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Get out the Gout!

Spiked rods of uric acid crystals photographed...

Image via Wikipedia

So this post was brought on by a question from a friend who has the pleasure of being afflicted with Gout.  Must be terrible, thank my lifestyle choices for not exposing me to that sort of pain.  In case you know someone with this problem as well (and you very well might as Gout cases are increasing every year), we’re going to discuss why gout occurs and what you can do about it.

So first things first, What is Gout?  Gout is hyperuricemia.  Which means your body has too much uric acid in it.  How does this happen?  Well you’re either making/consuming too much uric acid (via the liver and from your diet) or you aren’t excreting enough (through the kidneys).  This can lead to uric acid exceeding its solubility in the body and materializing in places it shouldn’t be, most commonly in the joint where the big toe meets the foot.  Unfortunately it doesn’t materialize into nice spongy soft happiness, it materializes into sharp, crystal-needle shaped, pain-inducing sadness.  But why is this happening?

I’m going to let my chiropractic/logical side shine through here and ask you a question.  Do you think your body was designed to get gout, and that after X amount of time you were meant to get it ?  Or do you think that what you eat and how you live might matter?  Ok then.  Coming from the stance that we aren’t meant to get gout, and that we’re meant to experience radiant health, what are we doing wrong that is causing this problem then?

Without knowing what the patients current diet is like, I’m led to assume that the typical gout patient has heard, “don’t eat protein, because it has high levels of purines and therefore will lead to high levels of uric acid.” from the people currently managing their health.  It’s logical thinking, but ultimately it doesn’t work (otherwise you’d hear about people resolving their gout with this approach, right?).

The problem with not eating any meat out of fear of the purines, is that eating dense protein sources stimulates your kidneys to reduce the concentration of uric acid in your body.  The other problem with eliminating meats/dense sources of protein is that you’re then left with fat and carbs as your two sources of calories.  The gout guidelines of what is safe to eat also think that eating sweets, and other great sources of sugar is a good idea and “OK” for gout.  It isn’t.  Gout is often seen as an additional player in Metabolic Syndrome (AKA Syndrome X).  This comes to fruition by following the “Fat is the devil, eat more ‘complex carbs’ mentality”.  This is unfortunately one of the main reasons why there are more obese, overweight people and a greater incidence of autoimmune disorders in the world than ever before.  But that’s for another day.

Insulin resistance is a huge player as insulin is a potent inhibitor of uric acid excretion by the kidneys.  Most important in this resistance (especially in the case of fructose) is our ridiculous consumption of sugar and high fructose corn syrup (HFCS).  Despite the commercials by the corn growers saying “it’s just as healthy as sugar!” (anyone else find that sounds odd?) HFCS is not healthy.  Full stop.  Fructose stimulates purine synthesis by lowering the inorganic phosphate levels which normally regulate uric acid production in the liver, which leads to higher uric acid synthesis.  And since fructose is selectively metabolized by the liver, eating a diet high in fructose sets the liver up for insulin resistance.  This resistance leads to more free-flowing insulin, and now we have fructose causing an increase in uric acid production, as well as a decrease in uric acid excretion.  Fructose’s metabolism in the liver also leads to lactic acid production, which eventually reaches the kidneys and competitively inhibits the excretion of uric acid.  Yay!  Fructose is quite the effective multitasker!

Finally the part that really might make you dislike having gout, is that alcohol is also implicated in inhibiting uric acid excretion via the production of  lactic acid.  Alcohol is also great at using up those inorganic phosphates in the liver that like to regulate the production of uric acid.  So alcohol isn’t quite the Deion Sanders of gout that Fructose is, but it hits you with a double whammy.

So, now what?

Well, now you eat the diet that you are meant to eat.  Being humans we seem to be the only species that eats what we shouldn’t be eating, without noticing the health effects.  So, if you want to be healthy, you’d eat what a healthy person eats right?  If you found a platypus in your backyard and needed to take care of it, you’d look up what healthy, wild platypus’ eat and feed it that, right?  Well, you’re my found platypus and I’m telling you to eat what the other, healthy platypus’ are eating.  Keep in mind if you have certain things that light you up and make you feel awful, well, avoid those things!  While we are all extremely similar genotypically, there is still some play phenotypically (which makes life fun!) that leads us to need to tinker and play with what we’re eating until we find what works for us.

What you should eat:

  • Meat.  Wild game, poultry, red meats, something that used to live a great life.  Preferably wild caught, organic, free range, etc.  Take it easy at first and work into it.  Don’t try the 72oz. steak challenge, our diet still provides 1/3 of our bodies uric acid, but we need the dense protein to stimulate the kidneys to excrete more uric acid.
  • Vegetables.  Eat them.  If you think “dang, I’m eating a LOT of veggies here”, you probably still aren’t eating enough.  Find which ones you like, try new ones.  Avoid corn and peas, as they aren’t veggies, they’re a grain and legume, respectively.  Don’t go TOO nuts with potatoes, sweet potatoes, or squash, they’re just a little higher in starch, and we’re trying to create some insulin sensitivity.
  • Fruit.  Don’t go overboard,  fruits main sugar is fructose.   But fruit are great for satisfying a sweet tooth, and avoiding crushing a Coke, or other crappy food that is super high in HFCS or sucrose.  Try to incorporate more avocado and coconut products in your diet.  They’re high in healthy fats and they’re delicious and filling.
  • Nuts & Seeds.  They’ve got lots of fat in them so can be a little calorie heavy as people can generally put away a lot of nuts and seeds.  They also tend to skew the omega 6 to omega 3 ratio in an unfavourable direction.  But as a garnish, the fats are satisfying and they taste pretty good.

Drink:

  • Water.  Tea.  That’s about it.

DO NOT CONSUME:

  • CRAP – i.e. candy, soda/pop, fruit juices, straight sugar
  • Alcohol – Just stay away from it for a while.  Try to eliminate it for 30 days at least, and then go light (if you must).  Avoid beer and drink something clear (tequila, vodka, rum).
  • Grains – they’re poison (lectins, phytates) tainted, nutrient-sparse and carb HEAVY.  They’re like fructose in that they’re great at multitasking; they destroy your digestive system while robbing you of minerals AND they spike your insulin.  The only things the grains are better than is the stuff in the “crap” category.
  • Legumes – they’re full of phytic acid and they’re a crappy source of incomplete protein.  If you absolutely MUST eat them, soak them overnight and then slow cook them.
  • Rice & Pasta – they’re also nutrient poor and carbohydrate dense.  Pasta and rice have their own lectins, and will wreak havoc on your digestive system, you want things that will improve digestion not destroy it.

In addition to the dietary recommendations, get some regular activity (walks, light hike, whatever you like to do that involves moving) and workout intensely once or twice a week.  Try to stay warm (to avoid uric acid crystal formation), and get some good sleep (8-9 hours in a BLACKED OUT room).  And I want to mention one last time, ease into this, find what works for you and what doesn’t (within the allowed parameters) and give it some time.  Like anything in life worth having, this will take time and effort.

All the best,

Dr. Ball

p.s. I have to give credit to Dr. Loren Cordain, Robb Wolf, Tim Ferris and Gary Taubes for providing a lot of this information through blog posts, podcasts, newsletters and books!  All four of them have great books and I highly recommend them for everyone!