The devil Gout and the primal paleo diet

I know an elderly person who suffers from the gout and so did a bit of looking into it.

Gout is a well known disease that was rare until last century. Prior to that it afflicted the rich and wealthy. The symptoms of gout are caused by a buildup of uric acid crystals in various joints- particularly the feet, ankle or knee but, can be present in any other joint. Gout is associated with various other conditions eg high blood pressure, heart disease, diabetes, obesity and increased blood triglycerides, increased small dense LDL cholesterol and decreased HDL cholesterol.

Gout is unknown in hunter gatherer societies. For those familiar with the primal - paleo diet the above picture will sound familiar- ie unknown in primitive societies, rare in the west till after the industrial revolution, greatly increased incidence in the last few decades.

Uric acid crystals cause the inflammation\pain in gout. So, more uric acid can arise from

• eating more of it (or things made into to it)
• making more of it
• excreting less of it.

It is the balance that is critical ie for uric acid to build up input must be greater than output (loss).

• turnover of purines - 2/3 uric acid arises from turn over within the body
• eating meat and shellfish
• about 1/3 of dietary purines
• meat and shell fish are largely protein which increases uric acid excretion by kidneys.
• eating carbohydrates (grains and refined sugars) increase uric acid synthesis in liver and reduce its excretion by kidneys
•  eating protein increases uric acid excretion by kidneys. This includes protein from meat and shellfish.
•  alcohol increases uric acid production and reduces its excretion.

It is well known that gout patients under excrete uric acid from the kidneys. It should be no surprise to learn that insulin inhibits uric acid excretion by the kidneys and that a higher carbohydrate diet will result in greater levels of insulin production. Remember gout patients usually have diabetes (or are pretty damn close) have insulin resistant cells and so must synthesise a lot of insulin. A person with insulin resistance (ie secreting large amounts of insulin due to cells less sensitive to insulin) and on a high carbohydrate based diet would be expected to build up uric acid.

This would all seem to indicate a higher protein diet, reduced high glycemic index\load carbohydrates (eg no grains but vegetables with some fruit). One trial of this was done and published in 2000. Back then, the idea of high protein diet replacement drinks was considered radical and needed a prescription in some countries. Now you can buy them off the shelf at your local chemist or supermarket. Times change. It be no surprise to learn that using a paleo diet for gout is not widely known and the most widely recommended gout diet is based on limiting protein and increasing grains and refined sugars foods. This is also well known to have only a small effect, if any, on the gout which is usually described as "difficult to treat".

The reference for that small published trial is:
Dessein, Shipton, Stanwix, Joffe, Ramokgadi (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on se rum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis59(7):539-43.

 

There may be other trials out there as well. Researchers out there.... there may be an oppurtunity here for a clinical study of paleo diet for gout sufferers or if you are very conservative a somewhat higher protein, low glycemic index, low glycemic load trial for gout sufferers. Mediterranean would be expected to work better than the conventional western diet but a primal paleo diet would be expected to work better.

 

Now many gout sufferers are elderly, although, gout does also affect young persons. Gout sufferers often, as outlined above, may be suffering several disease and may reap significant benefits from a paleo diet and life pattern. In these cases, "to much, to soon" can be as much as problem as "to little, to late". Medications will need to be monitored and may need to be reduced over time by your doctor (who you have told about your dietary changes etc and knowing your full diagnosis\history etc is keeping an eye on his\her patient). A conservative, gentler approach could be to transition across to a paleo -primal diet over weeks rather than the "its Paleo Day 1 today" approach. An example of one way this could be done is by shifting to lower glycemic index\load foods (ie cutting back on grains\dairy and shifting to vegetables and some fruit) with meat\eggs\shelfish\fish served as a portion in every meal (including breakfast- as the conventional diet often lacks breakfast protein) ie a Mediterranean style diet for a couple of weeks and then transitioning to a paleo - primal diet. There are various methods which could be applicable but in all cases there is a need for medical input and monitoring.

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Posting anticipated to resume in mid-January 2015

Posting is anticipated to resume in mid-January 2015. Meanwhile, all best wishes for the New Year to readers.

What have Weston Price, Ainslie Meares, Yoga & Meditation got in common

Weston Price is comparatively well known as the Dentist who travelled around the world in the 1930's and studied the diets of many cultures with far reaching findings. Less well known is the work of an Australian Psychiatrist, Dr Ainslie Meares (b1910-d1987). Dr Meares was a Founding Fellow of Royal Aust & NZ College of Psychiatrists and, for a time, the President of the Int. Society for Clin & Exp Hypnosis.

Like Weston Price, but in the 1950's-1960's, Dr Meares travelled around the world, witnessing and studying various mental states and the role these played in the lives of people from different cultures. In particular, he learnt an ancient method of meditation from a wise old yoga in Nepal who he describes as "different from any other man I have ever met"  "he was serene" "When you were in his presence the calm of it was all through you"  (Strange Places, Simple Truths pg25).

While respecting the value of traditional meditation, he developed a theory which differs significantly from meditation per se. His objective was to assist people in accessing the natural undisturbed calm within themselves. His method essentially consisted of treating his patients for anxiety, illness and pain by allowing the mind to rest.

He called this mental state atavistic regression. Some have misunderstood that term. Atavism which translates from Latin as "primitive". Regression means to go backwards. A better translation would be to use the word "primordial". Atvastic regression meaning returning to the original or elementary way that has existed from the very beginning. A return to a purer simpler state of mind- a mind free of disturbance. Meares definitely did NOT mean barbaric or uncivilised mind or anything like that.

He later changed to the term mental ataraxis to better communicate the idea of this mental state where there was a state of freedom from, and absence of, dis-stress and anxiety.

Many, many years before anxiety and stress were acknowledged as contributing to illness, Dr Meares had identified that. Long before the term mind-body medicine was coined, he emphasised it’s critical importance. And long before meditation was widely advocated as a potential means of healing, Dr Meares had established a solution to counteract mind- body distress.

It is believed that Meares meditation augments a natural physiological mechanism that restores ease to the mind. Undoubtedly, our hunter gatherer ancestors experienced this naturally as part of their way of life. Today, the search for it can be seen in the increasing numbers of Western people looking for answers in various Eastern practices. However, most of us are not Easterners. We are Westerners born in a Western culture with a Western mindset. Eastern mystics devote their lives to practice; they live for practice. By contrast, Meares Meditation (also called Stillness Meditation), is non-religious and non-sectarian. It was created as a mental restorative practice to assist modern Western people to live a better quality of life.

Is the Paleolithic diet 10,000, 100 or 15 years old?

They say there are no new ideas. Paleo - primal like diets have been around in one form or another for a long, long time. Listed below are some examples up until the year 2000 - after that much has been written.

Banting (1864). A letter on corpulence.
A smallish book on how to lose weight written by a grateful patient, given away and then priced at cost.
( While not pure paleo, the diet was in a paleo like direction ie consisted of natural meats, fruits, vegetables with dairy and grains excluded and small amounts of dry grape wine permitted (ie low sugar wine).
Stefansson, Vilhjalmur (1912). My Life with the Eskimo; The Macmillan Company, New York,
(He wrote several books but, this was the first)

Price, Weston (1939) Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects Paul B. Hoeber, Inc; Harper & Brothers

I'm an Australian, so I have to mention:

1. Shatin, R (1964) Man and his cultagens. An inquiry into the ecology of chronic diseases possibly affecting 3percent of the population. Scientific Australian 1964 Vol 1: 34-39.
2.  Shatin R (1967) The transition from food fathering to food production in evolution and disease. 12:104-107 Vitalstoffe Zivilisationkrankheitein 12: 104-107
3.  Boyden, S (1973), "Evolution and health", The Ecologist 3(8) 1973, pp.304-309
4.  O'Dea K (1984) Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes 1984, 33(6):596-603.

Voegtlin, WL (1975) The Stone Age Diet. Based on In-depth Studies or Human Ecology and the Diet of Man. Vantage Press. Eaton, S; Shostak, M & Konner, M (1988). The Paleolithic Prescription: A Program of Diet & Exercise and a Design for Living. New York: Harper & Row.

Cordain, L (1999) The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat.

(The first edition of the book that named the Paleo Diet and a good spot to end this post)




 



[ Paleolithic = Stone Age = Cave Man = Hunter Gatherer = Garden of Eden ] Diet

　
You can call it:

• Paleolithic Diet
• Stone Age Diet
• Cave Man Diet
• Hunter-Gatherer Diet.
• Garden of Eden Diet
• any other name you like or that sounds distinctive

They are all the same diet.However, if you read around you will find they are not the same!!

Some supposed version mention beans, potatos, butter, hard cheeses etc, etc. Some say you have to eat bucket loads of meat. Others mention eating an ever varying range of foods. Then some say it has to be organic or slow food or you have to drop out and grow it all yourself.

Who is right?
Assuming that you want your diet to bear a strong resemblance to what was eaten during paleolithic times (ie before agriculture) and in a manner consistent with modern hunter gatherers then:

                                        Say NO to
NO grains and cereals including bread, noodles and pasta
(try picking and eating raw wheat)

NO dairy 
(try and milk a large wild, horned herbivore that has young suckling, if you survive you will understand. Anyway, you are a human being and not a baby herbivore trying to grow into a cow and so drinking filtered cow's blood is not the way to go.)

NO peanuts - they are legumes and are different to tree nuts
NO Beans (legumes) eg string beans, kidney beans, lentils, peanuts and peas
NO added refined sugar, no added salt, no refined vegetable oils.
---------------------------------------------------------------------

                                         Say YES to

• natural pasture fed meats (NOT grain fed), seafood, organ meats like liver, kidney etc
• eggs
• fruits and berries
• vegetables (NOT potatos). 
• tree nuts eg. walnuts, brazil nuts, macadamia, almond. NO peanuts (a bean\legume)
• olive, walnut, flaxseed, macadamia, avocado, coconut oils 

If you do this you will go a long way towards fairly pure paleo eating.

What are the effects of making these changes? :

• a big increase in nutrients
• a significant reduction in toxins
• a decrease in carb\sugar content so you will burn carbs AND fat

 The short list:pastured meats, organs, seafood, eggs, fruits & berries, vegetables, tree nuts.

If its not on the list you can't eat it.
You can "flavour" dishes using small amounts of herbs
and use healthful oils (see above) for cooking as well. 

How do I know this is information is right?
Read up on your archaeology and anthropology, understand how botany and technology influence the ability to utilise foods, appreciate optimal foraging theory. If you want to do some modern pseudo experimental archaeology (also called first hand experience) take up farming, fishing, hunting and growing your own fruit and vegetables as an experiment. If you are an Australian maybe you could go walkabout... or learn about it. 
Read up from reputable sources. If you do these things, I guarantee that the following foods will be on the menu:

pastured meats, organs, seafood, eggs, fruits & berries, vegetables, tree nuts.