Gout

Gout is a metabolic disease involving sharp crystals of uric acid (urate) forming in joints or other areas of the body. Gouty attacks come on episodically, causing joint swelling and pain. Pseudogout is a similar condition which involves calcium pyrophosphate crystals.

Overview
Action Plan
Ask The Doctor
See Also

Overview

Gout can affect both women and men but is much more common in men and overall affects approximately 4% of the U.S. population.¹ Signs and symptoms of a gouty attack may include:

Severe and sudden pain in joint(s) (even light touch is painful)
Commonly involves joint at base of big toe
Arthritis pain comes on within hours and may last for several days
Involved joints may be warm, red, and swollen (also present with infections)

How do you know if you are going to get a gouty attack? Here are some risk factors to be aware of:

High uric acid level (can be tested by your doctor)
Dehydration
Certain medications can increase uric acid (diuretics, aspirin, niacin, cyclosporine A)
Excessive intake of alcohol
Excessive intake of animal products which are high in purines, such as seafood, meats, poultry, and organ meats (although plant foods have purines as well, they are not associated with gouty attack risk)²
Excessive intake of high fructose corn syrup (sweetened beverages, etc.)
Kidney disease (difficulty getting rid of uric acid)
Having certain factors can increase risk of pseudogout (hyperparathyroidism, hemochromatosis, hypomagnesemia, osteoarthritis, use of proton pump inhibitor medications, and others)
Genetic factors (rare)
Rapid weight loss (although not typically observed from weight loss, observed from eating a Nutritarian diet)
A recent injury
Being overweight or obese

Often when someone gets a gouty attack, there are multiple factors working together to reach a threshold. Overwhelmingly, the lifestyle factors that are modifiable (diet, water intake, alcohol use, sweetened beverage use) are by far the strongest factors contributing to gout risk. A Nutritarian lifestyle is a sure way of reducing this risk automatically, even in those with a predisposition to the disease.

References

Duskin-Bitan H, Cohen E, Goldberg E, et al. The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort. Clin Rheumatol 2014, 33:549-553.
Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004, 350:1093-1103.

Action Plan

Diet

A Nutritarian eating style addresses the important factors related to gout, including:
- Low animal product intake
- Low processed food intake (no sweetened beverages)
- Low alcohol use
- Increasing vegetable intake creates a more alkaline environment which neutralizes acids such as uric acid (gout) and pyrophosphoric acid (pseudogout)
- Helping you reach an ideal weight
Although high purine foods are associated with risk of a gouty attack, it appears only animal-based purine intake is associated significantly with risk of an attack¹
Stay hydrated
Avoid alcohol

Review secondary risk factors with your doctor, such as medications and diseases.

References

Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004, 350:1093-1103.

Ask The Doctor

The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

I’ve been on and off a Nutritarian diet for a while now. I have chronic gout and my uric acid levels are 10.3. My rheumatologist wants me to begin Allopurinol. How quickly can I expect my uric acid levels to drop with a strict Nutritarian diet WITHOUT the medicine? Should I take Allopurinol AND do the diet, or will that cause a severe drop resulting in worsening attacks?

I usually wait about a month on a Nutritarian diet before discontinuing the Allopurinol on patients requiring it in the past. In your case, you may not even have to start the medicine if you really stick with a Nutritarian diet. Doing both the medication and the diet won’t necessarily hurt you, but all medications have their risks, and you likely will see dramatic benefits in a week or two. So, if you eliminate all animal products at this point and follow a Nutritarian diet strictly, your uric acid levels will be dramatically lower soon. Drink a full glass of water between each meal too. Check your uric acid level again next month, and let’s see how it improves and how you feel.

I would like to know what I can do to treat gout.

Avoid animal products and all processed foods and oils. Limit spinach, asparagus, and mushrooms to two to four oz./day. Limit fruits higher in fructose (apple, grapes, melon, pear, and dried fruit). Limit beans to one cup/day until the swelling and pain are gone. Continue to avoid animal products until you’re better, then limit to six oz./week. Stay hydrated. Drink four oz. of tart cherry juice two to three times per day. It has been shown to reduce inflammation and pain related to gout. Get lean and eliminate belly fat.