Okay so I got my blood work done about 3 days into the diet (Maybe over three weeks ago now) so I could get a baseline. I just got the results back TODAY. My doctor called me in and told me that I had high uric acid levels.
URATE - 585 HI Reference Range: 230-480 umol/L Alanine Transaminase (ALT) 51 HI Reference Range: 12-49
So I was bummed. So apparantely you avoid red meat because of the high purine levels in them. Here are some foods that are high in purine: Sardines, Asparagus, Bacon, Beef, Cauliflower, Chicken, Crab, Duck, Pork, Rabbit, Salmon, Spinach, Tripe, Tuna.
Jesus. That's most of my foods that I eat on a daily basis right there.... With the exception of eggs.... Even sardines which I've been shoving down my throat, nose pinched, these past few weeks is on the red list.
What am I supposed to do? What am I supposed to eat now?
Also, since this was taken a little while ago in the beginning of the diet I was still drinking some pop and other sugary snacks. I'm hoping this high uric acid is due to my high intake of fructose in the past specifically of the HFCS variety. I have noticed that my eczema has started flaring up lately like crazy so maybe its a sign I'm developing gout or some sort of inflammation. Before I started paleo I had to put a topical cream on my face every night that would control my flareups. If I skipped it a night my face would be super red the next day. I actually enjoyed a week or two long period of not having to apply any cream on my face at night. Halleuljah, I know how you normal folks feel.
Unfortunately my eczema returned with a vengance. I did eat a slice of old cheese a the day before yesterday. Other than that my diet has been the same with the exception of taking magnesium and vitamin C supplements. The magnesium supplement (Natural Calm) contains no gluten, fructose, or anything like that. The vitamin C supplement (EmergenC) might contain like 6g of sugar but thats inconsequential.
So what do you guys recommend that I do?
I also migth have to postpone the leangains style intermittent fasting I was going to toy with. I don't know what sort of effects IF can have on my uric levels.
S.A.D. Doctors... give S.A.D. Advice.
Its not Red Meat, its Fructose.
From Gary Taubes:
The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels. A nearly vegetarian diet, for instance, is likely to drop serum uric acid levels by 10 to 15% percent compared to a typical American diet, but that’s rarely sufficient to return high uric acid levels to normality, and there is little evidence that such diets reliably reduce the incidence of gouty attacks in those afflicted.(4) Thus, purine-free diets are no longer prescribed for the treatment of gout, as the gout specialist Irving Fox noted in 1984, “because of their ineffectiveness” and their “minor influence” on uric acid levels.(5) Moreover, the incident of gout in vegetarians, or mostly vegetarians, has always been significant and “much higher than is generally assumed.” (One mid-century estimate, for instance, put the incidence of gout in India among “largely vegetarians and teetotalers” at 7%.)(6) Finally, there’s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.
Insulin resistance relation
By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.”
The second piece of evidence is much less circumstantial: simply put, fructose increases serum levels of uric acid. The “striking increase” in uric acid levels with an infusion of fructose was first reported in the Lancet in the late 1960s by clinicians from Helsinki, Finland, who referred to it as fructose-induced hyperuricemia.(20) This was followed by a series of studies through the late 1980s confirming the existence of the effect and reporting on the variety of mechanisms by which it came about. Fructose, for instance, accelerates the breakdown of a molecule known as ATP, which is the primary source of energy for cellular reactions and is loaded with purines. (ATP stands for adenosine triphosphate; adenosine is a form of adenine, and adenine is a purine.) And so this in turn increases formation of uric acid. Alcohol apparently raises uric acid levels through the same mechanism
The writeup and references are over on Tim Ferriss' blog: http://www.fourhourworkweek.com/blog/2009/10/05/gout/
Quote from a 2002 article on gout and uric acid in the Journal of Rheumatology (http://www.jrheum.org/content/29/7/1350.full.pdf):
There is growing evidence that a low energy, calorie restricted, low carbohydrate (40% of energy), high protein (120 g/day, or 30% of energy) diet, with unsaturated fat (30% of energy) and high dietary fiber, is more beneficial...
...in reducing uric acid levels (as well as triglycerides, LDL, etc).
Uric acid is more soluble in an alkaline environment, so some people take sodium bicarbonate in water.
Stephen-Aegis said it all, and I usually don't add another answer with the same information, but I really wanted to emphasize that he's right, my +1 on the answer isn't enough in this case. If you have high fructose, the liver-kidney signalling is all screwed up and you hoard uric acid which gets deposited in places like your toe and it hurts. The purines may be the source of the uric acid, but your kidneys will naturally clean it out right if they get the right signals. It's the same "salt = high blood pressure" story. Your kidneys will do a great job regulating sodium levels but only if they get the right signals. And those signals are screwed up by carbs (or more accurately fructose).
My first question to you would be. How do you feel? I stopped worrying too much about tests and started listening to my body unless you have some sort of condition you probably don't have to worry about it. Particularly so when you are just 3 days in on paleo....
I'd cut out all fructose and replace the emergen-c with a sugar-free C supplement and take at least 3 grams of it a day. Vitamin C increases urate excretion. If you don't get the desired reduction, then increase the C supplementation further.
This was very informative, thanks! I have been Paleo for about a month now, and get a lot of opposition from family members. My dad read an article yesterday in a magazine talking about Paleo and how "unsafe" it was, and cited a build-up of uric acid due to increased protein consumption as a side-effect of the Paleo diet. I highly doubted the legitimacy of the article, especially since it gave the impression that Paleo is a highly carnivorous diet, but clearly it's not. So, I decided to see what people at Paleohacks had to say, and I'm really glad I did. The references were especially helpful, and this will help me present another side of information to my dad.
I had terrible gout. My doctor gave the same typical advice. I decided to do the opposite: high meat, VLC. I've been almost flare-up-free the past year. I still had mild discomfort about twice in the past year, but nothing compared to what I've experienced in the past.
I had my uric acid checked a year ago, and I'll do it again sometime soon to compare.
Gout flair-up - any suggestions? 6 Answers