Can The Paleo Diet Increase The Risk Of A Gout Attack?

Throughout the past several decades, many have lauded high protein diets in the treatment and prevention of obesity. Research has shown that eating larger quantities of protein, at least 25 to 30 g per meal, improves appetite, reduces body weight and reduces cardiometabolic risk factors.¹

One specific high-protein diet, the Paleolithic or Paleo diet, has recently gained popularity throughout the United States. The concept of the Paleo diet developed around the idea of eating foods that our bodies were designed and evolved to eat.² Advocates of Paleo believe that the genetic code of our bodies has not yet evolved to properly digest the genetically modified and refined foods we commonly eat today.^2,3

While following the Paleo diet, one consumes foods that presumably were available to our ancestors thousands of years ago. These foods include nuts, seeds, vegetables, fruits, meats and fish.² Those on the Paleo diet rely on a pre-agricultural, “hunter-gatherer” type lifestyle with the foods they eat.³ 

The key features of the Paleolithic diet are high consumption of meats, fish and vegetables combined with a moderate consumption of fruits, nuts, seeds and berries. In addition, those on the Paleo diet avoid consuming dairy products, grains, legumes, processed foods and alcohol because these foods did not become staples until long after the Paleolithic era and the appearance of modern hominids.^4,5

An article published in the American Journal of Clinical Nutrition noted that the average American adult today has a median protein intake between 15 and 20 percent of their daily calories.⁶ When following the Paleo diet, that protein intake increases, accounting for approximately 38 percent of daily calories.⁷ 

How Can The Paleo Diet Cause Gout?

Uric acid is the final byproduct of purine metabolism. The enzyme xanthine oxidase in the liver breaks down uric acid. Once uric acid enters the blood, the kidneys can excrete it.⁸ 

As we know, approximately 90 percent of our patients with hyperuricemia are undersecretors of uric acid.⁹ A decrease in the excretion of uric acid by the kidneys leads to excessive amounts of uric acid in the bloodstream. The remaining 10 percent of patients are over-producers of uric acid.⁹ Any disruption in the balance of the extracellular fluid can lead to monosodium urate crystal deposition, triggering an acute gouty attack.

An extracellular fluid imbalance can result from a number of things. These triggers may include trauma, surgery, certain medications, starvation, dehydration, fatty foods and diets high in meat and fish.¹⁰ 

For some patients, the Paleo diet becomes problematic. High levels of meat and seafood consumption are associated with an increased risk of gout.¹¹ The body breaks down these purine rich foods and creates uric acid. Those following the Paleo diet are also eliminating dairy from their diets and dairy reportedly decreases the risk of gout.^11,12 Eliminating dairy products from the diet can lead to a significant overall increase in uric acid levels in the blood.¹²

Unfortunately, research is sparse on the effects of the Paleo diet. This may be due to the difficulty in controlling food consumption in test subjects or because the diet has only recently become popular. Several studies have examined the diet’s effect on waist circumference, weight loss, blood pressure and lipid profiles, but none of evaluated levels of uric acid. There is currently only one case study published by Repko and colleagues.¹³ In the case study, a 34-year-old male presented with a painful, swollen digit after following the Paleo diet for several months.¹³ The patient had successful treatment with colchicine (Colcrys, Takeda Pharmaceuticals) and was later lost to follow-up.

In Conclusion

Our patients may continue to utilize high protein diets in an effort to lose weight. These diets have proven effective in the management of weight through satiation. While these diets may be successful with weight reduction, practitioners should be aware of how these diets can affect the body. 

References

1. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015; epub April 29.
2. Primal Palate. What is the paleo diet? Available at www.primalpalate.com/about/the-paleo-diet/ .
3. Cordain L. The paleo diet premise. Available at https://thepaleodiet.com/the-paleo-diet-premise/ .
4. Osterdahl M, Kocturk T, Koochek A, Wandell PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. Eur J Clin Nutr. 2008; 62(5):682-685.
5. Jonsson T, Granfeldt Y, Ahren B, et al. Beneficial effects of a paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009; 8:35.
6. Fulgoni V. Current protein intake in America: analysis of national health and nutrition examination survey, 2003-2004. Am J Clin Nutr. 2008; 87: 1554S-7S.
7. US News & World Report: Health. Available at https://health.usnews.com/best-diet/paleo-diet .
8. Aringer M, Graessler J. Understanding deficient elimination of uric acid. Lancet. 2008; 372(9654):1929–30.
9. Wyngaarden JB, Kelley WN. Gout and Hyperuricemia. Grune and Stratton, New York, 1976.
10. Neogi T. Clinical practice. Gout. N Engl J Med. 2011; 364(5):443-52.
11. Choi H, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004; 350(11):1093-1103.
12. Ghadirian P, Shatenstein B, Verdy M, Hamet P. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol. 1995; 11(3):275-81.
13. Repko J, Niehaus N, Niehaus L, Hardy M. Acute gout flare associated wit healthy lifestyle modification: a case and review. N Ohio Foot Ankle J. 2015; 1(2):5.