We have on PH an excellent thread on paleo, uric acid, and gout, with many great pointers, here: http://paleohacks.com/questions/988/the-connection-between-paleo-and-gout but I have one important question that is unclear to me:
the (paleo + modern-scientific) consensus seems to be that fructose is the primary cause of gout. BUT: if you have very high uric acid levels, although very low fructose/glucose/etc levels, are you still at risk for gout?
Very selfish reason for asking: just got my blood checked, first time since I went mostly paleo and first time since I started my mostly-offal diet. My sugar and cholesterol and inflammation-related numbers are off-the-chart amazing, I'm super happy. Except my uric acid # is off-the-chart terrible. Traditional interpretations would, I think, put me at super-high risk for gout now; but since I eat almost no fructose/sugar/etc, I'm not sure if I should be concerned about the high uric acid and change my eating patterns or not....
The paleo + modern-scientific consensus is not really as strong as you state it, it's more speculation that excessive fructose intake across a population may lead to increased gout incidence.
There are some serious confounding factors to take into account. We seem to have higher levels of uric acid than most other primates, and it may be related to our lifespan.
High uric acid concentrations could be a human specific adaptation for whatever reason, and in certain circumstances it brings about something negative (gout).
In The Sugar Fix, Richard Johnson, MD demonstrates that people with elevated uric acid are at higher risk for a lot more than just gout: high blood pressure, obesity, heart disease, stroke, kidney disease, and others. He and his team have been studying the effects of uric acid on health, mainly hypertension, for many years. His book grew out of the recognition that fructose elevates uric acid, but it's not the only factor.
If eliminating fructose is not doing the trick, Johnson recommends also avoiding foods high in purines. They have been known for some time to cause elevated uric acid levels. Unfortunately, your offal or organ meats are very high in purines. Beer is very high, as are certain seafoods such as anchovies, clams, herring, lobster, mackerel, mussels, oysters, sardines, scallops, and shrimp. He actually recommends eating these foods no more than once a month, if your uric acid is high.
As usual, no studies have been done on people eating paleo, so we don't know if it's the uric acid itself or the fructose/glucose causing or in combination with uric acid which results in gout. I'm inclined to believe the latter.
For what its worth, the wikipedia page for gout says that "most people with raised uric acid levels never develop gout."
Gout flair-up - any suggestions? 6 Answers