Gout

Optimize your lifestyle

Truth About Kidney Health and Gout

People who are emotionally invested in avoiding protein often state that protein damages the kidneys, particularly when that protein comes from animals. Where did this theory come from? Not from studying humans. On the podcast I share with ultra-endurance world-record holder, Zach Bitter, I was talking with Dr. Stuart Phillips, one of the world’s leading protein experts, and we got into this topic. The misconception about this issue evolved from some work researchers did on rats, but no research on humans has ever shown the same results.
Protein doesn’t damage kidneys, but damaged kidneys tend to leak protein, which is something that contributes to the confusion about the relationship between protein and the kidneys. Many physicians have bought into this myth that protein damages kidneys even though the assertion has almost no scientific support. As with other misconceptions, you can look at the treasure trove of nutritional epidemiology and find some relationship between a high-protein diet and an increased incidence of kidney disease, but, as always, you have to ask the question, “Does it apply to all people in all situations?”
In my experience, people who eat a high-protein carnivore diet aren’t finding that their kidneys are compromised. I’m not saying that no one who follows the carnivore diet will ever have kidney problems; they can occur for many reasons. But I do not think that an all-meat diet causes kidney issues. I know of some cases where chronic kidney dysfunction has started to get better for several people.
Let’s put this in perspective. Humans evolved in an environment where eating copious amounts of meat was likely a common occurrence. We have several historical accounts of humans consuming very large amounts of meat, and those accounts show no evidence that the people experienced kidney problems. As I mentioned earlier, the explorers on the Lewis and Clark expedition were noted to have eaten as much as 9 pounds of meat per day. Modern-day competitive eaters have sometimes eaten more than 20 pounds of meat in one sitting without damaging their kidneys. If protein did indeed damage our kidneys, humans would not have made it this far through history.
Another common myth about the consumption of meat is that it leads to the development of gout. This perception goes back to the days when gout was considered a “rich man’s” disease. Because the financially well off were diagnosed with gout more frequently than the less affluent population, and the rich also were the people who could afford to eat meat, the assumption was that meat was the cause of gout. However, what do you think we find when we look at people who eat only meat? They don’t get gout, and if they had it before they start the carnivore diet, the gout generally clears up.
One of the beautiful things about a carnivore diet is that it tends to make some things crystal clear. You can wallow around in pointless epidemiology or use some questionably applicable animal studies to try to interpret something about the effects of eating meat, or you can take the simpler route and look at people who eat only meat. When we look at populations of meat eaters, such as the Maasai, Mongols, or Sámi, we see that there’s no indication that they were hobbled by gout. Today I routinely observe people with gout who go on an all-meat diet; for them, gout becomes a distant memory within months.
So, what about those rich dudes from a few hundred years ago? Why did they have gout? Because they had access to something that the common folk did not. Sugar! The wealthy also had more access to alcohol, and both sugar and alcohol are strong drivers of gout. The traditional view of gout is that it’s caused by an increase in uric acid because we can see uric acid crystals when we view gouty tissue under a microscope. I’ve taken care of plenty of gout patients over the years, and I’ve even removed large gouty tophi (which are basically giant blobs of crystal deposits in the skin that resemble toothpaste when cut open) from all parts of the body. None of my gout-afflicted patients has said he was a pure carnivore.
We know that purines form as food breaks down, and they can lead to increased uric acid production. Meat is often high in purines, and thus experts concluded that meat was the reason for the rich man’s disease. The problem is that most food leads to purines being produced, and high uric acid levels do not always lead to gout. As with all things, the path to gout isn’t a simple route. Is uric acid more of a problem when an underlying inflammatory state exists?
If so, what drives the inflammation? What about hyperinsulinemia (excess insulin)? Because of the complex system that comprises the human body, we have to look at issues like gout from all angles. Fructose is a vital component of table sugar, making up 50 percent of the sucrose molecule; the other 50 percent is glucose. We’ve seen that as fructose consumption goes up, the incidence of gout also goes up. Coincidentally, markers of inflammation and uric acid levels also rise as fructose consumption increases. Alcohol is another major contributor to higher uric acid levels. Like fructose, higher alcohol consumption tends to increase the incidence of gout.
One caveat is that if someone already has gout or is strongly predisposed to it, that person may experience a flare up during the transition phase into a ketogenic or carnivore diet. The flare-up is likely a result of a preexisting inflamed state combined with entering into a state of nutritional ketosis, or it’s because a transient uric acid elevation is a likely reason for the short-term occurrence of gout. After a person has fully transitioned to an all-meat diet, the gout generally subsides for good.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
Learn more HERE

Nine Tips for the New Carnivore

Transitioning from one thing to another can be difficult. It doesn’t matter where you’re starting or where you’re going. Changes in relationships, jobs, and family situations are challenging, and diet is the same. The transition period is a stressful time on your physiology, and problems can often manifest in several ways. A new diet, regardless of its composition, affects gut function, causes a stress response, and induces some metabolic changes. But I can give you some ideas of what to expect and how to handle any issues.

Fatigue
One of the most common issues of the transition period to a carnivore diet is fatigue, lethargy, or poor energy. As you ramp up your metabolic machinery to deal with a new fuel source, you initially will be fairly inefficient. Your capacity to extract all the nutrition from meat may be compromised. Many people suffer from decreased stomach acid production or other digestive maladies, and those issues may take a while to resolve after you transition to a carnivore diet. While your body works on resolving those issues, you may find that you can’t eat as much as you need to, or perhaps you’ll eat quite a bit but won’t fully absorb it. Whether you’re undereating or not making use of all that you do eat, a lack of adequate calories and other nutrients can lead to poor energy or fatigue. Eating more is the most helpful solution for this, and it’s what I suggest as the first line of treatment. Increasing your meal frequency and adding salt to your diet often allow you to eat a bit more. For some people, digestive enzymes—like lipases, proteases, or HCl supplements—aid with the transition period. Most people can discontinue them after a few weeks.

Bowel Movements
Malabsorption, typically of fat, can often show up as steatorrhea, or fatty, loose stools. As you transition to the carnivore diet, your microbiome goes through a shift in its composition. The fiber-loving magical bacteria in your gut dies off and is replaced with meat-loving bacteria. One of the more common digestive issues as this happens is not constipation but diarrhea. Most people on a high-fiber diet are accustomed to daily (and often multiple daily) bowel movements. Going on a carnivore diet will dramatically reduce the volume of waste you produce, and it will likely lead to less frequent bowel movements. What many people mistake for constipation, particularly early on in the diet, is just a dramatic reduction in waste.
If you’re not having discomfort or pain when you have a bowel movement, you don’t have anything to be concerned about. Some people find that adding a bit more dietary fat or avoiding dairy can help things move a bit quicker. Can you suffer from true constipation while you’re on the carnivore diet? Sure, but it’s not common, and sometimes it’s a result of an electrolyte issue that has caused altered gut motility. Adding fat, fluids, and sometimes electrolytes can be helpful.

GERD
Gastroesophageal reflux disorder (GERD) is a common condition for many people. In most cases, the carnivore diet seems to clear up this problem. However, some people find that the diet makes reflux worse or that nausea or other types of dyspepsia occur. For some people, fat, or perhaps meat in general, is difficult to digest. Strategies to deal with this problem include lowering the fat content a bit and temporarily adding digestive aids as you go through the transition period. Hydrochloric acid supplements (most commonly betaine HCl) or a bile supplement (like ox bile) can be effective. Some people notice that not drinking water around mealtimes can help; the theory is that water in the stomach dilutes the stomach acid and decreases the acidity of the stomach, which leads to difficult digestion. Some people have observed that adding salt to their diet helps with symptoms of reflux as well.

Joint Pain and Gout
For the vast majority of carnivore converts, joint pain or other musculoskeletal pain diminishes or goes away completely. A small subset of people reports a temporary increase in pain as they first start the diet. One possible reason for this phenomenon of more pain is higher uric acid levels. We know that elevated uric acid levels are associated with gout, and a diet that puts someone into ketosis can sometimes lead to increased uric acid levels. The uric acid level likely increases because the body is inefficient at using the ketones, so for a while, more ketones are excreted as waste in the urine. The ketones the kidney excretes can competitively inhibit the excretion of uric acid, so the level of uric acid rises and potentially results in joint pain or other pains. Over time, your body becomes more efficient at using the ketones you produce, the uric acid levels often normalize, and the joint pain disappears.

Skin Conditions
Some people report that they develop a rash as they transition to the carnivore diet, but the incidence seems fairly rare. Skin issues are likely related to the elimination of ketones (as I describe in the previous section). In this case, the body excretes the ketones through the skin, which results in an irritation response. Skin conditions usually resolve with time as the body becomes more efficient with using ketones.

Headaches
One transition-phase issue I dealt with was headaches. Headaches are most likely related to fluid and electrolyte shifts that occur as your body adjusts to the new eating regimen. In my case, the headaches were sporadic and very mild; I had them off and on for about ten days. For those who experience headaches when they first start the carnivore diet, I recommend eating more food and upping fluid and electrolyte intake. Even if you don’t alter your habits, the headaches generally pass fairly quickly.

Muscle Cramps
Muscle cramps are another fairly common occurrence that seems to crop up with some regularity among carnivore dieters. Electrolyte or hydration problems may be at play here. For most people, the cramps dissipate with more time on the diet. I’ve been following the diet for years, and I get an occasional muscle cramp, but I can almost always relate it to having exercised very hard and without eating at an appropriate time in relation to my exercise. Eating relatively soon after you exercise—at least within a few hours—can sometimes help reduce the occurrence of muscle cramps.
Some people find electrolyte supplementation helpful. People have tried adding regular salt (sodium chloride), potassium, and magnesium and have found varying results. Some people soak in Epsom salts to alleviate muscle cramps. If you experience cramps, the first thing I suggest you do is to look at your overall food intake to ensure it’s adequate. Beyond that, you can add various electrolytes in the form of salt (such as Redmond Real Salt) or electrolyte supplement.

Ketosis
The point of the carnivore diet is not to achieve a state of constant ketosis, and artificially manipulating fat ratios is not part of the program. I believe it’s counterproductive to measure ketones because it usually leads to unnecessary anxiety and a waste of money that you could otherwise spend on food. If you have a medical condition that requires you maintain a minimal level of ketones, you’re in a different situation. For most folks, though, I recommend putting away both the ketone monitor and the scale. Remember, your ultimate goal is to be in a position where appetite and eating are naturally controlled, and you’re not constrained by some arbitrary number or a predetermined fasting window.

Energy Level
Many people say they notice a general increase in their energy and work or exercise capacity. People often state that they have very restorative sleep, but the overall quantity of sleep they get decreases. Perhaps people on the carnivore diet require less sleep because they have better materials with which to repair their bodies, and they might be less beat up metabolically. However, not everyone immediately has deep, restorative sleep as soon as they transition to the carnivore diet. Some people have a hard time sleeping, particularly early on. Some people feel the need to urinate, and it wakes them up at night. Eating more protein can require more water for processing the food, which can lead to increased thirst. Salt ingestion also likely plays a role here. Modulating salt intake might be another strategy for preventing fluid shifts at night.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
Learn more HERE

Book A Carnivore Coach Now

30 minute zoom call - only $17.99