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Gout and blood type - might there be a relationship? And the gallstone connection.

 
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Anne Miller wrote:I had my 2nd gout attack on 1/9/18.  I feel my attack was brought on by stress and dehydration.  I am still having some minor pain.

From reading here on permies, I feel the long term cause is the high calcium content of our well water.

We are trying to find a water filter that will remove calcium and is reasonably priced, will last and do the volume of water that we need.

I am doing the ACV and cherries.



Anne, we also have high calcium well water. Maybe you've read about this already but I read some where that vitamin K2 is required to properly utilize calcium (as is vitamin D?). K2 is in meats (especially organ meats, egg yolks, some dairy products) or fermented foods.

We fell short on fermented foods for a bit with Paul (my January busy) and he noticed his fingernails were going soft. I'm back on the ferments now!

 
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Thank you for the info on K2.  I had not found that though I understand its use for dental problems.  I recently purchased it so I will be sure to keep taking it.

Due to the gout I am trying to limit meat to 1 or 2 oz.  At the end of the day my foot still has some pain, I don't know if it is from meat or being on my feet all day.  Since I have fermented veggies I will add some of those daily.
 
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howdy,

had my first gout attack last week, horrible pain.

anyways, have been doing lots of research about it.
a few things I keep running into is that gout is common in vegetarians and vegans as well as meat eaters.

so the theory that meat (purines) cause gout seems strange.





   First of all, there’s the problem of vegetables. Even though most vegetables are low in purines, a few (like spinach, for example) have a significant amount. But in the NEJM study linked above and in this one (completely different authors and population), purine-rich vegetables weren’t associated with gout at all.

   Then there’s the fact that only about 1/3 of uric acid in the body comes from dietary purines; the other 2/3 is produced by the body itself. In other words, no matter how many purines you eat or don’t eat, the majority of uric acid is coming from somewhere else anyway.


from https://paleoleap.com/gout-forget-purines-skip-sugar/


most of the research I am doing is on paleo/keto relations to gout as thats the diet I feel best on.


I believe for me years of alcohol, sugar spikes and dehydration lead to gout?

just throwing it out there,
any imput?
 
Jocelyn Campbell
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Tlr:dr:  I would agree that it's not simply how many purines one eats. There's more to it than that.

jordo acorn wrote:howdy,
had my first gout attack last week, horrible pain.


Uff. So sorry to hear that! I haven't had it myself, but watching Paul suffer, it seems excruciating.

jordo acorn wrote:anyways, have been doing lots of research about it.
a few things I keep running into is that gout is common in vegetarians and vegans as well as meat eaters.

so the theory that meat (purines) cause gout seems strange.





   First of all, there’s the problem of vegetables. Even though most vegetables are low in purines, a few (like spinach, for example) have a significant amount. But in the NEJM study linked above and in this one (completely different authors and population), purine-rich vegetables weren’t associated with gout at all.

   Then there’s the fact that only about 1/3 of uric acid in the body comes from dietary purines; the other 2/3 is produced by the body itself. In other words, no matter how many purines you eat or don’t eat, the majority of uric acid is coming from somewhere else anyway.


from https://paleoleap.com/gout-forget-purines-skip-sugar/


most of the research I am doing is on paleo/keto relations to gout as thats the diet I feel best on.


I believe for me years of alcohol, sugar spikes and dehydration lead to gout?

just throwing it out there,
any imput?


Well, you've likely researched more than me, though I think I confirmed somewhere (?) that it's the kidneys that process the uric acid (whether produced by the body or from the diet). It seems likely to me that sugar, alcohol, and dehydration would all be huge stresses to the kidneys (as well as the liver).

Our theory, that seems to be working to keep Paul gout symptom free, is that when he was dumping a LOT of pounds and water weight from the gallstone recovery (which was a pretty "clean" diet otherwise - no grains, low sugar/no refined sugars, no alcohol, high veggies, limited or at times almost no meat or dairy proteins), we didn't realize that his body was being overloaded with uric acid. Then, we had switched his diet to some high purine content foods both meat* and veg (to help with gallstone/gallbladder and liver issues), on top of what we didn't know was the freaky-high purine content chlorella (blue-green algae). So the dumping weight, high purines in food, and the chlorella created a "perfect storm" so to speak, creating a build up of uric acid crystals in his foot.

(*The irony for Paul is that beef and pork are considered major gallstone triggers, and not part of the blood type A diet. So we switched him to occasional chicken and fish. Though the chicken and fish are probably twice as high in purines as beef and pork!)

Now, Paul's weight has stabilized and he is off the chlorella. We've been able to add back in higher purine foods - spinach, green peppers, chicken - and he has stayed symptom-free (both for gallbladder issues and for gout). Paul said the uric acid build-up is a cumulative thing, so we're still keeping purines a bit on the low side to help his system (and kidneys?) normalize even more.

I realize I'm repeating a bit of what both Paul and I have written here, though I'm trying to relate it to your research and theory, too. It's plausible (probable even?) that without the chlorella, Paul never would have had gout issues. For some reason, for his system (years of pie and slight dehydration, too?), that supplement put him over the edge, and the gallbladder recovery/stress made it worse when he was dumping weight too fast.  

 
Anne Miller
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I don't do Paleo, though I have been doing low/no carb since I was in my twenties.  

"Gout is strongly associated with diabetes and metabolic syndrome. This suggests that there may be some kind of blood sugar connection, and there’s evidence that it goes both ways. Insulin resistance contributes to hyperuricemia, and hyperuricemia induces insulin resistance."

For me this may have some bearing as I was diagnosed with low blood sugar and a sluggish thyroid before I started doing low/no carb.

Before this 2018 attack, I have hard pain in both of my thumbs and have been wondering if I am going to lose use of my hands.  This attack lead me to believe the pain is from uric acid.

Over many years I have had a unknown pain in my big toes, now I know why.

It has been hard for me to adjust my diet to lower meat consumption since many times all I ate was meat.  I read somewhere that if you want to eat meat then over compensate with more vegetables. So what I am doing is eating a two cup salad made with 5 different vegetables (1/2 Cup each more or less) and then slowly decreasing my meat intake.  Let say I was eating a 4 oz serving normally so then I went to 3 oz. for a week or two.  Then to 2 oz., then 1 oz.  I am probably now at the one ounce stage.

" Eat more fresh vegetables (and fruits with low fructose levels): higher intake of Vitamin C may help control uric acid levels."

I also read somewhere that if you want to eat high purine vegetables then limit them to no more than a 1/2 C serving 5 times a week.

jordo acorn wrote:   I believe for me years of alcohol, sugar spikes and dehydration lead to gout?  



I agree about the dehydration as I feel the second attack was caused by stress and dehydration.  My 1st attack in Oct 2016, I believe was caused by aspirin.

I hope you are doing better and getting rid of the pain.  Mine lasted for a month before it finally slowed down.  After more than two months, the bump on the side of my foot is still red and shiny but no more pain.

 
Jocelyn Campbell
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Oh gosh, Anne, that sounds really rough! I hope you, too, are feeling better!

The insulin resistance, the non-alcoholic (or alcoholic?) fatty liver, the kidneys, the thyroid, the low blood sugar...and the resulting gallbladder issues and gout...all these things hinge so much on diet and food.

I, too have struggled with low thyroid and low blood sugar for a while now. So, in trying to heal both myself and Paul, I'm now attempting to focus on the mitochondria. Which is admittedly a broad, somewhat gobbledygook term.

Here's a couple easy reference points in my efforts to dial that in a bit (this first one is a repeat, but I think worthy of repeating even more!):


And then, this podcast helped me make further sense of what the mitochondria need and why anti-oxidants in our diet, among other things, don't do what we think they do:  https://wellnessmama.com/podcast/ari-whitten/.

While The Energy Blueprint guy, Ari Whitten, does have quite the stuff for sale at his website, I think that's okay (even smart!) to do and I also think his theories and content have quite a bit of merit. The mitochondria issues are well summarized in this podcast. Stick with his background on all these systems in our bodies at first, because he does tie it all together, and it's not just about fatigue and adrenals, IMHO. Blood sugar is controlled by cortisol which is linked to the adrenals, and since all these other systems are tied to blood sugar issues, too, I think it's relevant even if you're not interested in the "adrenal fatigue" topic.


 
Anne Miller
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Thanks for the links.  I probably should have explained better.  

A few years after being diagnosed with the thyroid/low blood sugar, I felt really bad, like tired all the time.  I went to the Dr. for blood work and he said everything was fine.  I knew I didn't feel right.  While searching a book store for something that might help I found low carb. Since I started eating low carb my thyroid is Ok. I had blood work last year and my thyroid was in the desired range.  When I eat too many carbs I can tell by the way I feel.  

So far, I am mainly eating vegetable and fruit carbs and everything seems OK.

I really want to control the gout with diet.

 
Jocelyn Campbell
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Anne Miller wrote:Thanks for the links.  I probably should have explained better.  

A few years after being diagnosed with the thyroid/low blood sugar, I felt really bad, like tired all the time.  I went to the Dr. for blood work and he said everything was fine.  I knew I didn't feel right.  While searching a book store for something that might help I found low carb. Since I started eating low carb my thyroid is Ok. I had blood work last year and my thyroid was in the desired range.  When I eat too many carbs I can tell by the way I feel.  

So far, I am mainly eating vegetable and fruit carbs and everything seems OK.

I really want to control the gout with diet.


Ah, gotcha! I guess I babbled a bit there.

I'm sure you read Paul's comment here that said:

paul wheaton wrote:

https://www.jstage.jst.go.jp/article/bpb/37/5/37_b13-00967/_html

A few numbers:

rice 26
almonds 31
peanuts 49
dried nori seaweed: 592
eggs 0(zero)
yogurt 5
strawberry 2
Avocado 18
broccoli 70
carrots 2
ginger 2
parsley 289
spinach 172
beef 79-110
chicken 122-154
pork 62-138

So, carrots and eggs are good.  Seaweed is bad.  During a gout attack, probably wise to not eat anything with a score of 20 or higher.  And eat plenty of stuff with a score of 10 or lower.  And, as always, lots and lots of cherries.

And then I spotted this:

chlorella 3183

This is bluegreen algae.  



I was putting spinach and parsley in a LOT of things, and we were eating nori seaweed snacks instead of chips. That was on top of the chlorella AND the chicken and fish to avoid gallbladder issues! All very high purines. Gah! As we might have already written, we cut those out, or significantly lowered them, and we cut out all mushrooms, too, because of potentially high purines.

I recommend making your own "safe" foods list out of the foods that you like to eat.

I like mushrooms, so I'm coming back to this stuff both to reply and to double-check on what might be "safe" for Paul. In the chart Paul linked to, there is a section on mushrooms which says:

Most mushrooms, except for dried shiitake and hiratake, contained 6.9–98.5 mg/100 g purines, so they were classified in the low or very low group. Dried shiitake contained more than 240 mg/100 g purines. It is thought that the amount of purine became larger because purines in mushroom was condensed and the weight became light by drying.


It listed raw shiitakes as having only 20 mg purines, so I thought that sounded low. Last night I made a curried pumpkin soup with shiitakes and Paul was a little nervous. No gout symptoms though - yes!

Then there is this purine chart:  https://www.goutcure.com/purine-food-chart.html

Which lists:
white rice 10
oats 42
tapioca 37
peanuts 42
almonds 13
pecans 13
sunflower seeds 65
yogurt 0
peas 62
apple juice 3
pineapple 8
apple 6
cherry 6
eel 48
pork chop 49
ham 83
chicken 125

I'm still confused on bell peppers - the former (more scientific looking) list showed them on the high end, while the latter (simpler) list showed them the low end. I use them a lot in our cooking, and have probably only reduced that a little since Paul has had his gout, and he's stayed symptom free with them in our diet.

It frustrates me in my cooking that onions and garlic are considered gallstone triggers, but they are VERY low in purines which makes them super safe for gout. I still cook with onions and garlic, though I have reduced what I used to include by about half and Paul seems okay on both fronts.

Is this kind of diet stuff more what might be helpful to discuss, Anne?

 
Anne Miller
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I really like the information at Mayo Clinic:

"High-purine vegetables. Studies have shown that vegetables high in purines do not increase the risk of gout or recurring gout attacks. A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus, spinach, peas, cauliflower or mushrooms. You can also eat beans or lentils, which are moderately high in purines but are also a good source of protein.

Fats. Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products.

Proteins. Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your diet with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, which are associated with reduced uric acid levels.

Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.

Selected seafood. Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna."

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524

 
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Something new to me that I learned a few months ago was that high complex carbohydrate diets can be malicious to the phalanges....because of fungus.  A diet of consistently eating lots of complex carbs often causes the body to grow fungus internally to help break down/digest the complex carbs.  A main byproduct of the fungus that grows within the body is uric acid.  Fungus prefers refined complex carbs, compared to whole.  So if you have gout and you eat tons of pasta or ...... there could be a link in that regard.

The best way to get rid of uric acid is to detox the body with foods, juices, fasting, and herbs.

Without altering your diet or detoxing you could probably get rid of a lot of health issues by making a small change in your daily habits.  Intermittent fasting.  You fast for 18 hours every day and eat within a 6 hour window.  It will give your body a chance to begin removing waste and heal.  There's lots of info about it out there.  A couple things I tend to do.  I prefer to eat in the evenings, and if you can dry fast during the whole fasting period it will be more effective.  You can do your workouts in a fasted state which will kick up the power of the fast and all the hormones being produced a bit more.

And I think herbs could help as well.  BUT....knowing everything I know now, they would work better if used as a wholistic approach instead of trying to target and treat symptoms.  To get the uric acid out of the body it needs to be excreted via the kidneys.  So you need to get the kidneys filtering which means the adrenals also must be working, then once your kidneys are removing waste, you can begin digging deeper into the body by taking herbs for the lymphatic system, and once the lymph system is pumping out the wastes you can take herbs to increase the function of it all.

It all works much better if your willing to cleanse the body so you can begin fasting and more specifically, dry fasting.  You can think of dry fasting like a dirty sponge being wrung out, over and over until it's clean.  That's in it's simplest form what is going on in your body.  You're wringing out all the detritus making you feel terrible.  Dry fasting will get the kidneys filtering waste better than most all of it.  It's the top of the mountain so to speak to get the body to begin dumping waste.  BUT....you must work up to this level, via diet and juice fasting.  Once you can safely juice fast, then you can experiment with dry fasting.

You can melt gallstones with herbs and foods.  The herb called Chanca Piedra aka Stone Breaker dissolves stones within the body.  Malic acid found in the skins of fruit will dissolve stones within the body.  Grapes and apples are high in malic acid.

 
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My doctor asked me to add mozzarella cheese and real dairy yogurt - but all other dairy (including all other cheese) is on the naughty list.

Weird, but okay.  

Further, wheat is on the naughty list, but rice is on the "okay in small quantities list".  When talking about what makes a small quantity - it sounds like it should never be more than a third of any meal.   Or, it can be half, if it is a tiny meal.  

Once every week or two, jocelyn and i pop into town for errands.  I like the idea of giving her a break from so much cooking.   But the food I can eat is so freaky limited.  And my last gallstone (october 20 - about five months ago) was from eating in town.  So we ended up rotating between three restaurants:  sushi, indian and chipotle (vegan bowl).  We tried to think of any other place that we could possibly go, but we would strike out over and over.  Nearly everything has wheat, corn, potatoes or meats and/or dairy on the naughty list.  

So here is something we tried a few weeks ago ...   I ate just a little and was nervous as hell that i would throw a stone.  We went to a pizza place that had gluten free pizza.  The crust is made with rice.  And pizza has mozzarella cheese.   Selected toppings that worked and ... no problem.  

Last night we tried it again, but I went ahead and had plenty.  No stone.  

The thing that makes it especially powerful:   when i first went to the hospital, the surgeon's office called me that day to set up surgery.   She told me that I had to eat a low fat diet until the gallbladder removed.  She specifically said that if i were to eat pizza then i would have another attack.  

To be fair to her:  I think that her advice does work - sorta.  But with a few changes, one can have pizza!

Also:  YMMV.  It could work for me because of my blood type.  This might not work for others.  

But it was nice to eat pizza again.

 
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@Paul,

Have you considered the "Flush" protocols for stones?
 
paul wheaton
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jim dee wrote:Have you considered the "Flush" protocols for stones?



Considered?  Oh yes.   I have given thought to the idea that I am probably packing 20 stones that are far too big to go down that little tube, and what would happen if I did something that would make them all try to go down that tube all at once.  Would I die or would I merely wish that I were dead?

 
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Joy Oasis wrote:My Dad had his gallbladder removed a few years ago. I never had official diagnosis of stones, however I occasionally dull pain and hard to describe feelings under my ribs, and when I was pregnant, I had pain from my son pushing (or so I thought) under my ribs. About a month ago, I was eating lots of chayote leaves (cooked and also raw in smoothies), and lemon (I like to put a quarter of frozen lemon in my water or a smoothie, including skin, seeds and all), and my usual herbal preparations and supplements. Possibly something else, but those might have contributed to me releasing the stones. Painlessly. The only reason I knew was because I kept going number two often and after couple of them within 15 minutes, I decided to take a shower to feel cleaner, LOL. While I was taking a shower, stone fell out, and I even thought it feel in through the window. We do have a screen, so that was not possible. I picked it up, and it was slippery, so I realized it was from me. I looked and took a stick and smushed it -it was like a hardish wax. I googled waxy intestine stones, and came up on info, that they are cholesterol stones and stored in gall bladder, but made by the liver. That's why getting the gallbladder out is not yet the end of the story. Not for very long, anyway.  Stone was not that small, and maybe I imagined, but my under rib area feels so much emptier now. I looked at my other stools for a while and saw several more stones coming out. One time a few -I could clearly see them as they were darker color than the stool and I pressed them with popcicle stick and they had the same consistency. Now the problem is, I am not quite sure, what exactly I did to soften those stones since I didn't do any official cleanse. However chayote leaves are one of the many herbs/plants that soften and help to pass stones.
  Here is what I have in my herbal files about herbs:
Liver/gallbladder herbs
Greater Celandine (Chelidonium majus)- whole plant is used. Also great for migraines and dissolves stones.
Gold Coin Grass (Lysimachia christiniae, Herba Lysimachiae, Jin Qian Cao) can be found in almost all Chinese ancient liver gallbladder cleanse recipes, thanks to its amazing ability on dissolving stones and other health benefits. Besides of the compound prescriptions, clinically it is also often being used alone for gallstone removal. Lysimachia is a perennial creeping herb. Stems are delicate, prostrate, and 20 to 60cm long; surface is gray-green or reddish purple; the entire plant is glabrous or sparsely hairy. Opposite leaves are glabrous and with 1 to 3cm petiole; blade is oval, nearly round to kidney shape, 1.5 to 8cm long, and 1 to 6cm wide. Suggested gold coin grass dosage is from 15 to 60 grams in dried herb or 30 to 120 in fresh herb, in decoction or juice.
Ground Ivy , creeping charlie ( Glechoma hederacea) is also used to melt kidney and liver/gallbladder stones.
Bile salts and lecithin supplements miht help to disolve stones as well.
Fresh radish juice - start with 2-3 ounces by weight, and increase slowly to 12-14 ounces per day, before breakfast. Continue for 2-3 weeks at that dose, then reduce to 2-3 ounces again and continue until problems resolve.
Bogbean (Menyanthes trifoliata)- tincture -a droper 3 times a day. Also great for viral conditions (including shingles), regulating hormones. Can make strong infusion (1 oz of herb to a pint of water), take 4 tabslp.  several times a day. Keep in the fridge.
Burdock
Kidney/gallbladder stones
Excess calcium and low magnesium, K2 and B group vitamin diet creates perfect conditions to form stones, especially where chronic dehydration is present.
******************************************
Kidney Stone Recipe:
· Raw Apple Juice (if you can find it or make it – the less processed, the better)
· Dandelion Root (capsule or tincture)
· Goldenseal Root (capsule or tincture)
To dissolve the stone, take 8 oz of juice and a capsule each or herb (or one dose of tincture) every hour that you are awake – and nothing else to eat or drink. (You won’t be hungry anyway – this juice fills up the tummy, and kidney stones masks any other sensation.) If it is not a stone, these herbs work to heal the kidney or maintain its natural healing.
                         recipe from beyonedwheatandweeds.com
*****************************************************************
Chanca Piedra
Jordan Princess Basma uses for kidney stones Silvery Whitlow-wort (Paronychia argentea Lam), foot of the pigeon in Arabic. She gathers a handful, rinses it with cold water and pours boiling water over it. She steeps it for a few mnutes and drinks it.  Pain is totally gone in 10-15 minutes.
Gromwell ( Lithospermum officinale)
Tulsi
decoction -- which consists of just two herbs -- Heart Vine (Tinospora cordifolia) and Chanca Piedra (Phyllanthus niruri)
Chayote leaves -make tea
Queen's Crepe Myrtle (banaba tea)
Horsetail
Lemon juice in water since it has citrate, that helps.
Cardamom seeds
Dandelion tea or tincture from whole plant
Garrya elliptica (coast silk-tassel, silk tassel bush or wavyleaf silktassel) great for gallbladder, kidney stone, and bile cramping pain. It can cause the duct to relax sufficiently to allow the stone, gravel or whatever else to pass with less resistance and pain.
Burdock seeds have often been used as a remedy for kidney stones and urinary calculi. Cook states they "are very serviceable in irritation and aching if the bladder, scalding urine, and urine charged with mucous and gray sediments." Colonial herbalist Johann Christoph Sauer, who wrote one of the first herbals in the "New World", stated that "The seed, taken in one-quint (1/8 ounce) doses every two weeks, will prevent stones in the kidneys and bladder."
"Herbs used for gallstones are dandelion, golden seal, mistletoe, yellow dock, oak, parsley, and wild yam."  Dr. Christopher
Hydrangea and marshmallow - hydrangea breaks them down and marshmallow coats them and keeps them from hurting as they exit.
Claudia Orgill from Healthy preparedness blog recommends:
Here are the three simple steps I do to eliminate the pain (and cause) that comes with having a kidney stone within 1-2 hours:

1) Take a magnesium pill - enough times a day to the point where diarrhea begins to occur. (Cut back on the magnesium once that occurs. You want to saturate the body with as much magnesium as possible for that first day.) You can also topically rub magnesium chloride oil over the area that is having spasms - or continually drink water from a glass full of water containing 1/2 tsp of magnesium oil.

2) Drink a mix of 1 part fresh lemon juice and 1 part olive oil. Drink 2-3 Tbsp's at a time - every 2-3 hours the first day.

3) Drink plenty of water to flush that kidney stone out.



Thanks for sharing this lengthy but informative post. i read every bit and I have learnt and appreciate your post.
 
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Kerrshay Peck wrote:

Thanks for sharing this lengthy but informative post. i read every bit and I have learnt and appreciate your post.



You are very welcome. This is actually from my notes. I always type up things for my and for people I know reference when i come up on them and add my personal or other people experience too. It comes in handy, when problem comes, and one is too sick to dig for info.
 
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As I read through the various comments, I can't help but notice a pattern, which is that most of the advice given, and seemingly, most of the successful outcomes, have been related to switching to a low carb, high fat diet (LCHF).

This takes many forms, and one of the stricter variations is the ketogenic way of eating. (Calling it a diet is a bit of a misnomer, but many diets CAN be ketogenic.) Keto is extremely anti-inflammatory and is useful in combatting many health problems.

paul wheaton wrote:
what i have been eating for the last two weeks

I think this should be taken with a grain of salt.

(Taken literally, salt is commonly a part of eating ketogenically. )

paul wheaton wrote:  This is just me.   And what works for me might not work for others.  And there might be a bunch of stuff here that is really messed up and I will come up with something better later.  Or it is messed up and I won't figure out something better.  

cherries, apples, pineapple, grapes, blueberries, tomatoes, dried fruits, bananas, lemons, limes, grapefruit
avacado, greens (except spinach), carrots, radishes (especially daikon), peppers, celery, squash, sweet potatoes
coffee with stevia and "nutpods"
kim chi
coconut oil
mayo made from avacado oil
fermented pickles
water
chips made from veggies
cheese-like stuff made from almond milk
fruit preserves sweetened with fruit juice
I like to get stuff to be more raw/fresh and less cooked.

Sometimes in small amounts:

white rice
corn
macadamia nuts


Zero:

potatoes, onions, asparagus, cole crops, spinach
wheat,
beans, peas, lentils, soy
dairy
meat or fish
eggs
mushrooms
nuts (except a few macadamia nuts)


Much of this is fine. The fruits have too much fructose and will take you out of ketosis, except the blueberries, and perhaps the lemon. Same with the rice and corn, they will spike your insulin.  Because the cherries specifically have anti-gout properties, I'll give them a pass.

paul wheaton wrote:
Here are a few things about supplements that i am sharing because I am a bit on the fence.  


One, is that a lot of sources desperately want both gout and gallstone folks to consume two tablespoons of organic raw apple cider vinegar three times a day, just before eating.


Many people who eat ketogenically also take ACV.

paul wheaton wrote:
Two super short videos.   The first one played a huge role in me moving toward trying the cheegan diet.  Especially the part where he mentions cooked foods:




In this one he talks about people fasting.  And while I wasn't fasting, I wasn't eating much.   But the big thing is where he mentions "potassium citrate"




Dr. Berg is a strong proponent of eating ketogenically.

Matt Walker wrote:I had Gout Paul.  Carnivore diet has cleared up all symptoms, and from what I've read from others who eat this way that's the normal.  Can't have gout without carbs, apparently.  Worth a month of experimenting in my opinion.


Todd Parr wrote:It's fascinating to me that you have people from all areas of the spectrum, vegan to paleo to carnivore, that thrive on their particular diet.  Obviously, no group is wrong, so rather than figuring out which is "better", I look for the similarities in diets that would seem, at first glance, to be polar opposites.  Without fail, the diets that are working for people, have some things in common.  No processed foods, no processed sugars, whole foods, whether meats or veggies or fruits.  It seems that as long as you follow those guidelines, personal preference can dictate.  There are some major differences, especially when it comes to grains and dairy, but an easy fix for that is to follow an elimination diet for 6 or 8 weeks, and then try adding in common trigger foods to see how your body reacts.


The carnivore diet is ketogenic.  Paleo can very easily be ketogenic, as most humans for mostof their lives for most of history were in a ketotic state. And vegan, if is is low carb high fat, is also ketogenic. (What seems to matter is net carbs, which is total carbs minus total fiber, and since vegetables are high fiber, they are low net carb, which generally means you can eat as many vegetables as you want without slipping out of ketosis. Also, slipping out of ketosis occasionally is not seen to be a big deal.)

Lee Kochel wrote:Others have covered this already, but I am moved to contribute also.  The answer to all gout and gall stones, regardless of blood type and personal genetics, is a ketogenic diet: high, 80+% fat ( a few percentage of which is equal amounts of  omega 3 and omega 6 fats and the rest any combination of omega 9 and saturated fats); moderate, 15 % protein (half of the body protein is formed from collagen  which is made up of 3 amino acids and is found in skin, hair, tendons, ligaments, all connective tissue, the outer layer of all the larger bones -- all the meat parts that most people throw out); and low, 5 % carbohydrates from green leafy vegetables including cruciferous which are mostly steamed.  No grains, no refined sugar, minimal fruits, no chemicals, no excess omega 6 fatty acids, no msg.  In your, Paul's, case it will have one drawback -- you will lose weight.  Dr. Berg in your video selection is a great reference.



One of the biggest most prevalent health risks is insulin resistance. The problems it has been linked to include obesity, diabetes, cancer, and dementia (sometimes called type 3 diabetes). Alongside obesity, there's risk of fatty liver and/or fatty pancreas which someone can have without looking obese.  A LCHF diet is an effective way of preventing, treating or reversing these issues to the point of being effectively cured. Lowering or eliminating carb and sugar intake reduces blood glucose, giving rest to your pancreas in producing insulin and allowing blood values to stabilize.  Lacking the quick and easy energy source of carbohydrates, your body turns to stored fat in your adipose tissue and the liver produces ketone bodies to convert fat into energy.  That is ketosis. People who eat ketogenically often experience a dramatic decrease in body fat, and that fairly quickly. Once the body switches to ketones instead of glucose, waist circumference inches seem to just melt away.

mark tompkins wrote:
Inflammation is also caused by glutin (Please read the Wheat Belly Book).  

I grow my own food using rock dust, in an area out on the prairies that has sandy soil, and my health is 10000000000000000000 X better improved.  Cut sugar 99%.  Cut bread 90%.  Cut meat 70%.  EAt mostly chicken for meat, that is almost like organic (no antibiotics, hormones, ...).  EAt mostly vegetables, quinoa.  I also eat my own potatoes, which is a no no, but, they seem to be beneficial.  Rice is not beneficial, especially the processed rices.


William Davis, author of Wheat Belly, is a cardiologist who promotes eating ketogenically.

paul wheaton wrote:
A few numbers:

rice 26
almonds 31
peanuts 49
dried nori seaweed: 592
eggs 0(zero)
yogurt 5
strawberry 2
Avocado 18
broccoli 70
carrots 2
ginger 2
parsley 289
spinach 172
beef 79-110
chicken 122-154
pork 62-138


Again, except for the rice, this is basically ketogenic.

Lee Kochel wrote:My fallback is always a ketogenic diet (high fat - 80%, but no extra omega 6s, moderate protein - 15%, low carb - 5% from leafy dark green vegetables), combined with intermediate fasting.  And occasionally total fasting for more than a day.  Except for emergency situations this can help often more than any medicine or procedure.  Also, I know you didn't ask, and I know that there are a few decent doctors out there, but in general asking a doctor for diet advice, when his business model depends on return visits, is a little like asking a wolf for design assistance when building your hen house.


Another doctor, Jason Fung, is a Nephrologist who recommends LCHF/keto, especially combined with intermittent fasting. (My understanding is that he's not well liked by some because he suggests that rather than spending multiple thousands of dollars on bariatric surgery (stomach stapling), he advises patients to not spend any money and achieve the same results by fasting.)

Jocelyn Campbell wrote:The main goals:
--whole, real foods
--good fats, moderate quantities  (NOT low fat, not quite keto either

May be closer to keto than you realize.

Jocelyn Campbell wrote:
; though we have steadily increased fats without any gallstone attack or gallbladder symptoms)
--LOTS of veggies (goal of 4 cups each meal, 12 cups per day! ala Dr. Terry Wahl's protocol)

Terry Wahl's protocol qualifies as ketogenic.

Jocelyn Campbell wrote:--low-to-no grains
--low-to-no legumes, no soy
--low starchy carbs
--no potatoes, no refined sugars

After the gallstone attacks, we had switched Paul to chicken maybe twice per week, fish once a week, and egg whites frequently. We were just starting to add egg yolks back in (not more than one yolk per day) since egg yolks are high on the list for gallstone attack triggers.

Spinach in big tubs was my frugal, speedy go to for adding greens to eggs, sautes, soups...lots of things. Frugal because it was affordable and because it lasted longer than other washed and ready greens.

Cauliflower was my substitute for rice, mashed potatoes, savory crusts...many things.

Seaweed snacks were our substitute for salty chips.

Mushrooms started going in many things in place of meats.

Parsley went in almost everything, too, plus I made these lovely lemon, olive oil parsley gremolatas which Paul loved

I like the "low-to-no" qualifier, but I'd aim for the "no" side of the spectrum.

Jocelyn Campbell wrote:So I would make him roasted root veggies (no potatoes), veggie sautes, vegan Mexican soup, vegan curry, vegan tikka masala, vegan squash soup, vegan marinara sauce on konjac noodles, vegan stuffed squash. Raw sliced veggies adorning many plates. Fermented foods at most meals. We would have rice or quinoa maybe once a week. Lots of avocados. Oils have been olive oil, avocado oil, macadamia nut oil, coconut oil and grassfed organic ghee. Lots of fresh pineapple and fresh berries. Some dried fruit (especially dried cherries) here and there.

All ketogenic.

Jocelyn Campbell wrote:Paul's standby foods when I wasn't cooking have been plain whole milk yogurt with jam (usually fruit juice sweetened) and berries on top (somehow this has been working for him); these Forager chips that have veggies as the main ingredients, and a Kite Hill brand almond milk chive dip (amazingly simple, whole foods ingredients for a vegan "cheese!"). I usually try to expand the dip by at least double with minced, "safe" veggies: celery, radishes, green onion, etc. And have carrot sticks handy to use in place of chips some of the time. Oh, and maybe there was a "cherry pie" larabar here or there.

Any vegan, vegetarian or omnivore debates aside, all-in-all I think most might agree Paul was eating a fairly healthy diet! (I was damn sure working hard at it!)

Except for some fruit and rice, it sounds like he was eating ketogenically.

Jocelyn Campbell wrote:
I'm okay if Paul wants to stay vegetarian, or go even more vegan, that's no biggie. We're still figuring out what works best to keep him pain free and healthy, so we'll be optimizing as we stumble along.

Yay to the pain free!!



It's been a while, and maybe I missed it, but I'd love an update on Paul's current health and whether or not this is fully resolved or how it's being managed.

One thing I've been obsessed with the last week is the trial of Timothy Noakes. He's a sports doctor and professor in South Africa who was asked a question over twitter about weaning a child onto a LCHF diet. (Noakes is a proponent of the Banting diet, which is not quite as strict as keto, and very popular in South Africa.) He answered the tweet, and one of his detractors reported him to the Health Professions Council of South Africa (HPCSA) for medical malpractice. Instead of choosing to retire (he was 67 or so at the time) in order to avoid the whole unpleasant ordeal (no doubt the desired outcome of the plaintiff), he chose to contest the charges in order to keep his medical license. In so doing, he became, in my view, a real hero for the causes of truth, justice, and human health.

Over several days, he very thoroughly and systematically laid out why his medical advice, as opposed to the conventional high carb, low fat advice, is superior for human health.  He cited numerous medical studies, randomized controlled trials, scientific research, and prominent leading authorities in many fields related to various internal organs and processes, dietary health and so on.  He made a very compelling case and (spolier alert) was eventually found not guilty. The opposing dieticians (likely backed by the sugar industry and/or other major players) appealed the case, and at the second trial, he was again found not guilty.

He's very likeable and the trial is quite interesting to watch. If you're not too science-y, some of it might be a bit of a slog to get through, but I find it REALLY good, worthy of a podcast review, if I may make that suggestion.

I'm very thankful that it was filmed and uploaded to YouTube. It's divided into 83 parts, totalling just under 23 hours of viewing time. Long, but easy to consume in chunks.

You might have to click through to youtube to get the whole playlist. Here's part 1:
 
Anne Miller
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Anne Miller wrote:I really like the information at Mayo Clinic:

Fats. Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products.

Proteins. Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your diet with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, which are associated with reduced uric acid levels.

Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.

Selected seafood. Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna."

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524



Cutting back on the foods that the Mayo Clinic recommends to cut back on makes doing low carb or a keto diet hard for me. I have never really done Paleo though I feel Paleo is much better for Gout.

I was a Meat and vegetable kind of girl.  High carbs foods were easy because I never eat many of them.

I do find that the recommendation of eating Cherries really seems to help.  Here are some info I posted in this thread earlier:

It has been hard for me to adjust my diet to lower meat consumption since many times all I ate was meat.  I read somewhere that if you want to eat meat then over compensate with more vegetables. So what I am doing is eating a two cup salad made with 5 different vegetables (1/2 Cup each more or less) and then slowly decreasing my meat intake.  Let say I was eating a 4 oz serving normally so then I went to 3 oz. for a week or two.  Then to 2 oz., then 1 oz.  I am probably now at the one ounce stage.

" Eat more fresh vegetables (and fruits with low fructose levels): higher intake of Vitamin C may help control uric acid levels."

I also read somewhere that if you want to eat high purine vegetables then limit them to no more than a 1/2 C serving 5 times a week.



Unfortunately, every attack that I have had has been worse than the previous one.

I really hate the advice that you find on the internet because it makes me feel that the person who wrote that information has never had the kind of attacks that I have suffered.

I have not found a trigger like Paul has.  I eat the same way day after day...
 
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This might be a good time to point out that I am approaching the two year mark since I threw my last stone.  

Nearly all restaurants were off limits when i started, but I have found that there are several options for sushi.  And i can eat certain pizza's with a gluten free crust.   And i can eat a chicken or vegan bowl at chipotle.  

For breakfast, i can have some oats or some yogurt.   Plus fresh fruit.   Sometimes i can do an egg white omelette, but i have to do so many weird exceptions (no cheese, no potatoes on the side, no toast of any kind ...) that I generally don't even want to try.

But mostly Jocelyn cooks great stuff for me, so there isn't much thought for restaurants.   Lots of sweet potato stuff. lots of fried veggies - either vegan or with chicken. On taco tuesday, it's rice, black beans, guac and salsa with my chips made from casava flour.  On special occassions, she will make lasagna with rice noodles, mazarella cheese and a vegan ricotta.  So much variety that I don't really think about the stuff I can't eat.

 
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Hi Jocelyn and Paul, I'm so sorry you are having to deal with gout, I've had several people in my life that suffered from it, and at times, it really made life difficult for them. Reading your posts that low meat consumption was helping you, (Paul) I thought you might want to look into the work of Dr. McDougall (https://www.drmcdougall.com/) there are many others,  but his plans (look into the forums for the free guides) have helped many people overcome many dietary-related illnesses.
 
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B positive blood type here. Have experienced gout many times. But no gallstones, phew!

The eat right for blood type diet says no tomatoes for me. Before I saw that, my gout was so bad I was on crutches a few times per year.

Eliminating tomatoes gave me my mobility back. Eventually realized all nightshades were triggers for me. Led me to research solanine sensitivity.

Long story short, nightshades bad, magnesium good.

Black cherry juice, mag citrate, and when acute, activated charcoal help me recover.

Avoiding tomatoes, potatoes. Blueberries, peppers of all kinds keeps me from being triggered.

 
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