Preventing Gout Attacks with Diet

Preventing Gout Attacks with Diet
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If the uric acid crystals that trigger gout come from the breakdown of purines, should gout patients avoid even healthy, purine-rich foods, such as beans, mushrooms, and cauliflower?

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Over 2,000 years ago, Hippocrates described gout as a “disease of kings,” primarily because it was the wealthy who could afford the rich foods which seemed to precipitate gouty attacks. But now, we can all eat like kings and acquire some diseases of royalty ourselves.

 Gout is caused by needle sharp crystals of uric acid in our joints, and uric acid comes from the breakdown of purines. And purines are the breakdown product of genetic material, DNA, the foundation of all life. So, there is no such thing as a purine-free diet, but foods do vary in their purine content, and it was long thought that people with gout just needed to stay away from all high-purine foods, whether from animals, like organ meats, or plants like beans, but this strategy proved ineffective. Yes, all uric acid comes from the breakdown of purines, and so limiting meat makes sense, but that means all kinds of meat, and plant sources have now largely been exonerated.

 The association of gout with both alcohol intake and increased dietary purine consumption has been known since ancient times, but there were no prospective trials to back it up… until just a decade ago. The Harvard Health Professional’s Follow-Up Study, about 50,000 men followed for a dozen years, and alcohol intake was strongly associated with an increased risk of gout, and in terms of food, they found an increased risk of gout with higher meat and fish consumption, but not with higher consumption purine-rich plant foods, maybe because the purines in plants are less bioavailable? So, though it’s been suggested that gout sufferers should moderate both purine rich animal and plant foods, their results suggest that this type of dietary restriction may be only applicable to purines of animal origin.

 Although it was not surprising that meat and seafood had significant associations with the incidence of gout, this lack of effect of purine-rich plant foods was new. There don’t appear to be any long-term studies showing purine rich, plant foods increase risk, though there are still some guidelines continuing to disseminate outdated recommendations.

Not only has the intake of purine-rich plants not been associated with high uric acid levels, but the vegetables gout sufferers are specifically told to stay away from –  mushrooms, peas, beans, lentils, and cauliflower – were actually found to be protective. This may be because foods rich in fiber, folate, and vitamin C appear to protect against uric acid buildup and gout. For example, fiber has been recognized as having a potential role in binding uric acid in the gut for excretion.

 Lack of association between purine-rich vegetables and urate could be due to the co-packaging of these beneficial plant components (such as vitamin C, dietary fiber, or some phytochemicals), which may have masked an effect of purine on uric acid. Vegetable intake, regardless of purine content, may also be protective as it may increase uric acid excretion.

 By changing the pH of our urine, we can change uric acid clearance. Eating an alkaline diet, a vegetarian diet in this case, was found effective for removing uric acid from the body. Those eating the alkaline diet excreted significantly more uric acid than those eating the acidic diet. As such, uric acid levels in the blood of those eating the acid-forming diet rose within days.

So, one would assume uric acid levels are lower in vegetarians. And indeed, those eating vegetarian long term were found to have significantly lower levels in their blood. To prove cause and effect, though, you need to do an interventional trial, where you take people, change their diets, and see what happens. So, they took ten guys for a study of the build-up of uric acid in the kidneys, kept them on a standard Western diet for five days, and measured their relative super saturation for uric acid. Then, they tried a vegetarian diet for five days and got this. The intake of the vegetarian diet led to a 93% decline in the risk of uric acid crystallization, within days.

Or, you can do it the other way: take a bunch of people with gout, feed them a big meal of meat and see if you can trigger an attack. Seven patients were put in a hospital, stabilized on a low-purine diet, and then challenged with a meat-laden dinner. In response, uric acid levels shot up, and they started getting gout attacks. Then, they added alcohol and uric acid levels shot up even further. In all, just with single meals, they were able to trigger gout attacks in six out of seven patients.

 Now, some meat has less purines than others. Superworms have particularly low purine levels, super, because they’re like two to three inches long.

Not all animal foods increase gout risk, though. Low-fat dairy products were found to be protective. If that’s the case, we would predict vegans would be at a disadvantage, which is indeed what was found, though these all were within the normal range, which is like 3.5 to 7.

Should gout patients add milk to their diets? Well, although drinking the equivalent of ten cups of skim milk at a time appears to have an acute lowering effect on uric acid levels, in the long term over months, at the equivalent of two cups a day, there was no significant lowering effect. They gave skim milk powder to gout patients for three months, and it did not appear to help. Though soy milk has also been associated with a lower risk of uric acid buildup, there are no interventional trials to back that up.

 The bottom line is that we now have good research on how to reduce risk of gout without the use of drug treatments, through modification of diet. That’s important, because allopurinol is the drug of choice. It’s considered generally safe. What does it mean when doctors talk about a relatively safe drug? Well, about 2% of patients develop hypersensitivity reactions, which can sometimes be severe and fatal with a mortality rate of up to 20%–and that’s the safe drug. The other leading drug, colchicine, has no clear-cut distinction between the nontoxic, toxic, and lethal dose.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to piper60 via Pixabay and Brian Gratwicke via Flickr.

Over 2,000 years ago, Hippocrates described gout as a “disease of kings,” primarily because it was the wealthy who could afford the rich foods which seemed to precipitate gouty attacks. But now, we can all eat like kings and acquire some diseases of royalty ourselves.

 Gout is caused by needle sharp crystals of uric acid in our joints, and uric acid comes from the breakdown of purines. And purines are the breakdown product of genetic material, DNA, the foundation of all life. So, there is no such thing as a purine-free diet, but foods do vary in their purine content, and it was long thought that people with gout just needed to stay away from all high-purine foods, whether from animals, like organ meats, or plants like beans, but this strategy proved ineffective. Yes, all uric acid comes from the breakdown of purines, and so limiting meat makes sense, but that means all kinds of meat, and plant sources have now largely been exonerated.

 The association of gout with both alcohol intake and increased dietary purine consumption has been known since ancient times, but there were no prospective trials to back it up… until just a decade ago. The Harvard Health Professional’s Follow-Up Study, about 50,000 men followed for a dozen years, and alcohol intake was strongly associated with an increased risk of gout, and in terms of food, they found an increased risk of gout with higher meat and fish consumption, but not with higher consumption purine-rich plant foods, maybe because the purines in plants are less bioavailable? So, though it’s been suggested that gout sufferers should moderate both purine rich animal and plant foods, their results suggest that this type of dietary restriction may be only applicable to purines of animal origin.

 Although it was not surprising that meat and seafood had significant associations with the incidence of gout, this lack of effect of purine-rich plant foods was new. There don’t appear to be any long-term studies showing purine rich, plant foods increase risk, though there are still some guidelines continuing to disseminate outdated recommendations.

Not only has the intake of purine-rich plants not been associated with high uric acid levels, but the vegetables gout sufferers are specifically told to stay away from –  mushrooms, peas, beans, lentils, and cauliflower – were actually found to be protective. This may be because foods rich in fiber, folate, and vitamin C appear to protect against uric acid buildup and gout. For example, fiber has been recognized as having a potential role in binding uric acid in the gut for excretion.

 Lack of association between purine-rich vegetables and urate could be due to the co-packaging of these beneficial plant components (such as vitamin C, dietary fiber, or some phytochemicals), which may have masked an effect of purine on uric acid. Vegetable intake, regardless of purine content, may also be protective as it may increase uric acid excretion.

 By changing the pH of our urine, we can change uric acid clearance. Eating an alkaline diet, a vegetarian diet in this case, was found effective for removing uric acid from the body. Those eating the alkaline diet excreted significantly more uric acid than those eating the acidic diet. As such, uric acid levels in the blood of those eating the acid-forming diet rose within days.

So, one would assume uric acid levels are lower in vegetarians. And indeed, those eating vegetarian long term were found to have significantly lower levels in their blood. To prove cause and effect, though, you need to do an interventional trial, where you take people, change their diets, and see what happens. So, they took ten guys for a study of the build-up of uric acid in the kidneys, kept them on a standard Western diet for five days, and measured their relative super saturation for uric acid. Then, they tried a vegetarian diet for five days and got this. The intake of the vegetarian diet led to a 93% decline in the risk of uric acid crystallization, within days.

Or, you can do it the other way: take a bunch of people with gout, feed them a big meal of meat and see if you can trigger an attack. Seven patients were put in a hospital, stabilized on a low-purine diet, and then challenged with a meat-laden dinner. In response, uric acid levels shot up, and they started getting gout attacks. Then, they added alcohol and uric acid levels shot up even further. In all, just with single meals, they were able to trigger gout attacks in six out of seven patients.

 Now, some meat has less purines than others. Superworms have particularly low purine levels, super, because they’re like two to three inches long.

Not all animal foods increase gout risk, though. Low-fat dairy products were found to be protective. If that’s the case, we would predict vegans would be at a disadvantage, which is indeed what was found, though these all were within the normal range, which is like 3.5 to 7.

Should gout patients add milk to their diets? Well, although drinking the equivalent of ten cups of skim milk at a time appears to have an acute lowering effect on uric acid levels, in the long term over months, at the equivalent of two cups a day, there was no significant lowering effect. They gave skim milk powder to gout patients for three months, and it did not appear to help. Though soy milk has also been associated with a lower risk of uric acid buildup, there are no interventional trials to back that up.

 The bottom line is that we now have good research on how to reduce risk of gout without the use of drug treatments, through modification of diet. That’s important, because allopurinol is the drug of choice. It’s considered generally safe. What does it mean when doctors talk about a relatively safe drug? Well, about 2% of patients develop hypersensitivity reactions, which can sometimes be severe and fatal with a mortality rate of up to 20%–and that’s the safe drug. The other leading drug, colchicine, has no clear-cut distinction between the nontoxic, toxic, and lethal dose.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to piper60 via Pixabay and Brian Gratwicke via Flickr.

Doctor's Note

Uric acid is double-edged sword, as both high and low levels are associated with increased mortality. If our uric acid levels are too high, we can get gout; if they’re too low, it may increase our risk of neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. This is presumed to be because uric acid acts as a powerful brain antioxidant. See my videos Miocene Meteorites and Uric Acid and Parkinson’s Disease and the Uric Acid Sweet Spot for more on this.

What about treating gout with diet? See:

And, for alkalinizing your urine, see How to Treat Kidney Stones with Diet and Testing Your Diet with Pee and Purple Cabbage.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

173 responses to “Preventing Gout Attacks with Diet

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  1. I just had this conversation with two patients and some of my medical staff yesterday regarding a patient who is refusing to change their diet and wants me to keep prescribing prednisone. Thanks so much for this eduVideo this will come in very useful just like all the other videos. Keep up the fantastic work!

      1. I just spent a happy afternoon yesterday delving deep into references for yesterdays’ talk on fruits and veggies promoting wellbeing and “eudaemonia”. In the “carrots and curiosity’ paper they make the really useful point that in seeking to promote healthy eating patterns we can now say – in an evidence based way – you will actually feel better, THE NEXT DAY!! Everyone wants to feel better – its just they are doing it with junk food, meat and alcohol which is actually just acting as a kind of grand toxic sedative – not so much feeling better as feeling less. certainly less alive!

      2. Jonathan Swift made this statement and it fits here:
        “You can’t reason someone out of something they didn’t reason themselves into.”

    1. I was curious regarding what conditions one would prescribe prednisone to treat.
      Prednisone is used to treat allergic disorders, ulcerative colitis, psoriasis and arthritis, AND
      One of its side effects is…

      Wait for it, wait for it:
      Severe allergic reactions, including: skin rash. itching or hives.

      Now there’s pharmacological solution for you.

      1. I had a severe psoriasis outbreak once (I have mild psoriasis) and the prednisone worked absolute wonders. All psoriasis symptoms completely disappeared. So I can sympathise with somebody wanting to continue it.
        However, the risks and long-term effects of continued use are not nice. And short term it gave me acne which, of course, is a common side effect of steroid use generally.

        1. No disrespect meant Robert. I certainly was not suggesting that one suffer needlessly. I get it. Individuals have been know to resort to desperately drastic measures in order to escape debilitating pain.

          It didn’t occur to me until your post that Dr. Dynamic may have been prescribing prednisone to treat his patient’s gout. My perfunctory search regarding prescribing guidelines had not identified gout as a target.

          I believe the point is that one would do better in the long run to address chronic conditions by treating the underlying causes instead of continually masking symptoms.

          1. Absolutely Joe. Have you seen pictures of a toe with gout. Oh my! We are talking pain. Like glass in the joint. And that it what is so crazy about Dr. hemo’s post. If I had that I would jump at the prospect of never having to go through a flare up again. And yet they say they won’t change their diet. Nuts!

            1. Ouch! It is painful just to gaze at the affliction. The thought of one’s body rotting from the inside out is horrific beyond imagining, and yet, there is a segment of the population who are unwilling or unable to make the lifestyle modifications that would either cure or ameliorate the condition.

              The only explanation that makes sense is that they have given up on the possibility that their condition can be satisfactorily treated, and that they are not going to give up their last pleasure in life. It is so sad really.

              1. I believe it has to do with the business. I am a physical therapist so my thinking automatically goes to how can we fix this orthopaedic condition and keep it from happening again–what made it happen in the first place? But not all medical fields are the same. MDs tend to go for the prescription pad and don’t actually think about what might be causing an issue. And diet plays such a big role as we have all learned here. Thank you Dr. Greger!

                1. Right, this has been my experience with trying to figure out what triggers my gout, and how to control attacks with diet. I’ve had 3 attacks in 5 years, but none of 4 doctors ever expressed interest in helping me figure out how to control the attacks with diet. To make matters worse, in my state of NY, consumers are not allowed to order blood test online, so it is virtually impossible for a health and nutrition conscious person to track key measurements, e.g. in my case, iron levels (I am predisposed to absorb too much iron, which is associated with gout), vitamin C levels (which lowers UA but increased iron absorption), etc. Very frustrating.

                  1. David J: re: “… in my state of NY, consumers are not allowed to order blood test online…” That’s horrible! I’ve never heard of that. Being hindered in helping yourself with a health problem, especially one that the medical establishment has been unable to fix for you is criminal. I hope you are able to find a way around that in the future.

                  2. You can cure gout … i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout

                2. As a dietitian, patients who have discovered plant based cures for common ailments (i had a patient taking tart cherry juice for Gout), unfortunately, they came across on their own research. I get questions from patients all the time about something they came across online or in the paper…. RARELY (none that I can think of) came from a doctor (other than Dr. Greger). Hopefully, more doctors will find food is medicine and can often treat the underlying causes of many conditions.

              2. And a short story to share. My neighbor had a really bad gout flare up after a weekend of lobster, steak and wine! Of course the MD put him on medication. But with no instruction on diet or lifestyle changes. He had to go to a naturopath months later and after many flare ups to recommend a diet change. He has been fine ever since–and it looks like he has lost 50 pounds in the process!

                1. It would appear that obesity has much more to do with long term UA levels than diet (although binge eating will get you a gout attack).
                  I’ve had hyperuricemia for over 20 years and although I went 96-97% veg over 3 years ago (I still have fish a couple of times a week) – UA is still only controlled w/Allopurinol.
                  The correlation between vegeterianism and lower UA rates is probably related with lower body weight (unfortunately, going veg has really done anything for my spare 50 lbs)
                  I’m currently working on the 50 lbs – it will be interesting to see if there will be changes to UA

                  1. Have you ever attempted to eliminate the fish on a trial basis? You are correct about lower UA rates with lower body weight. But also, DURING weight loss. Check out, this article by John McDougall regarding gout flare with weight loss. In which he states when losing weight, uric acid is released from fat stores. Dramatic weight loss may also precipitate a gout flare. In this case, a combination of plant based diet and medication may be necessary to get over the surge in UA. Once in a steady state, plant based diet would likely be able to manage future gout flares.

                    https://www.drmcdougall.com/misc/2006nl/june/gout.htm

                  2. I just ran across this posting as I am searching everything to understand what I can do for gout. It is extremely painful. I am a 85% vegan and I do not drink, eat shellfish nor any meats and yet I have GOUT! It is so frustrating. I have a flare up about every two months. I suffer through it. I drink cherry juice (high in sugar), eat celery and take Ibuproferin for a “little” relief. I have been refusing Allopurinol. I hate meds and I often get the side effects. And like you I have about 30 lbs I need to loose. I eat no dairy, I don’t know where else to cut out food as a cause. Perhaps sugar? Anyway thanks for your post it seems to be a first hand experience I can relate to.

                    1. I have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

                    2. My husbands gout flares up when he eats tomatoes. He didn’t believe it at first but once again when the first tomatoes arrived at the fruit stand this spring his toe was in pain after eating two tomato sandwiches. Was pain free all winter since we do not buy tomatoes from the store.

                  3. correlation is not causation ! i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

                2. It is a painful mistake to think that gout happens suddenly from a single weekend or holiday of indulgence. It builds up over time, more than 10 years usually, before reaching a point of ‘critical mass’ when the body floods the site with an immune response, which is the actual cause of the painful inflammation. High uric acid levels are maintained over a lifetime of unbalanced diet and NOT ENOUGH WATER. If you are not drinking 2-3 liters (12-15 cups) per 24/hrs, you will be chronically dehydrated. This can and does lead to gout and kidney stones. Medication only masks the underlying problem. Unless you have a severe kidney disfunction, then you can absolutely reverse gout permanently. Skim milk, low meat protein intake no more than 2 days per week, and get plenty of water, water, water. If your urine is yellow, then you are not drinking enough water. Clear urine = no more gout. : )

        2. yeah, but long term, diet works, whole-food-plant-based diet, that is

          i have managed my gout since I’ve gone on a WFPB diet
          flare ups occur only when I eat something like sourdough bread or when I drink a lot of beer…

      2. People can have allergic reactions to any drug.
        The effectiveness of prednisone is that it suppresses your immune system and that helps tremendously with the inflammation caused by the body but especially with gout, toxicodendron contact (poison oak etc.) with itchy allergic reactions and autoimmune disorders. That’s a quick breakdown.

      3. Pharmacy shares is linguistic origin with “pharmakon”. In philosophy it means “Remedy”, “Poison” and “Scapegoat” all at once. Who said that antique wisdom was antiquated?!

    2. Next time you discuss diet with a patient, I suggest mentioning that a whole food plant based diet actually tastes better than a diet with salty/ sugary processed foods and meat. After about 2 weeks on this diet, I noticed the taste of whole plant based foods changed dramatically for the better. Now, I have no desire to eat meat and most processed simple carb foods. And I got rid of the gout to boot!

    3. I too have had this conversation with patients resistant to changing their diet. One of them being, of all people…my sister. As someone who has struggled on occasion with eating something I know isn’t good for me I can appreciate the struggle. For me personally, when I find myself struggling with wanting to eat something I know will have adverse effects, I picture what I felt like the last time I did it. That’s usually enough to deter me. For my patients, I’ve learned to adopt the attitude, you can lead a horse to vegetables, but you can’t make him eat.

      1. The trouble is that the horse is getting a lot of conflicting information and so does what so many do and tunes it all out, adopts a fatalistic attitude and makes their dietary selection based on personal preference, because after all what’s the point, nothing is ever going to help me get better, so might as well eat something that tastes good.

        I think for some people you have to go full Esselstyn and just make it abundantly clear how badly they have been mislead by people who have a financial stake in their not understanding what is and isn’t healthy to eat, and in the case of the pharmaceutical industry, keeping them sick so they can sell more pills. Give them homework to read/view. Make a follow up to talk about what they found, what they thought and answer questions. Then maybe once the horse really has all the straight information there is a much better chance they will see that there is a path forward and dig into the veggies with gusto.

      2. Dr. Greger hits the nail on the head in his book, “How Not To Die”, that when people/patients are told to go plant based, they panic because they don’t want to give up some of their favorite foods. He goes on to say that the problem with “all or nothing” thinking is it prevents people from taking the first step. I have found that some people are fully ready for change and embrace abandoning old eating habits completely and never look back. Others, (probably the majority) are not quite ready for such a dramatic change. They need to test the waters first, they are not yet convinced that they will feel better. Often, I have found that those who start down the path more cautiously, stumble across subtle health improvements. Those subtle health improvements start to give momentum to their journey of changing their diet. Don’t give up on the conversations, keep leading the horse to the vegetables ;). You can’t make them eat, but they may be open to baby bites!!

    4. I changed my diet years ago and still struggle with gout. No alcohol, meat, fish/seafood for years and I still keep a relatively high level of uric acid. I eat plenty of veggies and fruit. So while I am sure this represents a good approach it doesn’t seem to work for everyone. I’m still staying away from those things…just disappointed that they don’t seem to make enough of a difference for me to go unmedicated.

  2. Beans, beans, the magical fruit
    The more you eat, the less you…

    …have to worry about the sharp needle like crystalline formation of uric acid in your joints leading to the excruciatingly painful condition know as gout.

    Let’s eat beans, every meal!

      1. Hi Nancy,
        I rarely eat three meals a day anymore. I make a habit of only eating when I’m hungry so I usually end up eating just two times a day.
        I use peanut butter (legumes) and refried beans as a spread when making a sandwiches or tacos and I usually stuff grilled tofu and/or grilled tempeh in them as well.
        If I make a tomato based pasta sauce, I usually throw pinto, kidney, black or great northern bean and tofu into the mix along with a heap of vegetables.
        I like beans. I always have, so it’s no hardship at all for me to eat them, but I must admit that on occasion there is the odd meal where no beans are available so I make due as best I can. (-;

  3. Putting gout patients on a western-style high purine diet to induce gout attacks?
    How did that pass the ethical review board for approval? :)

    1. I believe they said for this study that the study subjects were hospitalized and when given meat and alcohol were being closely monitored.

    2. I was surprised by that, too, but it was a study from 1980. Perhaps the standards were lower, or perhaps feeding people massive amounts of meat could not be construed as unethical by definition. (Not that I would agree….)

  4. Thank you for this information. I’ve been completely plant based for over five years but this winter I’ve started having problems with gout when I eat beans but not when I eat
    mushrooms or other non-bean sources. I’ve got MCS and I was wondering if
    that would be a contributing factor. I’m sticking to my ‘vegan’ diet
    but I’ll continue to avoid or limit legumes (when I do have foods containing beans I take bromelain, tart cherry and vitamin C).

    1. I’m also a vegan who has had gout attacks (3 in 5 years). Besides taking tart cherry extract every day, I drink 4-5 cups of decafe coffee to help lower my uric acid levels (there’s at least one studying indicating coffee lowers UA). Dr. Ronald Johnson (gout researcher at U of Colorado) has published research arguing that fructose can be a prime trigger for gout since it raises UA levels. Since reading about this, I have been limiting my fructose intake- in particular I no longer eat dried fruit. I am not sure how strong the evidence is for the fructose connection (although it is a fact that UA is a by product of fructose metabolism), but I thought “better safe than sorry”, although it’s a difficult restriction for a vegan.

      1. Thank you, it’s good to know about the fructose although I don’t have a problem with fructose as I dislike sweet things but beans used to be a staple in my diet. I hope that your condition improves. As long as I don’t ingest beans I rarely have a problem.

      2. I’m curious, if you don’t mind saying: what is your uric acid level whenyou have thes eattacks and when you don’t. Also does gout run in your family? Were you at one time a big meat eater who got the crystals in your joints and they have stayed there?

        1. Sure, I’m happy to share my personal history. My brother has gout. I have eaten little meat over the last 50 years (I am 69). Even when very young I did not like to eat meat. I did eat some, but not much, poultry but quit in the mid80s. I never ate a lot of fish but quit completely about 18 months ago. So I don’t see how meat eating could have been a cause of crystal build up. I did drink quite a bit in my misspent youth, including beer, but pretty much quit drinking when I got out of college, and have had no alcohol since in about 20 years.

          I suppose the answer lies in my genetics – my bother is an underexcreter, and no doubt I am too. Nevertheless, my UA has never been measured to be above 6.8, even though I have had 3 attacks since 2010. At first I was told I did not have gout, but it was confirmed after the 2nd attack in 2014 by aspiration (but no blood work done by the orthopedist for some reason). In fact, in June 2015 my UA was only 5.2! I thought I had gout licked, and attributed the low value to drinking coffee, taking vitamin C supplements, drinking tart cherry juice and staying well hydrated. But nevertheless I got my 3rd attack in late November 2015. Unfortunately, my UA was not measured until late January 2016; amazingly it was only 5.8 (despite having quit taking vitamin C supplements, which my doctor insisted I do before testing me). One doctor suspected dehydration, which was possible for the first two attacks, but not for the third. I blamed the last one on fructose, since I had greatly increased my fruit intake, but given Tom Goff’s comments on that topic (did you read those?), I am no longer confident in that theory. I do eat a lot of beans and quite a lot of soy (~ 1.5- 2 servings per day of tofu or soy milk), so perhaps there’s something there. But other than the genetic link, I have little clue as to what is triggering the attacks. One theory I had regarding the last one is that the low UA levels pulled crystals from my joints, triggering an attack; this happens with medication. If so, that would actually be a good thing, and hopefully will not repeat. I find it frustrating that no doctor has expressed any interest in my case – my UA is normal, case closed. I recently bought a UA meter, but have not used it yet. Also, it is not clear it will be very accurate, but at least I could observe trends in relationship to diet. Hope that information is helpful to you or someone else.

          1. I changed to a whole plant food based diet (with exercise) about 8 months ago and all signs of my gout disappeared quickly. I also lost about 25 pounds, but I needed that too. Seems like you are doing most of the logical things in your diet like avoiding alcohol, meat, etc., but I would also avoid simple carbs and stick to whole plant foods like broccoli for vitamin C instead of supplements. The key for me in my view was eliminating the theft of nutrition from simple carbs and animal protein in favor calories from whole plant based foods that are rich in fiber and other nutrition. Exercise, I believe, was and is also very important since that along with fiber caused my system to flush toxins more regularly. It worked for me anyway and I feel much better and stronger.

            1. That’s great to hear a WFPB diet is working for you! I also avoid simple carbs/sugar, get lots of various whole grain fibers, drink a lot of H20, and eat cruciferous vegetables at least once per day, in addition to chard, spinach, etc. and exercise a lot. I agree the vitamin C supplements were unnecessary and have quit taking them.

              Cheers.

              1. bang on stop refined carbs!!!! i cured my gout ….if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks a ton

            2. great reply —sugar is the cause –not purines if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

          2. Thank you, that’s very interesting. It’s not me that has gout, but someone else. If I was having gout attacks ( or any other serious condition) I think I would get on Dr. McDougall’s diet at least as long or as often as I could manage his extremely low fat vsion of WFPB, since it reverses arteriosclerosis, and opens up the blood vessels increases circulation and would probably get the crystals out of joints once and for all. If you go to his site, DrMcDougall.com, and search gout, you’ll find a good article by him on the subject. Be well.

            1. Thanks. I’m generally familiar with Dr. McDougall’s basic plan (and listen to his free videos), but will go back and see what he said about gout.

              All the best.

          3. Hi David, my husband and my Mum both vegan had separate attacks of gout. In the big toe for him and in the knee for my Mum. Both were eating a lot of beans and lentils. Once they were removed they both slowly improved. My husband took apple cider vinegar and cherrys. My Mum took medication from the doctor. Neither have had another attack because beans and lentils are now eaten twice a week. We all were eating it everyday. Too much it seems.

            1. Thanks very much for the feedback. I do eat a lot of beans daily (actually more now that when I had my last attack 8 months ago), so if I get another attack, I’ll know that’s a likely suspect.

              1. stop eating beans and gout will come again !!if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

            2. may be lentils and peas help!! but i have tons of lentils and chickpeas etc ….the main cause of gout is sugar not purines ….if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

          4. i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks a ton

          5. Thank you David J for your insight and information. I, too, cannot figure out why I have had two gout attacks. Being a vegan vegetarian, I assumed that my diet and lifestyle would improve my health not cause health issues. In articles presented on this website and other websites, I have not read any articles that actually outlines what to do. I feel frustrated with regards to the lack of helpful knowledge on this subject. I do not know what I need to do to prevent a gout attack in the future. Some people say it’s the beans others say it’s fructose, some say it’s purine rich vegetables, some say it’s not the purine rich vegetables. I feel so confused by all the differing opinions on the subject!!!! My diet is already severely limited by being a vegan vegetarian and eating less or avoiding altogether processed foods, sugar, salt (limited), grains (limited), dairy and all oils except olive and coconut. If you research and find information that would be useful to us, gout-sufferers, please share. Thank you for your information.

            1. In addition, I eat fresh cherries and drink either organic tart cherry juice or organic tart cherry concentrate, take a Vitamin B12 daily, and eat 2 Tlbs of flaxseed meal and 2 Tlbs of raw apple cider vinegar. Some people say it’s the fiber, so I eat chia seeds on my salad daily and eat 2-3 serving of fresh fruits daily and guess what? I still have issues with gout! HELP!

      3. if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks a ton

  5. Thank you so much Dr. Greger! My dad has gout and I was wondering
    whether i could somehow add subtitles of my native language (lithuanian)
    to this video on youtube so he could understand? He is a big meat eater and this would really help him. Thank you so muich for what you do!!!

    1. As another approach, you might want to view the transcript text by clicking on “view Transcript” to the right of the video. Then copy and paste the text to a place where you can use Google Translate to translate it to another language.

    2. if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks

  6. Ok I’m really confused about this sentence. It sounds like a contradiction: “In this large prospective cohort study involving men, we found an increased risk of gout with higher meat consumption or seafood consumption but not with higher consumption of animal or vegetable protein or purine-rich vegetables.”

    How do they have an increased risk of gout with higher meat consumption and yet not have a higher risk of gout with animal protein consumption?

        1. Thank you for the reference. Just a guess as I have not read the study yet but recall that low-fat diary was protective for gout. that may be what is being referenced.

    1. I believe the point of that statement in the study is to indicate “protein”, regardless of the source is not related to gout occurrence though those who ate more meat and seafood did have more problems. Thus the indication that it isn’t the protein in the meat that is the problem but something else.

  7. Note re: “If that’s the case, we would predict vegans would be at a disadvantage, which is indeed what was found, though these all were within the normal range, which is like 3.5 to 7.” – if one is susceptible to gout (which has a genetic component), a supposedly normal uric acid level of 7 can be too high. gout sufferers need to aim to keep their uric acid levels below 6.

  8. “Low-fat dairy products were found to be protective. If that’s the case,
    we would predict vegans would be at a disadvantage, which is indeed what
    was found, though these all were within the normal range, which is like
    3.5 to 7.”

    Hmmm…interesting. So there is indeed something good to be said about dairy products. Who’d a thunk?

    1. “Hmmm…interesting. So there is indeed something good to be said about dairy products. Who’d a thunk?”

      certainly not from the cow’s perspective…

      1. Touche’. I agree the cow gets a lousy deal throughout its whole life (unless it ends up at an animal sanctuary). However, the casein and other nasties in milk do NOT do a human body any good either. Just for starters, It clogs it up with sticky phlegm and cough-producing mucus. :-(

        1. lousy deal does not begin to describe it. dairy cows, like chickens exploited for eggs, are among the very worst abused and tortured beings on the planet. this is one of many reasons why becoming a “lacto ovo vegetarian” for ethical reasons is ludicrous. if one is interested in leading a more compassionate and ethical life, eggs and dairy are the first products to stop supporting.

          btw, cows are not an “it”-they are “he’s” and “she’s” just like humans are. refering to non-human animals as “it” just reinforces the false concept that they are objects and property instead of living, feeling, sentient beings.

          1. Yes, I could have extended the sentence by saying, “lousy deal throughout his or her life.” However, to be technically correct spiritually speaking, cows are neither he nor she. We all are part of Source — which has no gender.

        2. Phlegm and mucus are the least of the problems with dairy for humans. As well-documented in “The China Study” by T Colin Campbell, casein (milk protein) along with other animal proteins promotes the growth of cancer tumors and heart disease. In my case, a whole plant based food diet also eliminated all signs of my gout in a very short period of time.

          Dr Greger’s book, “How not to Die” is a wonderful resource for anyone interested in avoiding all forms of disease with whole plant based food. It’s much tastier than animal protein food too once you remove the high blood pressure inducing salt and obesity promoting sugar from simple carbs, so it’s a real shame people (not to mention the government, medical and food industries) won’t make any effort to discover the taste and health benefits. It’s all about the money, I suppose.

          1. Yes indeed, “the least of the problems.” Which is why I added the phrase “for starters.” Years ago, “The China Study” is what first alerted me to the horrors and dangers of casein. It seems most dairy eaters know zilch about casein, if they’ve even heard the word at all.

            I can’t imagine what it must be like to have gout…pretty painful, probably (tongue twister?). I’ve never experienced heart burn or acid indigestion either, thankfully. (Or is it called acid reflux?)

  9. I eat a very healthy, 98% vegan diet. So several months ago I was mortified to find myself with a case of gout… in my foot… not pleasant! It came after eating a Tai meal with lots of tofu and (if I recall correctly) mushrooms. I finally had to deduce that excess tofu was the culprit as I eat mushrooms almost daily with no issues. I’d eaten tofu before without any ill effects, but, like I say, this was a large serving. Lesson learned… go easy on the tofu. However, I recently suffered another case of gout… this time in the lower back (even less pleasant, I can assure you), and this time I realized it was from a particularly large serving of soy chorizo and tempeh in my homemade chili. I know it was the soy products because the first night I ate the chili, I experienced only minor gout. But the next night, I had an unusually large serving, and the result was a much worse case that lasted for days. I strained the soy particles from the chili, and the gout went away even though I kept eating it. Soy?! I wonder if this is an anomaly specific to my body type… or something???

  10. I was diagnosed as hyperuricemia with a value of over 12 .. no symptoms, so I wasn’t given anything to treat .. but I have this late night awful feelings in my lower legs that keeps me up or wakes me, forcing me to move them .. thought it was restless legs .. could it be from my high uric acid instead? Dr’s blaming 30 yrs. of T1 on nerve damage but aren’t looking into it .. ya think they would! Taking Invokana for bg control and urine smells horrible .. could it be the high uric acid being eliminated … so many questions .. so few answers. Thanks anyways

    1. Wow, that’s an incredibly high UA level! Are you seeing a rheumatologist? I’ve read there’s a connection between diabetes and hyperuricemia. Seems to me you need a better doctor.

  11. Take cherries for gout! Have you explored if elemental Cobalt, perhaps coming from lunar waves? Is essential for life? I think extra cobalt never hurt anyone.

    1. Matthew, Cobalt can accumulate to toxic levels in the liver, kidney, pancreas, and heart, as well as the skeleton and skeletal muscle. Cobalt has been found to produce tumors in animals and is likely a human carcinogen as well.

      1. Thank you. I did not know Cobalt is toxic. It is used and sequestered by every plant. I do not know how it is stored. It is an essential element in life. I think toxic accumulation can mean desperate need. I think you could take the cobalt out of my body and rebuild me. It starts self assembling people. B12 seems to be the holy kingdom. Cobalt is used by the body as more than just B12, in my opinion. It comes from the sky I night, it my opinion.

  12. I’ve been suffering from hyperuricemia for several years. Despite following a vegan plant-based diet for 6 years, and even a fully alkaline diet for an entire year, I’ve had several gout attacks and elevated levels of uric acid throughout. (I first noticed that I had high uric acid levels about 8 years ago while on a meat-rich omnivore diet, so it just seems to me like my diet isn’t having any noticeable effect.) I’ve also tried cherries and cherry juice concentrate, but the only thing that seems to work for me are colchicine and allopurinol. I would love to stop taking pills… Any idea what the source of the problem could be?

    1. I had myself tested for HIV. The test came back negative. They said the only question was, “how are your feet.” When I insisted on a blood test, I believe they checked my B12 levels. I believe you can infer that B12, Potassium, Selenium, Vitamin K2, and the amino acids glutamine, cysteine and tryptophan treat HIV, possibly also the Vitamin Cobalt, found in the night sky or maybe cherries. I had a plug of coenzymes built up in my heart from worry that came out when I had myself tested. Good luck to you.

    2. People on strictly vegetarian (misleadingly termed “vegan”) diets do tend to have high uric acid levels. Also, in the EPIC Oxford study
      “In men, there were significant positive correlations between uric acid concentrations and intakes of beer, alcohol and energy from soy protein.” Low calcium in the so-called vegans may also have been a factor, and another study found that spinach (which is high in calcium) reduced uric acid concentrations in blood.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572016/
      http://jn.nutrition.org/content/129/12/2162.long

      Another study found an association between sugar-sweetened beverage intake (but not fructose intake) and gout,
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368949/

      So,perhaps eliminating soy products and anything sweetened with sugar, and ramping up spinach intake might help?

      1. Tom Goff: Great post. I just want to comment on the part about spinach and calcium. It’s my understanding that while spinach *is* high in calcium, it is also high in oxalates, which in turn binds (?right word?) the calcium within the spinach, preventing the human body from absorbing the calcium. It’s not that eating spinach is bad for you (oh contraire!) and it’s not that eating spinach along with say kale, will prevent the body from absorbing the great abundance of calcium in kale. But it’s why experts will tell people that when trying to maximize calcium input, to focus on dark leafy greens except spinach, beet greens and ___ (one other that isn’t coming to mind at the moment).
        http://www.choose-healthy-food.com/brenda-davis-interview-calcium-rich-foods.html
        .
        So, with all that in mind, I’m thinking (but don’t know) that it is something else in the spinach (not the calcium) that is the help. Does that make sense to you too? Or do you think I’m missing something?

        1. PS: For anyone who things that interview (link above) with Brenda Davis RD was just great, Dr. Greger recommends Brenda’s books and so do I. Her “Becoming Vegan Express Edition” is a truly awesome reference book for when you want to look up specific nutrients. Or get one of her other related books. Just a tip.

        2. Thanks Thea. Yes, it makes sense. Certainly, I think that I have read somewhere that only 5% of calcium in spinach is bioavailable. On the other hand, human biochemistry is extremely complex and even bound calcium may invoke certain processes. that may be involved in gout. Full fat dairy is high in calcium but does not appear to be protective. so there are undoubtedly other factors in play as well as calcium.

          However, I have one thing to add to my original post that people may find welcome. The link between alcohol and gout appears to apply only to beer and spirits. Apparently, wine may even have a protective effect. That said, Medscape commented:
          “Low-fat dairy products and wine appear to be protective for the development of gout in several epidemiological studies. Due to potential confounding variables and ascertainment bias, however, it remains premature to recommend their use (preferential to other foods and beverages) in the management and prevention of gout or hyperuricemia, ”
          http://www.medscape.com/viewarticle/524766_7

          Note also the observation there that dietary ketosis may be setting our HFLC enthusiast friends up for gout.

      2. I don’t understand why you suggest eliminating soy products; soy is associated with a reduction in gout even though it is high in purines:
        http://www.ncbi.nlm.nih.gov/pubmed/21277179
        “Our data suggest a direct association between seafood consumption and hyperuricemia and an inverse association between consumption of soy food and hyperuricemia among middle-aged, Chinese men.”

        Fructose, as mentioned in other comments, increases UA, and is considered a primary potential cause of attacks by at least one gout researcher, Dr. Richard Johnson (U of Colorado), who recommends strictly limiting fructose intake, even from fruit.

        Cheers.

        1. Thanks David. The research on these issues is not consistent and the findings are often just based on observed associations. Such findings can be misleading or are in effect of the “relative to X consumption” variety. For example, it is possible that in the Chinese study you mention, soy consumption is simply a marker for low animal food consumption. And soy has less purine than animal foods. On the other hand, soy is relatively high in calcium which my be helpful (but it is also relatively high in purines compared to most other plant foods but not animal foods)
          Similarly, fructose has indeed been alleged to be involved in gout. Perhaps on the reasoning you refer to, it should be. However, at least some studies have found no association.

          Certainly the studies I referred to showed:
          1. “”In men, there were significant positive correlations between uric acid concentrations and intakes of beer, alcohol and energy from soy protein.” and
          2. “Overall SSB consumption was positively associated with urate (p = 0.008), however, energy-adjusted fructose intake was not associated with urate (p = 0.66). The intake of purine-rich vegetables was not associated to plasma urate (p = 0.38).”

          So, you can take your pick of studies. However, Mike seemed to be asking what he could do differently on his already WFPB diet. Reducing soy, alcohol, caffeine and SSB (if they are in his existing diet – I don’t know) might be worth considering. I don’t claim to know the “answer”. It’s unlikely that anybody does at this moment. Part of this is because there are several possible gene interactions that can lead to gout (and presumably some may be better managed by one strategy than another).
          http://jrheum.com/subscribers/05/05/773.html

          1. I’ve had one severe gout attack, which was the first, and a few minor attacks since. The dietary cause of each remains mysterious, but one common factor is dehydration born of very hot weather and intense exercise. The triggers for gout seems to be a complex story and those triggers may be different across individuals with similar diets. Possibly the simplest thing gout sufferers can do to avoid attacks is to ensure they avoid dehydration, regardless of other dietary patterns, and take it from there.

    3. There’s also a genetic component. I’m also a vegan who has had gout attacks, and am very interested in dietary approaches to lowering UA. Vitamin C increases UA excretion and ~ 500 mg/d supplement can on average lower UA ~ 0.5 mg/dL:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853937/

      Coffee, even decafe, can significantly lower UA levels:

      http://www.ncbi.nlm.nih.gov/pubmed/17530681

      With respect to fructose (cf. VegGuy’s comment below), I switched from cherry concentrate to tart cherry extract, since the latter has only 1g of sugar per serving, compared to about ~16g per serving of the concentrate I was taking. I estimated about 8g of the 16g was fructose, but try to keep my daily fructose intake no higher than 15g (no dried fruit!).

    4. Thanks everyone, for all your helpful responses. To answer some of your questions, I consume very little alcohol (on average one beer/spirit/glass of wine per month) and almost never consume any sugary beverages or soft drinks. My main source of protein comes from soy/tofu and other beans/legumes, so perhaps this is something I should be looking into.

      As for the genetic component, gout is present in my family, and I’ve had myself tested for that – and it appears that I have a higher than normal risk of gout based on my genotype.

      Tom and David: Thanks for the tips about calcium and Vitamin C intake – I’ve never given it much thought, but I’ll definitely look into it and consider taking supplements.

  13. Good video, though unfortunately a little frustrating for me (I’ve had similar conversations here in the past). I eat a healthy WFPB diet (predominantly fresh fruits and vegetable) and don’t drink but yet have had a couple of gout attacks over the last couple of years. These (the first gout attacks I’ve ever had) came relatively late in life and maybe just the combination of age with some genetic tendency means there’s nothing I can really do preventively. Oh well, off to have some tart cherries and cross my fingers…

  14. Theobromine is a purine and cacao is rich in theobromine. I wonder if there’s any evidence that people who eat a lot of chocolate get gout.

    1. For the past decade or more, I’ve been chowing down on three squares of 72% dark chocolate every day; it’s my only dessert after dinner and I never get tired of it (okay, I’m addicted). So far, no health problems of any sort. Yaaaaay, chocolate!

    2. There are SCORES of “dual-existence” food components, or those that have been identified in both plant and animal sources.

      In those cases ALMOST nearly every single time without fail, human health is more positively affected by consuming the plant source (whole as practical, not some silly derivative powder/pill/potion), whereas the animal source typically brings a host of negatives along with it.

      This is why I don’t pursue such lines of thought any more. I eat plants for nutrition and animals for tradition/variety/etc. in about a 9:1 ratio.

  15. In the study in which patients improved by eating a “vegetarian diet,” were any animal products consumed? Were high purine plant foods consumed?

    1. There were two studies referring to a “vegetarian diet”. Check the “sources cited” for the references and you can go directly to the source yourself to find out.

    2. Thanks for your question Mary! I am a Registered Dietitian and I have recently joined NF as a Moderator.

      If you are referring to this study, then yes, the alkaline diet was effectively a vegetarian diet. However, this was a crossover study, meaning that participants went through both diets. Hope this answer helps!

    3. Thanks for your question Mary! I am a Registered Dietitian and I have recently joined NF as a Moderator.

      If you are referring to this study, then yes, the alkaline diet was effectively a vegetarian diet. Animal products included butter. For purine bodies, there was 351 mg/d in the alkaline diet and 494 mg/d in the acidic diet. However, this was a crossover study, meaning that participants went through both diets. Hope this answer helps!

    1. Congratulations Matthew. Have you noticed an improvement in your health and the way you feel because I did? It feels good to go (WFPB) vegan. People should be aware of that. You give up a little, and you get a whole lot back.

      1. I feel much more knowledge about the world, the way it works, and how people are saved. I would like to share that the vitamins that simulate this diet are Vitamin C, Vitamin E, Niacin, Lysine, and Vitamin D3 in orthomolecular doses. I feel less hunger. I feel more hope. I feel more given too. I feel like my reality is what I feel. I am happier, but greedy for more plants, for more opportunities. I feel smarter. I feel more drive. I feel like I have more power to stay on topic. I would like to give my year to you, to the temple, to the country, to the people, to the Lord. I am thrilled that Vegan diet is so environmental. I feel like life is a little bit more sustainable here because of this diet.

        1. Congrats Matthew, I wondered when you would transition, you used to say to folks here that they were very cool for being vegan. Well, there you are now. :)

          You took a giant step for your health and wellbeing, to top it, you are saving innocent animals every day.

          1. Thank you, You win here. You win very big. Berry Picker Thule! You win, you win it all. You win and win and win and win!

    1. Going out on a limb here, but what causes the “poor kidney function”? Could it be diet or effects from Rx drugs? I don’t know, but would almost put money on improper diet or chemical interference first.

  16. All signs of my gout disappeared after changing to a permanent whole plant based food diet about 8 months ago. I’m also now a normal weight, down 25 pounds, which notably could have been an indirect factor. Based on the video, it seems logical that the additional fiber and extra nutrition from high vitamin C plants (e.g. broccoli) would account for at least some of the improvement. I would also attribute some of the improvement to the flushing action of exercise and the elimination of meat and simple carbs which robbed me of higher alkaline and higher nutrition foods.

    1. That’s great! I would agree with your conclusions. Thanks for letting us know. It encourages the rest of us to keep it up for the long term

  17. Lawrence: Maybe have some cherries, or cherry juice with your beans. See the “Doctor’s Note” beneath the video, which has great links about cherries. And consider alkalinizing your urine — also in the Doctor’s Note.

    1. We are reviewing video comments questions, Mike, and it appears yours hasn’t been addressed. Sorry for the delay. You asked about spinach and increase in uric acid. The video you watched and commented on does mention leafy vegetables including spinach as not being a culprit to contributing to gout. In addition I reviewed PubMed for “Spinach and uric acid”‘ with one study cited specifically mentioning spinach which you may want to review: Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones. Massey LK, Roman-Smith H, Sutton RA.J Am Diet Assoc. 1993 Aug; 93(8):901-6. I hope you find this helpful and your gout is under control. You have tried cherries?

    1. Cara, you posted a month ago and sorry for the delay in responding. There are several of us assuming Volunteer Moderator duties trying to get to your questions/comments. You asked about ph and food combining. I searched Pub Med and NutritionFacts.org and could find no i information on food combining and ph, although the recent NF video “Protein Combining Myth” addresses(and dubunks) the need to do food combining for protein. Your ph will certainly be dependent on the foods you intake(combine) in your diet but I know of no specific recommendations to combine certainly foods in certain ways/times to affect ph. Rather it makes sense to eat a whole food plant based diet to gain more alkalinity. Dr Greger’s video “Test to See If Your Diet is Alkaline or Acid Forming” may be helpful to review, since you’re interested in ph.

      1. Thanks so much for investigating this! It seems like this is an area that is lacking in research. I look forward to the day when there is data on food combining and its affect on absorption, digestion, ph levels, etc!

  18. So in the EPIC-Oxford study, vegans had the highest levels of serum uric acid of any group. I have now seen this point used on some websites and blogs to claim that the suggestion to limit meat intake to reduce gout is faulty, which of course is ridiculous based on the preponderance of other evidence. However, how am I to explain these findings? (I know the EPIC-Oxford vegan group wasn’t particularly healthy, since their fiber intake was so low–couldn’t have been eating many whole plant foods–but that sounds like I am trying to defend my position by discounting the evidence, not a very compelling stance.) Please help me understand this. Why would vegans have higher serum uric acid levels than meat-eaters? And how do we square this against contrary findings in the other cited articles like the 2004 article in Nutrition (uric acid levels in plasma) and the 2003 article in the European Journal of Nutrition (uric acid in kidneys)? Thanks!

    1. Thank you for this question. As a vegan who began to suffer gout after about 3 years of moving more progressively toward vegan diet, eating lots of beans, soy products, totally giving up dairy, eliminating shellfish….I am down to wondering what on earth I can eat besides broccoli! I must have some taste to my food…or I might as well stop eating. I am wondering if I should add back in yogurt? GOUT is one of the most painfull experiences of my 70 years of life.

  19. I’ve had gout attacks for 20 years, 14 years as a vegan and 3 years oil-free. Legumes, mushrooms and stress set me off.

  20. In this above video no mention has been made with regards to the no.1 main cause of gout –very crucial info for a gout patient-I have cured my gout after struggling for 8 years in 2009 i quit meat since the docs told me stop proteins -coz ur kidneys will get damaged-kidney,and pain were enough motivation for me to act!

    no change no weight loss no stop in gout attacks–in 2013 i quit dairy and sugar both since i had watched more than 2000 videos on youtube-mc dougal mercola and all other videos–from 2013 -2015 i had 0 gout attacks now i was not sure whats the main cause dairy products or sugar..and after watching a video on fruits on youtube i was told that fruits have natural sugar and we all love sugar-so i started binging on fruits in 15 days i got massive gout attack..now you and i know the cause of gout is FRUCTOSE. and sugar–not purines not meat not alchohol–

    You must understand causation and correlation to get what i am putting accross i have no product to sell if you know anyone suffering from gout pls let them know that i have cured my gout after 8 years of struggling i have short listed wht to eat –meaning first i quit meat in 2009 nothing then i quit dairy along with sugar then my gout went -meaning no more gout attacks so i finally had fruits and i got my gout attack back–so now i have 0 fructose and now no more gout http://bit.ly/28JqWOJ no product to sell just daily motivation to save the kidneys of the person suffering from gout -thanks a ton

    May be like me you have a blind spot which is not making you see videos on youtube ppl saying they cured their gout by quiting fruits and sugar–do it a 100% first so that YOU KNOW the truth and then after 6 months you can have 1 fruit every 2 days …

  21. Since reading How Not to The Die, I’ve been on a WFPB diet for the last few months. So I’m bewildered by having my worst ever attack of gout. I’ve also been eating dried cherries and drinking cherry juice. I started on cilantro today. How can this be? What else can I do? Colchicine, indomethacin and prednisone have been added to my usual allopurinol and I have had little improvement in three days.

    1. Nancy: I’m forwarding your question onto our medical moderators. Hopefully they will have some ideas for you. I’m sorry to hear you are going through this problem. I’m a lay person myself. I don’t have any ideas. I just wanted you to know that your post is not being ignored. Hopefully we can get you some help!

    2. Hi Nancy – I’m so sorry to hear of your trouble. It sounds like you’re on the right track in terms of diet. However, it’s important to remember that there are many other risk factors for gout. Some of these risk factors include higher BMI, other medical conditions (such as untreated high blood pressure, diabetes, metabolic syndrome, and heart/kidney diseases), certain medications, family history, age, and recent surgeries or trauma. I would recommend continuing with a whole-food, plant-based diet. Also, it might help to eliminate all alcoholic and sweetened beverages. Make sure to drink adequate fluids (water) throughout the day and keep up with regular exercise. Making these changes under the supervision of your physician will hopefully lead you to the results and relief you’re looking for. Wishing you all the best!

  22. My father is on P.D dialysis and his kidney function is quite low. He recently had a mild heart attack with a stent (though I know the stent might not even help, there was plenty of doctor pressure and we didn’t know how to deal with it).

    He also had gout and says that when he eats bean sprouts or sometimes mushrooms or tofu he gets gout attacks.

    Can I still advise him to eat based off of Dr. Gregor’s Daily Dozen app? I don’t want him to eat the Renal 20 Diet as it contains so much junk like chicken and fish! I am hoping his heart will be strong enough to receive my kidney transplant soon. Will that be possible if he fixes his diet?

    Any help is greatly appreciated.

    Sincerely,
    Frank Tsaur

    On a side note– I’ve read few published articles on Gum Arabic’s ability to get rid of the need of dialysis in certain patients… Perhaps it is worth looking over for the team.

    I’ve also read that patients with CKD have low vitamin D levels. Would it be advisable to take vitamin D3 if his levels are low? Would he be able to take ubiquinol for his heart?

  23. My uncle has gout and claims that drinking baking soda water reduces his symptoms. Why would this happen? Has there been any studies on it?

  24. Beer drinkers and wine drinkers are different. The wine drinker, in my experience tends to be better educated and, leads a generally healthier lifestyle…..
    ie less smoking…. exercise…… and better diet.

    Could this, in studies, mask equally damaging effects of alcohol in wine compared to alcohol in beer?

  25. Confused? I recently completed a 21day water fast in order to cleanse my body and switch from a meat based diet to a whole food plant diet. During the fast i had no problems with gout even though i read that uric acid levels can rise during a water fast.

    I started the whole food plant based diet about a week ago on Friday. Yesterday i got a gout attack? I havent had one in over a year when I ate meat.
    I only can attribute to beans or spinach. But some info says beans spinach are good…some says there bad…any other studies that can help. Thk

      1. Thats was not the question…also please check out Dr. GOLDHAMER regarding the aff3cts of fasting. His work is in a pretigious medical journal.

        The question was why did i get gout switching to a vegan diet and did not experience it from a long fast.

      2. Usually with water fasting your body will go through extreme detoxing. I have had friends that went 40 days and afterwards felt great but during part of the time felt crappy.  There are several. People I follow that have done it long periods several times.

  26. Dr. Greger,

    You mentioned most plant foods haven been largely exonerated. Can you do a video of the vegan foods that have not been exonerated? I am new to this lifestyle…looking how to best navigate these “waters”.

    1. Hey Patrick, thanks for writing. I don’t know if Dr. G WILL do such a video, but my experience – after seeing people with gout throughout my thirty years of working in hospitals, ambulatory care medical clinics and private practice – is that NONE of the gout sufferers were vegans or strict (ovo/lacto) vegetarians. They ALL ate meat. The key may be the presence of flavonoids, which inhibit the enzyme (xanthine oxidase) that causes the formation of uric acid. (see this video if you haven’t already: https://nutritionfacts.org/video/preventing-gout-attacks-with-diet/)

  27. I have heard that “excess grains” and “yeast” are problems for gout. Am i harming myself increasing my whole grains and having nutritional yeast?

  28. Hi, Randy. I am not sure where you are hearing these things. Grains are generally more acid-forming than many other plant foods, but less than animal-derived ones. I am unaware of a connection between nutritional yeast and gout. If you have research showing an association, please share. I would like to see it. I think it is probably okay to have whole grains and nutritional yeast, in the absence of allergies or sensitivities to these foods, but you should max out your intake of dark green leafies and other colorful fruits and vegetables, especially cherries and other berries. I hope that helps!

  29. Thank you for your information, I’m a vegetarian and just found out I have gout- my Dr. believes it is probably hereditary since I don’t eat any of the foods that normally trigger an attack, it’s a bit confusing.

  30. Sandy,

    You’re right in that meat consumption is a common risk factor for elevated uric acid levels. High vitamin C intake can reduce uric acid levels, so try including more foods rich in this nutrient, such as strawberries, mango, Brussels sprouts, bell peppers, and broccoli.

    Julia

  31. i have just turned vegan starting in jan. and unfortunately i am having a second gout attack in two months. the last i remember my gout attacks were spread out to 2 – 3 years…….my diet is very normal with lots of indian food, veggies, potatoes, legumes, beans etc. These things should not cause a gout attack, but here I am. Unfortunately the doctors don’t know whats causing this because they don’t under stand vegan diet…

    The only think out of ordinary I eat is this: https://www.benjerry.com/flavors/coffee-caramel-fudge-non-dairy and am thinking the sugar in this is probably causing my gout attacks….unless there is something else wrong with my kidney or liver….any help would be great.

  32. It has been 4 weeks since I switched to a whole plant based diet and I have not lost any weight and in fact have added 5 pounds. But more concerning is that something in this new diet and I can’t figure out what it is has been causing me to have severe gout attacks. If I try to recall what I have been eating there are a number of new foods such as cranberries dates figs turmeric flaxseed. This is of course very painful and discouraging and I was wondering if anyone had a suggestion about what I may be consuming that is irritating my condition. What I have been reading is also concerning because different online doctors are saying that things like turmeric and soy products as well as tofu and mushrooms might be the cause. As well as lentils which is something that I have been adding to my diet as recommended on this site and in the how not to Die book. Am I that limited?

  33. Also how do I resolve articles that are linked on this site two studies that’s a dairy as in milk is good for preventing gout but everything else written in how not to die says to do away with all Dairy.

  34. We’d like to help but need a complete picture of what you’re eating.
    IN the mean time, you might try eating unprocessed whole food plant based, and make sure you avoid dried fruit. That would include dates and dried figs. Fresh figs are ok. Eating totally raw (only foods that are ok to eat raw, i.e. no beans) will help you lose weight faster. In addition, start each meal off with a large salad full of green leafy veggies. If you use dressing, make sure it is whole food and has no added sugar or oil.

    Dr. Ben

    1. Thanks Dr. Ben. I have been eating a lot more beans than before. I am on a completely Whole food plant-based diet. No processed foods, no dairy, no cheese, no eggs. Most of the veggies are eaten raw. I have eaten dried fruit in the past and it never caused gout but I will stop. I have been eating figs but only fresh figs and if I do use dressing it has no sger and is 100% whole food based. In addition I have a large green salad before lunch and dinner. SO according to your good input it appears my weight gain is only connected to beans?

  35. Regarding dairy: most US dairy herds are infected with Bovine Leukemia Virus. 37% of breast cancer tissue tests positive for BLK. Are you sure you want to use this to treat your gout?

    Dr. Ben

    1. Thank you Dr Ben but I am not adding dairy to my diet just trying to figure out why have a gout attack this entire week when I am on a complete whole food plant based diet, no dairy, eggs, or cheese. No processed food and no added sugar in anything. Still something is causing this gout and it is awful as you know. Doing a review of foods the last week and previous week I had the following foods that were an unusual addition to my diet: cranberries, medjool dates, lots of greens and sprouts, tahini, avocado, cauliflower (never a big fan), oatmeal, cinnamon, flax seed, turmeric, lots of fruit and berries including kiwis and grapes (both a new addition to my diet). Any thoughts? Thank you very much for your consideration.

  36. Hi D kent27, thanks for your comment and your question regarding Gout. Firstly, well done with all the good changes in your diet and following Dr Greger and all the good suggestions that Dr Ben mentioned in response to your question.
    I was checking the literature and found that an increasing body of literature has suggested that a significant influence of parathyroid hormone on SUA( serum Uric Acid ) exists [7], [8]. Meanwhile, vitamin D deficiency or insufficiency can activate parathyroid to induce the release of parathyroid hormone [9]. Thanks
    Association between Vitamin D Insufficiency and Elevated Serum Uric Acid among Middle-Aged and Elderly Chinese Han Women

    1. I looked up and read about parathyroid hormone and you may be right. I see my urologist in the next few weeks. He monitors my kidney stone issues and is very thorough. It has been 6 months since I saw him last and he doesn’t know me yet on this new plant based whole food diet. I don’t have any symptoms related to issues with parathyroid hormone levels but calcium levels and vitamin D are ongoing issues. We will see what the new blood tests may tell us. Thanks for the direction and thoughts and time.

  37. I have a question. I was recently dignosed with gout. My uric acid levels have been only slight over 6 when I have been tested. But something nevertheless is triggering attacks. I rarely eat meat and have cut out most dairy as well. I do not want to take allopurinal and am wondering if reintroducing non fat dairy back into my diet may be preferable. If so how can one best avoid dairy’s effect of blocking the absorption of certain health promoting compounds and other negative effects of animal based protein. Thank you

    1. Todd,
      Thank you for your question. It’s not unusual to have relatively normal uric acid levels in gout sufferers.https://www.ncbi.nlm.nih.gov/pubmed/25581951
      If you are avoiding the things that tend to increase your risk (alcohol, meat, fish, soda, etc..), then my suggestion is to focus on consuming plant based foods known to decrease your risk, such as cilantro, cherries, and alkaline forming foods in general. https://nutritionfacts.org/topics/gout/
      Your fluid consumption is another consideration. This study suggests drinking at lease 64 ounces of water per day can dramatically reduce your risk.
      https://www.medpagetoday.com/meetingcoverage/acr/16548

  38. I’ve suffered with gout for 10 years. And I’ve been vegan for 4 years. Going vegan didn’t help the consistency of my attacks, if anything it got more consistent (once a month). I’m thinking the vegan diet isn’t the best for my gout. This video also shows that vegans have the highest level of uric acid. However, vegetarians have the lowest level of uric acid. What is it about the vegetarian diet that keeps the uric acid low? Also, what is it about the vegan diet that causes their uric acid to be so high? BTW my levels are at 10.9 when normal should be below 6. Thanks for any and all help with this =)

    1. Kris,
      When you say you are vegan, do you mean WFPB? Vegans can still consume a lot of processed foods, sugar, and alcohol which could increase uric acid. WFPB is eating minimally processed plant foods. Vegetarian diets are alkalizing which helps you to clear out uric acid. Animal foods tend to be acidifying which can result in uric acid forming crystals. The one exception is fat-free dairy mentioned in the video that slightly decreased uric acid, at least temporarily. Here are some other videos on gout that you may find helpful.https://nutritionfacts.org/topics/gout/

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