ate last night going out).

    I tried to explain to him and he seems to think my choice was a bad one for himself. I keep trying to convince him that traditional wisdom on this – his list of bad uric acid foods, is not accurate anymore.

    Western medicine thinking is out of date and he’s not convinced.

    Can anyone point me to some articles? I really want to convince him.

  9. I am in theory a big supporter of the paleo diet but I’m suffering serious consequences of moving to the diet so I am starting to think there is more to learn about it. I have had kidney failure since I was a child as a result of a childhood illness. It was stable for 20 years and didn’t inhibit my life and I even played sport at an international level. I remain slim and healthy and have never indulged in fast food or sweet foods.

    4 months ago I learned about the paleo diet and made the change. Within 1 month my kidney function declined dramatically resulting in gout and other issues. After ignoring the doctors request to change my diet initially I eventually compromised. I didn’t drop the meat but I introduced some carbs back into my diet and my kidney function improved again.

    While I disagree with the medical world approach I think much of the paleo diet information focuses on the health issues caused by poor eating which can logically reverse with better eating and overlooks medical conditions unrelated to lifestyle and therefore leaves itself open to criticism and skepticism.

    I am still a supporter in principle but would like to see more research and information for people like me who don’t follow the usual unhealthy lifestyle to begin with but still have unhealthy lifestyle issues.

    1. Hi Claire – I’m so sorry about your situation. I’ve actually written about this in my high protein diet myths blog posts and my gout post. http://www.paleoplan.com/2011/04-22/meat-is-not-the-devil-high-protein/ and http://www.paleoplan.com/2011/04-01/qa-gout-and-paleo/

      Basically, you’re right. When you already have kidney failure, you can’t eat a high protein diet (more than 20% of your diet). The studies that scared everyone away from eating high protein diets because of kidney problems were actually all done on people who already had kidney problems, like yourself. Most “normal” people won’t have these issues with their kidney on a high protein diet.

      So you can definitely still eat Paleo, and as you’ve figured out, you just have to keep your protein lower than some other Paleo eaters. Thanks for bringing this up, and I wish you the best.

  10. i have had gout for about 8 years now. My gout is very sensitive. I have tried everything under the sun. You name it, South Beach, Atkins Diet. Raw Vegan (Which worked well but not that enjoyable) and everything else. I became a Lacto-Ovo Vegetarian about 3 years ago and has worked very well. Before then I would suffer from gout attacks about once or twice a month. Now the only time I get a gout attack is when I have beans on accident or I don’t drink enough water. Which is maybe once or twice a year. I do not take any regular medication unless I have or feel a gout attack coming on, which is like I said about once or twice a year. I do notice that I do have respiratory issues and mucus when I have dairy so I have been contemplating cutting that out. I miss seafood a lot. I tried adding fish to my diet several months ago and that failed in a 2 week long gout attack. Never again. So I think the closest I can get to Paleo is to cut out grains, dairy and become essentially a Ovo-Vegetarian. Better than being a Vegan. But if thats how I was built to eat. Thats just how it is for me to be healthy. We are all made differently. I believe do what works for you. Just make sure it isn’t a processed, fried, overly starchy food diet. Explore who you are Physically, Mentally, Spiritually and find the balance and harmony within. Which I believe will in turn equal good health.

  11. Another great help for gout is daily doses of Tart cherry juice concentrate (don’t add sugar) – just a shot every day has helped my guy greatly. I’m working on getting him paleo — but it’s taking time!

  12. I’m 39 5’11” 200 lbs male. I’ve been getting gout 1 or twice a year now for the last several years. When I get severe gout flare ups, its be cause I’m not eating healthy. Too much meat, sugar, fruits, nuts, hard workouts, dehydration, and not managing stress properly. So now I try to balance everything by sleeping 7-8 hrs consistently. Eating balanced meals consistently. Avoiding trigger foods. Exercise moderately 3-4 times a week with weights and cardio for 60-70 min total. Drinking 2-4 liters of water daily. So far it’s been better and controlled. I don’t take any meds for gout. I only took pain relievers during the painful times when I really felt desperate. I feel I’m gout free when I stay balanced and careful of my daily approach. I can no longer act and think I’m in my teens, 20’s, early 30’s like eating fast food, drinking alcohol, indulging on junk and sodas, and partying all night without enough sleep as much as I want. Those days are gone or minimized for me and I have to accept it. I use to love to run and play basketball. But those were really hard on my joints. And once my joints were irritated I would have flare ups. So now I have to find other activities that are low impact and easier on the joints. Basically taking it easier nowadays trying to find my YinYang to avoid pain and injuries especially gout as much as possible. It’s key to build your own personal routine consistently and carefully and slowly adjusting to new routines to adapt the changes your body has to make. I’ve never listened to my body more carefully as I do now. Now I understand when my aunts and uncle say they wish they were 18 lol because I’m saying that now lol. Eat cleaner, stay active, get plenty of rest and good water. Hope this helps.

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