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I seem to keep hearing of people getting gout on both LC and Paleo diets. Of course some might seize upon this fact, and claim it as "proof" that we are not adapted to a very high purine/meat diet. (I think most paleo folks already know to avoid excess fructose which also causes gout) But the fact is that gout has been found in other animals besides humans, such as crocodiles and T-Rex skeletons. So if even a pure carnivore acting 100% within it's evolutionary niche can get gout, then perhaps no surprise some humans do as well, when eating lots of meat and seafoods high in purines?

- T-Rex Had Gout

- Crocs with Gout - PDF Doc

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Obesity, high fat diet, alcohol and inactivity set you up for gout. Paleo diet increases the risk of gout for those that live a sedentary lifestyle. – thhq Sep 28 at 2:32

2 Answers

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Dietary purine makes up a very minor rise in serum urate (http://www.jrheum.org/content/29/7/1350.full.pdf).

The diet is not to blame. Lack of exercise, and lack of vitamin C are typically the primary causes.

Where could humans possibly get get vitamin c? fresh herbs, dark leafy greens, cruciferous vegetables, citrus fruits, and berries are all very paleo. I know a lot of people on LC atkins style that get gout and blame the diet. The real reason is they dropped cereals that had been "fortified" with vitamin C, and didn't replace it with anything. simply eating a salad or some straw berries would have done the trick.

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As for T-Rex, I've got no clue.... – CD Aug 23 at 19:52
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And were they feeding those crocodiles anything except pig lungs, livers, and spleens? That's not eating head to tail! Totally un paleo, guys. – Mscott Aug 23 at 20:10
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Agreed. Purines are higher in fish anyway, and alcohol and fructose is the much bigger statistical influence on gout. Of course the lower carb may or may not lower your urine clearance according to some very short term studies (due to urine output of ketones), but as we all know, once your fat adapted, urinary ketones go down, making "room" for uric acid again. – Jamie Aug 24 at 3:54
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Where are you getting the idea that "lots of people" are getting gout on Paleo? I know at least one person who has "cured" themselves of gout with a Paleo diet. (I use "cured" because you never know when it'll come back...but he hasn't had a single attack since starting.)

The literature is very clear: gout is a problem of underexcretion of urate, not overproduction of urate.

Bonifacio Álvarez-Lario and Jesús Macarrón-Vicente
Rheumatology (2010) 49 (11): 2010-2015.
http://rheumatology.oxfordjournals.org/content/49/11/2010.full

"Uric acid (UA) is the end product of purine metabolism in humans due to the loss of uricase activity by various mutations of its gene during the Miocene epoch, which led to humans having higher UA levels than other mammals. Furthermore, 90% of UA filtered by the kidneys is reabsorbed, instead of being excreted. These facts suggest that evolution and physiology have not treated UA as a harmful waste product, but as something beneficial that has to be kept."

Pathogenesis of Gout
Ann Int Med October 4, 2005 vol. 143 no. 7 499-516
http://www.annals.org/content/143/7/499.full?ijkey=9d498ba985d9d77015d0e365eec67dd4be379803&keytype2=tf_ipsecsha

"Hyperuricemia results from the overproduction of urate (10%), from underexcretion of urate (90%), or often a combination of the two.

What causes the body to hold onto urate? The primary culprits are alcohol...and fructose. (There is also a role of systemic inflammation...as UA is an antioxidant, the body seems to want to hold into it in response to oxidative stress, including exercise. Therefore: exercise + energy bars/GU/drinks/Gatorade = gout problems.)

Reducing purine intake addresses the 10% issue of overproduction, not the 90% issue of underexcretion.

JS

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Keep hunting for devils...fructose causes gout???? Come on man. – thhq Sep 28 at 2:08
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Fructose raises serum uric acid (sUA) levels, at least in part because it shares transporters with uric acid. This is basic science and is not controversial. See, for instance: nature.com/ng/journal/v40/n4/full/ng.106.html For its role in gout, see, for instance: ajprenal.physiology.org/content/290/3/F625 jasn.asnjournals.org/content/17/12_suppl_3/… edrv.endojournals.org/content/30/1/96.full +++ But thanks for the downvote, thhq! – J. Stanton - gnolls.org Sep 28 at 2:32
Lustig is rather firm on fructose having a role in gout. His viral YouTube video he stetches out the pathway in the where fructose leads to rise in uric acid pretty convincingly to a layman like me. – Anondson Sep 28 at 2:58
This is right, regardless of specifics, its about an overly low clearance. – Jamie Sep 28 at 3:43
Maybe fructose could trigger it in an obese alcoholic eating a high fat diet. But not for the rest of us on the planet. – thhq Sep 28 at 18:51
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