Is Your Diet "Rich" Enough to get Gout?

Gout - the "Disease of Kings" - The incidence of gout has risen considerably in the last 40 years, affecting millions of men and women in the U.S. Gout is a type of painful inflammatory arthritis which is often referred to as the "disease of kings" because it was seen long ago in affluent classes such as aristocrats/royalty like kings and queens. King Henry VIII of England suffered from this painful condition as well as other prominent figures like Benjamin Franklin and Thomas Jefferson. Ancient art of these affluent societies reveals how overweight and ill they were. Because gout is an affliction seen predominantly in those that consume diets rich in meat, poultry, fish and seafood, typically only the upper class developed it since they were the only ones that could afford to purchase these products. Thus, gout is considered a "disease of affluence." Gout is essentially unknown in countries of the world that consume a diet based on starchy whole plant foods.

Today, Everyone Eats Like Royalty

However, "Everyone today eats like royalty" says Dr. John McDougall. "People are overweight and sick because they eat like aristocrats of old. Kings and queens 3,000-4,000 years ago suffered the same diseases...yet everyone can eat rich foods now." Breakfast consists of bacon, eggs, toast with butter and a glass of milk. Lunch is a double-cheese burger with fries and a milk shake, and dinner is thick steak with dessert. As a result, the incidence of gout has doubled in the U.S. over the past 20 years. Without question, the rise of incidence parallels to the sharp rise in the rates of obesity. Gout attacks are also more prevalent in those consuming popular high protein (meat-centered) diets like Atkins, South Beach, etc.

Foods High in Purines Raise Levels of Uric Acid

Gout is a type of inflammatory arthritis which typically involves the base of the big toe yet other parts such as the knees, hands, and elbows can also be affected. This form of arthritis is caused by a build-up of uric acid crystals in the joint(s), resulting in swollen, red and extremely painful joints. Excessive uric acid levels in the blood promote the development of these crystals. This is called hyperuricemia. This build-up can be a result of the body producing too much uric acid as well as the kidneys not being able to eliminate it. However, all forms of animal flesh are high in uric acid precursors (called purines) which is the greatest influence in the development of gout. According to an article in the New England Journal of Medicine, “Higher levels of meat and seafood consumption are associated with an increased risk of gout" whereas vegetable sources of protein and purines do not contribute to the risk of having an attack of gout. Consuming alcohol, sugar sweetened beverages and foods high in fructose are also believed to contribute to uric acid crystal formation. Click here to see the purine content in meat vs plant foods. 

Popular low-carb diets are very high in purines. They also cause rapid weight loss which "facilitates the release of uric acid from the body fat." Some patients who have made the transition to a plant-centered diet develop gout for this same reason. Uric acid accumulates in the fat stores, thus, when the fat stores dissolve, uric acid is circulated into the bloodstream. Low-carb diets can also cause dehydration which can burden the kidneys in an attempt to eliminate the higher levels.

High-Fat Diets and Obesity Increases Risk

Dustin Rudolph PharmD, author of The Empty Medicine Cabinet, highlights a study in his article Gout - Prevention and Treatment Options which compared the prevalence between chronic disease and gout. Rudolph writes, "Not surprisingly, the following medical conditions were associated with a higher incidence of gout – heart disease, diabetes, hypertension, hyperuricemia, obesity, kidney disease, elevated triglycerides and cholesterol levels, menopause, and undergoing surgery. Most of these diseases are a direct cause of the high-fat Western diet. Keeping excess body fat off may be of benefit due to its role in the inflammatory process of gout. Recent research has shown that an increase in uric acid crystal deposits in the joint(s) may not be enough in and of itself to cause the excruciating pain that goes along with gout. Instead, it is believed that free fatty acids—like those obtained when eating high-fat meals—acts synergistically with uric acid crystals in the joints to promote the inflammatory process leading to the inevitable debilitating pain of gout attacks."

Preventing and Treating Gout

Avoiding animal flesh is strongly recommended for preventing attacks of gout as well as consuming more vegetables (which is associated with a lower risk.) Dr. McDougall summaries in his article Gout is on the Rise, "Based on population studies and the well-established cause-and-effect mechanisms between animal muscles and gout, I believe the common form of diet-caused gout cannot occur in people who follow a McDougall-type diet. However, most people have large storages of uric acid in their tissues which may take months of healthy eating and associated weight loss to dissolve away."

Treatment options which involve the use of pharmaceutical drugs for acute attacks of gout are discussed in both Dr. McDougall's and Dustin Rudolph's articles.

Additional Resource: 

(1) What Makes us Sick?

(2) Diet, the Only Hope for Arthritis

(3) How to Treat Gout