Question: A client of mine is concerned about consuming organ meats, shellfish and full-fat dairy because he’s had several attacks of gout during times when he was eating “rich” foods, (specifically crabmeat, crawfish and cheesecake). He has high triglyceride levels (400) and a family history of diabetes. He is fairly active but also smokes cigarettes.
Answer: The understanding of gout gets into some of the most interesting questions about the history of medicine and the understanding of physiology and its relationship to human disease. It is also interesting because there are many misconceptions that abound about gout, among both laymen and medical professionals. Gout is one of the oldest and probably most painful diseases known to mankind. We know of cases of gout dating back at least 500 years as some of the most notorious of the England’s monarchs were apparently afflicted with the disease. There are treatises explaining the causes and treatments of gout that also date from the Middle Ages. The typical description of a patient with gout was a wealthy, corpulent aristocrat, particularly one with an enormous appetite for food, drink and women. It was almost always associated with men, and in fact still has a male predominance, and was considered a consequence of overindulgence.
The symptoms of gout are intermittent, excruciating attacks of pain in the joints, although typically each gouty episode only affects one joint at a time. The most common joint affected is the joint at the base of the big toe, which often becomes red, swollen, hot and so painful that the patient cannot even bear the weight of the bedsheets on his affected toe. Other joints, particularly the knees and elbows, can also be affected, but, again usually one at a time. The individual episodes usually last about two weeks then subside, only to recur at some seemingly random time in the future. The episodes can vary from every few months to every few years or longer. In some cases, the symptoms do not go entirely away between episodes and the patient has some degree of joint pain all the time.
In the twentieth century, through the use of microscopic examination of the fluid removed from affected joints of those with gout, the “real” cause of gout was identified. That is, in the inflamed, painful joints pointy crystals of uric acid create the excruciating pain so vividly described by those with gout. In some patients, there is so much uric acid in their system that they develop yellowish chalk-like deposits around the joints or in other places such as the ear lobes. The blood of patients with gout often, but not always, contains elevated levels of uric acid, a fact that usually confirms the diagnosis of gout.
The next step in unraveling the mystery of gout was to find out how this excessive uric acid is produced and why it is associated with a “gluttonous” lifestyle. It turns out that uric acid is a by-product or a breakdown product of purine, a type of protein found in many common foods. It therefore seems logical to conclude that gout is caused by excessive protein intake, particularly of proteins that are rich in purines, such as organ meats, fatty fish, shell fish and game.
As a result of this information patients are put on low-protein, or at least low-purine, diets and given drugs that prevent the formation of uric acid, or stimulate its excretion through the kidneys. Typically, patients also receive advice to choose lean meats, low-fat dairy products and limit fat intake.
This simple explanation, however, does not account for all the facts about gout. For example, high-protein intake is not necessarily connected with obesity so why are many gout patients overweight?. Also, we now know that gout attacks can occur with almost any change in diet, even to a better diet, or even to a lower-protein diet. In fact, it seems that the precipitating factor is often change, even the particulars of the change. And finally, there is a connection with fat, as your doctor suggested, although the solution is not to eat less fat.
The newer theories about gout recognize the fact that the disease is not simply a result of high-protein intake. For example, we have discovered that uric acid levels are high in those patients with syndrome X, otherwise known as insulin resistance. This means that excessive carbohydrate consumption, particularly of refined flour and sugar, foods that in previous times were solely the domain of the wealthy, can also raise the uric acid levels and precipitate gout. This fact also explains the frequent finding of obesity in those suffering from gout.
Another overlooked factor is the fact that traditional peoples always balanced protein intake with plentiful fat intake as well as gelatinous soup broths. Thus, gout is better understood as a situation of excessive protein intake compared to the fats and gelatin intake, two factors which balance the protein intake. This is why people with historically high protein intake who also ate lots of fats and soup broths, with no refined carbohydrates, rarely if ever suffer from gout.
Finally, it will probably come as no surprise to the readers of Wise Traditions that the specific nutrient that seems to prevent the buildup of uric acid is vitamin A, a fat-soluble vitamin that is particularly associated with the kidney. In fact, gout can be seen as a problem of the kidneys not being able to excrete enough of the uric acid to prevent the buildup, rather than simply a matter of excessive protein intake.
In my years of treating patients with gout, a program of decreasing protein intake along with liberal use of all the usual animal fats and the regular use of gelatinous stocks has been the key to preventing uric acid buildup and further attacks of gout.
As for other medicines, cherry juice is a virtual specific for preventing uric acid buildup and further attacks of gout. I have patients with gout take 1 teaspoon 2 times per day of cherry juice concentrate (without the sugar), literally for the rest of their lives. I also make sure they take 1 teaspoon per day of high-vitamin cod liver oil to supply the vitamin A, which antagonizes the uric acid buildup and also nourishes the kidneys. Of course, the patient should avoid refined carbohydrates and alcohol (which contributes to syndrome X).
As for medicines, I use arginex from Standard Process at a dose of 1-2 tablets three times per day. Arginex is made from fermented beets and helps stimulate excretion via the kidneys. For acute attacks, I use the antiinflammatory Boswellia comp from Mediherb 1-2 tablets three times per day. Hopefully, with these measures your client will be able to overcome the tendency for these painful attacks.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Winter 2004.
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Hi, I have been transitioning to higher nutrient density foods as per the advice on this site for over a year now, and have become afflicted with gout. I was actually suspecting the higher fat and protein intake, especially vitamin a. I eat limited refined carbs. I have also started suffering from anxiety, which usually worsens when I get a gout flare up. Am I overdoing it? I know that fat soluble vitamins can build up in your system. Should I observe some kind of veggies only fast for a time?
You might have a parasitic infection, or something else of the like. Switching your diet can cause deep seated illnesses to show their head as your body is healing from the abuse of a lifetime of poor food. Fat soluble vitamins from food sources do not build up in the body in the same way that synthetic fat soluble vitamins do.
HI Tricia- I noticed your reply as I was searching for my husband who just developed gout for the 3rd time — we started eating liver and that was the issue. I took me a lot of time to find an accurate purine food chart – finally 10pages of it… all the other list are terrible. He has also been drinking lots of tequila on weekends and topped it off with a donut –
we are using standard process products – phosfood liquid that breaks up crystals – artichoke extract and I ordered celeryseed. My husband has elevated blood sugar for 10 years – this damages the kidneys. He also have vit A defiiency ( I am nutritionist) I will not be giving him organ meats in the future – I am giving him nordic naturals cod liver oil now. He is alos prone to dehydration – overeating- not chewing his food – hope any of this is helpful – the kidneys are damaged that is why they can not process the purines Marlese
Uric acid is a naturally formed waste element in the body. Gout is a painful form of arthritis. It is mostly caused by deposits of uric acid in the joints. We can prevent this disease by controlling our weight and avoid drinking too much alcohol. I was a victim of gouty arthritis. I survive with the help of InflammaGo. It is natural and non-addictive. I also used Cherry juice for the faster healing. I got rid of gout and I am now able to do what I want.
“Arginex is made from fermented beets”,so wouldn’t beet kvass work too?
All things fermented or aged beans meat most beef is 30 days old when it gets to grocery store to be cut up then sold shrimp is frozen an can be months old soda pop alcohol aged or fermented gas pr poo produces higher uric acid. Fresh is GOOD MEAT OF VEGETABLE OR FRUIT. FRESH
Good to know charles — fermented is worse!
Purines are NOT proteins – they are nucleic acids. Proteins are entirely different macro-molecules composed of amino acid residues. Purines are organic compounds that do not have any amino acid residues incorporated in to their structure.
This is an extremely important point to get straight because it is an extremely basic biochemistry fact and there is no protein metabolism pathway that ends in uric acid; protein deamination produces urea, but this is not the same compound as uric acid. Some insects, reptiles, and birds inter-convert these compounds but humans do not.
Nucleic acid metabolism, however, ends in production of uric acid. Uric acid has beneficial properties in humans, such as acting as an antioxidant. It only causes problems when the processes controlling its metabolism and/or excretion fail and it accumulates sufficiently to crystallize. When you look at a histologic slide of uric acid crystals under a microscope, it is very obvious why gout flares are so painful!
Again, this is an extremely important biochemistry point. Proteins and nucleic acids are fundamentally different macromolecule classes. This is like from the first chapter of any biochemistry book. If you have any questions, please feel free to reply. I am a second year medical student and generally think this group is on point with regard to nutrition.
Hello, I need some advice. My husband has been suffering with a foot and ankle injury off and on for a few years now. We are not really sure of the cause. I wonders if it has anything to do with the fact that he jumped off some bleachers when he was a teenager, because he remembers it hurting really bad and bruising some but he could still walk on it. He did not go to a doctor though so I cannot tell you what was wrong. But since at least a few times of the year his ankle and foot swell and it is very hard for him to walk on it. He is obese and we are trying to eat better. I have been trying to feed him the nourished foods, what we can afford anyway. But the worst flare up he had was when we were doing keto. And surprisingly I gave him bone broth, because you are supposed to have lots of that on keto. And it didn’t seem to matter. I did use just antibiotic free chicken so I don’t know if that makes a difference in regards to bone broth. Anyhow I don’t know if low carb is the cause? I added raw milk back into our diet. But he doesn’t have it every day. Should it be a daily thing? And how much? We did go to a doctor recently and they said he did have a high amount of uric acid . So they think it probably was gout. And they advised he go on their diet (the SAD diet) but I didn’t want to do that. And we still pretty low carb because my husband wants to keep losing weight. I guess if you could advise me on what foods would help. I think he may actually have gout and the food is just not right what I am giving him. Also he generally works night shift but in the weekend he is off so is sleep schedule is all over the place. And this week he is training so he is during the day. I don’t know if that would mess with anything. Any advice would be much appreciated.
Hello. I suffer from FMF. FAMILIAL MEDITERRANEAN FEVER. I take colcrys twice a day for this, but I recently had a terrible flare up. Colcrys is the same medication used to treat gout. Do you have any info that might help me?
I would suggest you contact a functional or holistic medical doctor who can better asses and advise. This is beyond the scope of this forum. The only suggestion we might have, and this is a shot in the dark, but could avoiding inflammatory foods such as sugar, pasteurized and conventional dairy, vegetable oils, and even grains, perhaps help? You may try contacting Dr. Thomas Cowan; he may at least be able to point you in the right direction.
Hi, I was reading.about gout and Dr. Cowan said to take Cherry Juice. Is that just any cherry juice? I always heard it needed to be tart cherries. Just need some clarification please.
Also, what is high vitamin cod liver oil? Is that fermented cod liver oil?
Thanks!
Don Smallman