Rose885

Whole 30 Gout!

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It seems that my boyfriend has developed gout since doing Whole 30! For a few days he's had a sore/inflamed big toe joint and a quick consult with doctor google points to gout. He's never had any problems in the past with gout so why has this happened? I thought it was caused by an unhealthy diet!

He's been eating very little fruit so I don't think it could be caused by fructose, he's drinking plenty of water/tea and alcohol has obviously been out during our W30. Is it the high protein/fat that's caused it?

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I am so sorry your boy friend is in pain, but I doubt his symptoms developed from doing a Whole30.

The exact cause of gout is unknown according to PubMed - http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/. Doctors have identified a collection of risk factors, but the best they can say is that "some diet and lifestyle changes may help prevent gouty attacks."

PubMed recommends limiting how much meat you eat at each meal, but a palm-size portion (or even two palm-size portions) of meat at each meal is limited. PubMed also recommends reducing how many purine-rich foods you eat, especially anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking or brewer's yeast. Was your boyfriend eating more than 2 palm-size portions of meat at each meal and a lot of purine-rich foods?

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I'm fairly certain he doesn't eat more than a palm sized portion of meat with each meal. He typically doesn't eat much for breakfast, usually egg/veggies and nuts, then bigger meals for lunch/dinner but always a big helping of veggies.

The only possibility is that in the last week of our W30 we did eat quite a lot of the foods you list. Anchovies, oils, mushrooms, spinach and cauliflower. Plus turkey, lamb and game meat (venison, partridge and pheasant). Could eating a lot of these purine-rich foods together cause gout so instantaneously?

He is overweight and lost a significant amount during the W30, I wondered if he might be in ketosis since he hasn't been eating much fruit (some sweet potatoes) but has upped his exercise significantly. As I said it's not something he's ever suffered from before when his diet was unhealthy and he did no exercise.

I feel really bad for him, he's done so well sticking to W30 and wants to keep eating this way. I guess we should cut out the purine rich foods and eat lots of cherries!

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The PubMed article warns, "If you are losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form." Losing a significant amount of weight may explain the sudden onset of symptoms.

Overweight people sometimes lose a lot of weight at first, but your boyfriend may need to be careful about how fast he is losing. PubMed also warns about needing to eat "enough" carbs. Your boyfriend may need to make sure he is eating sweet potatoes or winter squash regularly.

I'm not familiar with any value from eating cherries except that they taste good.

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He lost a stone (14lbs) over the month but most of that was in the first week (he was naughty and weighed himself) and 5 inches off his waist! *proud face*

I've actually been trying to encourage him to eat more since he's pretty much eating the same as me despite him being a man. His main aim is to loose weight so it's difficult to drill into him that he needs to eat more. My reasoning is if I've lost weight doing W30 and I'm in a healthy weight range already then surely it must be a shock to his system if he's overweight... plus the increased exercise.

I've read a few things about cherries and cranberries clearing up gout so worth a shot. Thanks for your help Tom. I'm not trying to say W30 causes gout btw, I'm sure it was an underlying issue for him already!

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Random question: could he have bumped his toe? I know that sounds silly, but my personal first reaction to strange happenings in my life is to look at my food. I often have to remind myself that Good Food is the foundation of good health, but it's not the cause or cure for everything. Sometimes the answer is really simple and I miss it because I'm too busy wondering if I put too much honey in my kids' breakfast.

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Weight loss increases uric acid levels. Lots of weight loss really increases the uric acid. Weight loss isn't just fat disappearing. Burning off the fat creates chemical changes in the body and losing a lot at once can overwhelm the body's management systems. Decades ago, I did co-therapy with a dietician and it seems like I remember her scolding clients who lost more than 1 pound per week (or was that 2 pounds). Her concern was loss of muscle by losing too quickly, but with your boyfriend, the issue seems to be uric acid production that triggers a gouty attack.

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Hi!

My husband also has gout so I can sympathize...it's very hard to watch the pain it causes! He thought he bumped his toe for a few days and then couldn't get out of bed or even have a blanket over the foot :( We had no idea it was gout until he went to the doctor and was diagnosed.

The main things that have helped my husband are cutting out red meat, organ meat, dark meat and all seafood. As Tom stated, it's high purine foods and those are the ones to let go. The high purine vegetables don't make a difference for my husband, it's the meats that causes attacks so he avoids them.

If your BF also has autoimmune or kidney problems it's a good idea to check with a doctor because they can give medications to assist kidneys that aren't up to par on elimination that really help to shorten the episode, then you can control the attacks with diet. Also, yes on the cherries, they are supposed to be great for gout. Good luck!

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Hi Guys, Thanks for the help. I am said boyfriend! Just a few details I should probably share. I have a bad ankle which sometime causes discomfort and recently my toe started to become more and more painful. I have doubled, maybe even tripled my exercise in the past 2 weeks (ish), mainly cycling to and from uni (about a 6 mile round trip) 4-5 times per week. Its just a dull pain, nothing too extreme. Initially I thought maybe I did stub it but I cant remember doing so.

After reading a lot online, I think that previous to Whole30 I had quite a bad diet which may have caused underlying problems but who knows, I have an appointment with my GP next week so a professional diagnosis hopefully will be provided. Thinking about the situation, I have transitioned quite dramatically to whole 30 and paleo severely increasing my vegetables, natural fats and meat intake.

But I really appreciate the information, and will try the recommendations, thanks.

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I too have had gout episodes while on the whole 30. This is my third whole 30, and I've had two very painful gout attacks so far. And no, I didn't "bump" my toe. I think I would have noticed a bump that causes pain as intense as this.

I've had successful whole 30s in the past, but frankly, this time I'm having a hard time finding the motivation to continue. If I need to limit my meat, seafood and other veggies to prevent the attacks, and eat even less fruit than I do now, I honestly don't know what I'll eat.

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Uberwiess, what day are you on? Gout's a metabolic issue, and its root cause is almost always too much fructose, rather than too much protein.  Here are some good articles about gout and Paleo:

 

http://chriskresser.com/will-eating-a-paleo-diet-cause-gout

http://www.marksdailyapple.com/gout-primal-paleo-diet/#axzz2b7EYqbxK

 

It's definitely something that should resolve the longer you're eating a diet like Paleo that cuts out all the extra triggers and can fix the metabolic derangement. but that doesn't really help you if protein's triggering your attacks NOW.

 

You can definitely do the Whole30 with lower protein intake, but you're going to have to tweak the template to make sure you're eating enough. A consultation with somebody on the Whole9 team might be worth looking into? Otherwise staying away from the VERY SUPER EXTREMELY HIGH purine-level proteins and sticking to the basics, with a heavy egg bias, should be a good starting point.  I don't think you'll have to keep that up though.

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Jumping in on this old thread since at Day 27 of my first W30 I seem to be suffering a gout attack. :/ It's very discouraging! This is my 3rd (I think) attack ever, but my Dad started having gout in his 70's so I know I'm predisposed. I'm only 39 though, and hate how it almost instantly forces me to be inactive. The first attack (2 or so years ago) was so bad I couldn't even walk around the block with the dog. This one is not as bad, but definitely can't do lunges on that side and if I even slightly bump it, the pain becomes excruciating. While Drs have suggested it's arthritis and probably gouty arthritis, my uric acid tested normal. My option now that I'm having a flare up is to get a joint aspiration (involves "giant" needle being stuck into the joint to withdraw fluid) so they can test the fluid...not really motivated to do that yet. LOL

 

My W30 diet has not included ANY organ meat, and 1-2 servings of fruit per day. Lots of veggies and healthy fat. However, I made the "Emergency Meatballs" (using all beef) 2 nights ago, and ate them for 2 meals yesterday...and in general, my red meat consumption has increased over the last 2 weeks as I shifted to more variety. I've eaten quite a bit of wild caught tuna and salmon, and lots of eggs...I think I generally eat just 1 serving of protein per meal, but I've tried to bump that to 1.5 palm's worth, and a couple times this month have managed 2 palm's worth in a meal. 

 

I must also note, that while I've been commuting to and from work by bicycle (9 miles round trip) 5 days/week all month, less than a week ago I installed new "power" straps on my bike pedals (bought wider bike pedals to avoid putting stress on the big toe joint - bought new, longer power straps so I could fit more of my foot in the strap, also to avoid putting pressure directly on the joint - I'm only having trouble in my left big toe ATM, but the strap does seem to still apply unwanted pressure - although this may be because a flare up was already starting, so that toe is more sensitive...) and I will try NOT using the toe strap on my left foot today and see if that helps. I haven't had any other joint issues this month, although my sciatica acted up a bit about mid-month and seems to have tapered off this week. 

 

It seems like every article on this issue is conflicting (meat/fructose correlation on one hand, but then others saying that paleo-type diets *don't/won't* make this condition flare up.) Plenty of anecdotal evidence that high meat (& possibly fruit) intake *does* cause flare ups in sufferers of gout (I'm not trying to debate whether these types of diets will cause gout on someone who does not already suffer from it or is not pre-disposed). Anyone out there with anecdotal evidence that W30 will reduce or eliminate gout flare ups??? As in, you used to suffer from gouty arthritis (chronic or acute) but after following W30/paleo/etc diets for some time have become symptom free???

 

So far my 1st W30 has proven incredibly successful in managing my binge-eating disorder, and for that reason alone I want to continue in some form of this approach to eating. But I also want to be active. Clearly my previous "diet" was not keeping me symptom free either, so I'm just doing more research and collecting information. Last time, a gout flare up happened, I turned to food which obviously was counter-productive. This time, at least, I seem to have no desire to do that and I'm very grateful and completely attribute that to my W30 experience, since it's the first thing other than sheer stubborn will-power that has had any effect on my bingeing habits that usually seem "out of my control". I plan to continue with some form of this diet after re-introduction, and will just have to be mindful of various factors in seeing what contributes to, or helps to limit, my gout symptoms. 

 

Any thoughts from other gouty folks and/or medical folks welcome. Thanks!

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This has been helpful to read. I never ate much red meat prior to W30, but I am now! Hamburgers, steaks, beef stew, etc. Allways lots of fruits and veggies. I've also added a lot of nuts and more sea food. I've probably lost 6 pounds (on an already lean body). Yesterday, 32 days into W60 my first ever gout attack in my finger joint soon after eating a large strip steak and kale! I guess it is the combination of weight loss and diet high in purine. I'm will try cherries, cranberries and vitamin C. What else can be done to stop and/or reduce the flare up?? How long will it last?

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Gout and diabetes go hand in hand.  You can research it.  Quite often the gout shows up and diabetes follows.

Both conditions affect the kidneys/pancreas...everything.   It takes longer than 30 days to bring both conditions on.

 

http://www.diabetes.org/research-and-practice/patient-access-to-research/high-uric-acid-levels-raise.html?referrer=https://www.google.com/

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Updating my previous post from Day 27. Days 28 & 29 I started to have some relief - looking back now, I can't believe I said this attack was "not as bad". On Day 30, what should have been an exciting day, my foot got insanely worse. Blew up like a balloon, very red, inflamed, and excruciatingly painful to even the slightest touch. SO FRUSTRATING to have this reaction after loving everything else about W30! Went to the Dr. the next day, expecting them to do a joint aspiration, but they decided to just do blood work and try me on a gout medication called Colchicine. The Dr. said if my uric acid levels were high, and I responded to the medication, that was good enough for a diagnosis of gout and much less painful and invasive than "tapping the toe". She also said if the meds worked I should see "significant improvement" within 24-48 hours. I had absolutely NO relief for the next 5 days, at which point my foot was *maybe* *slightly* less painful to the touch. I spent that whole week on crutches, missed several days of work; taking 800mg ibuprofen did absolutely nothing to touch the pain. Codeine barely lessened it. I called the Dr. again and was prescribed a 2nd round of the Colchicine, which I just finished this past Saturday. By the end of last week the redness and swelling had diminished significantly. I can now stand flat-footed, gently, without pain, but any bump or bend to the toe still results in excruciating pain. My blood results did show raised uric acid levels, but I'm not convinced I responded to the medication. I've reduced my meat intake to about 1/2 a palms worth per meal, and sometimes eat a vegetarian meal, but my meals are no longer satisfying and I've struggled with stress eating (did not have a single problem with this during my 30 days of W30 and it was amazing!) "Traditional gout diets" (in Western medicine) recommend no more than 2-6oz of protein PER DAY! :o

I continued into the re-introduction period only because a) I know that the inflammation started while I was being completely compliant, and B) I am approaching a 2-week vacation and while we plan to stay fairly compliant, we needed to know how our bodies would react to certain foods. 

 

My Dr. has of course said it's the meat intake. I was relying on canned tuna quite a bit, and most seafood seems to be out on "traditional gout diets", which makes me REALLY bummed out. I'm eating about 6 eggs/day - does anyone think that's a problem long term? As far as re-intro goes, dairy is a no-go (didn't make me sick but instantly constipated both of us for 3 days, so really not a fan of that!) and I've read that dairy helps increase the excretion of uric acid, so I wondered if that contributed. Pre-W30 I probably ingested dairy every single day of my life. My Dr. doesn't think I need to add it back into my diet though, so that's good. No problems with non-gluten grains, aside from my tendency to binge-eat. I'm doing a 2nd day (with 2 days in between) of legume re-intro because I'm not sure on that one. Haven't re-intro'd gluten grains yet...

 

Let me be clear, I'm not completely convinced that the meat intake triggered this - it may have been coincidence. I've also read some thoughts from the bodybuilding community that it has less to do with a specific food group, and all to do with a PH imbalance (meat & some other things are acidic, and if not balanced out with alkaline foods can trigger gout attacks). Any W30 thoughts on that one? 

 

I'll be meeting with my Dr. again tomorrow - recovery has pretty much stalled at this point and I'm concerned since I can't even wear a shoe on my left foot (today it was raining and I traveled to work in a slipper with a plastic bag tied over it), and every time I go to eat I find myself in a panic that ANYTHING could trigger further inflammation. Has anyone had a gout attack during W30, continued with paleo-style eating, and seen improvement? I was seeing great results and while I'm continuing to eat compliant foods (I really do enjoy the menu!), I'm not feeling satisfied. Partly that has to be psychological, and that's my burden to bear (in the past I've always binged on junk food any time I'm injured - now I'm just struggling not to binge on bowls of fruits, nuts & coconut milk), but gout is such a weird, mysterious condition, is there ANY relief? I'm so stressed about it. 

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Hi - Both my husband and I suffer(ed) from gout. It can be so excrutiatingly painful, I definitely feel for your husband! After trial and error, we pretty much know what triggers it for us. I'm lucky, I only get it in my big toe joint and really the only thing that seems to trigger gout regularly for me is pistachios.  Once in awhile if I've been eating too much red meat I'll get a twinge, but it's bearable, and I know to ease off the steaks, etc.

 

My husband, on the other hand, gets it terribly in his knee and elbows and now his ankle. It's very debilitating for him, chills, swelling in the affected joint, redness - he's unable to do anything when he has a particularly bad bout. His is triggered by shellfish, beer (which he rarely drinks), orange juice and if he skips meals and then eats a meal with too much red meat.  Because his gout is so severe, he takes daily medicine for it, but we also keep tart cherry juice and a tart cherry supplement pills on hand. Both seem to work, in tandem with his meds.  (My husband does not do Whole 30)

 

I would suggest really keeping track of his intake and when he gets gout to figure out exactly what he's eating that's causing his flareups.  He may find that it's just one or two things that he can eliminate from his diet.

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"root cause is almost always too much fructose, rather than too much protein."......This is a little simplistic.  I am a big fan of the whole thirty and my most recent whole thirty was probably the fourth or fifth that I have done.  However!!!!  I do think the moderators may be a bit quick to blame anything but the whole thirty......I am Religious about not overdoing fruit on the whole thirty and barely even eat a potato...but I had my first ever gout attack exactly 4 days after my last whole thirty.  It was horrible, as bad or worse than anyone describes.  Doc did the blood test and found high uric acid levels and then said something significant...."I noticed you had a high uric acid level two years ago" I did not have a gout attack at the point....BUT the blood test he referenced coincided with my first round of back to back whole thirties....It might be useful to do some actual research regarding uric acid levels and whole thirty participants.  No matter how passionate we all are about this way of eating......perhaps the number of times that gout comes up when you search the forums for the word is something that needs to be questioned.  I can cut back on meat and shellfish, but I am already paired to the bone on fructose, have NEVER been a much of a drinker - don't like beer, don't drink fruit juice, never eat more than 1-2 smallish servings of fruit per day.  I am in a bit of a fret over what I can actually eat as I went on the whole thirty to solve issues I have with grain and dairy.  If I have to cut out all the high purine foods (and the pain was enough to reinforce that notion rather stridently) it really doesn't leave me much that is okay.

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Gout and diabetes are related.  There's usually a genetic component with both conditions.  The W30 could've been the tipping point but it was already there, laying dormant or just ready to pounce on your joints. 

There's no such thing as one plan fits all.  Food is not my religion and if certain foods are causing more harm than good - adjust accordingly.  

http://www.diabetes.org/research-and-practice/patient-access-to-research/high-uric-acid-levels-raise.html

Uric acid is a waste product that is normally found in the blood. It comes from the breakdown of substances called “purines” that are part of many foods. High amounts of uric acid in the blood can cause crystals to form in the joints, leading to gout. However, only a small portion of people with high uric acid levels get gout.

Research has shown strong links between uric acid levels and metabolic syndrome, a combination of medical conditions that are related to insulin resistance (the body’s inability to correctly process insulin) and increase a person’s chances of getting heart disease and diabetes. Studies in people with pre-diabetes and in the elderly have suggested that high uric acid levels raise a person’s chances of getting diabetes.

 

 

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