Gout: Is it Meat, or Metabolic Syndrome?

I’ve never experienced a gout attack, but if common graphical representations are to be believed, it feels like there are shards of broken glass embedded in your joints, or like someone’s holding a flamethrower on full blast and aiming it right at your big toe. For whatever reason, the big toe seems to be the joint that suffers the worst in gout, but the condition can manifest in other joints as well.

Conventional medicine holds that animal proteins and alcohol are major triggers for gout, so typical advice for those who suffer from gout is to reduce consumption of alcohol and animal protein—red meat and seafood, in particular.

Part of the rationale for these recommendations is that gout results from an abnormal accumulation in the blood of a compound called uric acid. At high blood concentrations, uric acid can crystallize and be deposited in the joints, and these uric acid crystals are responsible for the pain, swelling, and other fun stuff that comes along with gout. And a major source of uric acid is the metabolism of purines, which are nitrogen-containing compounds found in proteins (and other substances). Some foods are higher in purines than others, hence the recommendations to eliminate or reduce red meat and seafood in the diet. Beer is also high in purines, and other plant foods are sources of purines as well.

But uric acid is a normal compound in the body. It’s not solely a metabolic waste product; it performs important functions as well. So we don’t want to get rid of uric acid entirely, and we certainly don’t want to eliminate protein from our diets.

So if the body normally produces uric acid, what’s really the problem in gout? Does the body produce too much uric acid, or is the uric acid not cleared away properly?

If it’s the latter, and the problem isn’t with overproduction, but rather, with impaired clearance, how is uric acid cleared from the body, and what impairs this?

Well, to cut right to the chase, the kidneys filter excess uric acid out of the blood so it can be excreted in the urine. And what impairs the kidneys’ ability to do this? Insulin. Yes, dear readers, our old friend insulin strikes again. (I mentioned this insulin and gout connection way back in the insulin series.) Alcohol also reduces the kidneys’ ability to excrete uric acid, so there might be some truth to cutting back on alcohol if you have gout.  

Mankind has been consuming animal proteins for a long time now, and gout is a relatively new disease. Well, “new” since about 300 years ago, which is when more accounts of it started being recorded. At that time, it occurred mainly among wealthy people—the people who could afford to eat rich meats and drink alcohol. But something else these “refined” individuals could afford that most common folk couldn’t, was sugar. Refined sugar.  ;-) 

Interesting, huh? 

Typical old-school representation of gout: a demon shooting fire at the toes.

Notice what appears to be a wealthy looking man eating what might be a meatball, and there’s alcohol on the table.

So what’s the real deal with gout? Is it caused by meat, or metabolic syndrome--that is, chronically elevated insulin?

Read all about it in my latest post for the KetoDiet Blog: Is Gout Caused by Red Meat or Metabolic Syndrome?  I think you’ll find the details interesting, and what’s really fascinating is that a few studies have shown that diets that are higher in protein can actually reduce uric acid levels and frequency of gout attacks—provided that the diets are also lower in carbs. Nice, huh?

If you or someone you know suffers from gout, and you think you’ve been relegated to a life without steaks and red wine (perish the thought!), check out the post to learn why it’s not meat, but rather, chronically high insulin, that causes gout.

As a personal aside, I have a friend who suffers from gout, and he’s a vegetarian. No red meat, but lots of fruit, fruit juice, and grains. And fructose, via its effects on the liver, can be a huge contributor to hyperinsulinemia and gout.

If you’d like to learn more, Georgia Ede, MD, has a fabulous post that covers all of this as well—gout, meat, insulin, alcohol, and fructose, and it’s a highly recommended read: Got Gout but Love Meat?

Also, the must-read book, Good Calories, Bad Calories, by Gary Taubes, originally included a chapter on gout, but it didn’t make it into the version that got published. Fortunately, this “lost chapter” is available online and it’s another educational read on the connections between insulin, fructose, and gout: Gout: The Missing Chapter from Good Calories, Bad Calories

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Does Protein Harm the Kidneys?

Hey kids! My previous blog post laid waste to the myth that a high protein intake is harmful for bone health. This time, it’s my great pleasure to decimate another “high protein is bad for you” thing. Today, it’s kidney function. Many of you have been eagerly awaiting this post. Here’s hoping I don’t disappoint.

Even if you’ve accepted that everything we thought we knew about saturated fat and cholesterol in our diets was almost completely wrong, and you’ve been following a low-carb or ketogenic diet confidently for fat loss, migraines, GERD/acid reflux,  reversing type 2 diabetes, reducing insulin needs and evening out blood sugar for type 1 diabetes, or for some other health issue, maybe there’s still some lingering fear in the back of your mind that the protein you’re eating—especially animal protein—is bad for your kidneys.

We’ve heard this over and over from just about everyone with an agenda to discredit the efficacy of low carb diets. Now, mind you, low carb diets are not, by definition, high in protein, but in walking away from sugars, grains, beans, and starchy vegetables, many of us find that, compared to our former high-carb life, our protein consumption does increase, whether in absolute grams, as a percentage of total calories, or both. Not to mention the growing carnivore movement, where people are eating only animal foods. For these folks, protein consumption almost certainly increases compared to a standard Western diet, and likely even compared to if/when they were following a ketogenic diet.

So with all this in mind, it’s important that we set the record straight about the influence of dietary protein on kidney function.

Is a High Protein Intake Bad for Bones?

Tl;dr Read the very short version of this here.  For the juicy details, stay here!

Let’s start with an enticing tidbit from a paper in no less than the Journal of the American College of Nutrition, with the wonderful title, “Dietary protein: an essential nutrient for bone health.”

“In agreement with both experimental and clinical intervention studies, large prospective epidemiologic observations indicate that relatively high protein intakes, including those from animal sources are associated with increased bone mineral mass and reduced incidence of osteoporotic fractures.”

Let’s not be guilty of the same sloppy epidemiological science we accuse other nutrition camps of, though. Epidemiology can generate hypotheses, and give us ideas to think about that then need to actually be tested.  Epidemiology can’t prove cause and effect, but it can generally disprove it.  For example, in the case of dietary protein, if epidemiological findings suggest that higher protein intakes—including animal protein—are “associated with” better bone health, we can’t conclude that the protein itself is directly responsible for the stronger bones, but we can safely assume that protein isn’t harmful for bones.  And in the case of protein and bone mass, we do have pretty good clinical and experimental evidence showing that indeed, higher protein intakes do induce positive changes in bone tissue.  Not in cultured bone cells. Not in mice. In actual living, breathing humans.

It’s hard to believe that in certain circles, protein has gotten a reputation as being harmful for bone health.  After all, Paleolithic hunter-gatherer diets typically contained a large amount of meat, yet anthropologists can sometimes distinguish the remains of hunter-gatherers from those of agriculturalists solely by examining the bones: the high-protein eating hunter-gatherers typically had bones that were larger, stronger and denser, and showed fewer signs of chronic disease. 

Scientists believe the differences in physical activity between the two civilizations played a bigger role than any dietary changes, and sure, hunting and gathering no doubt required a lot of time on one’s feet, but ask any farmer: farming isn’t exactly sedentary work!  Even if a heavy physical workload was responsible for Paleolithic peoples’ stronger bones, we can still conclude that a high intake of animal protein didn’t work against building bone mass.    

So how did some people come to think that protein—animal protein, in particular—is harmful for bones?