The path to fixing diet and metabolism, which cures gout by fixing purine excretion from the body, can be done rapidly or slowly. It depends on willingness and commitment to real change. The key is getting to a way of eating (diet in the true sense of the word) that you can live with. It is a diet which, ALSO, eliminates the chronic assault on metabolism from sugar, processed carbohydrates and refined grains, and regular alcohol use. In other words, dumping the Standard American Diet (SAD). If you want to eliminate gout medication from your daily life then you will need to replace it with a way of eating (diet) that you can live with for life.
Fixing your metabolism requires getting to a diet of real, whole foods, that provides the nutrition for a healthy metabolism. Hard work yes, but the alternative is a life of gout and a constellation of progressive disease driven by the SAD diet. You need to choose which you can accept.
For most people, its best to make logical transitions over time. This will make it easier to stick with the changes, have few adverse side effects, and will help you learn what works best for your body. A suggested progression is as follows.
| Phase | Time | Strategy |
| Phase I | 1-2 Months | Eliminate alcohol, sugar, manufactured/packaged foods, seed/vegetable oils. Increase healthy fats from animals, coconut oil, avocado oil, or olive oil. Goal of less than 100 carbs a day coming from fresh fruits and vegetables. Limit the highest purine foods for now. |
| Phase II | 6-12 Months | Introduce feasting windows. Slowly increase the time between your last meal and the first meal of the following day. Goal by 6 months is to be at a 8 hour feasting window (implies 16 hrs of no food between last meal and the first meal of the following day). Months 7-12 stick to 8 hour window or reduce to 6 hours if you feel so inclined. |
| Phase III | Months to Years | If you are happy with the results (body composition and visceral adipose tissue) and uric acid has dropped below 6 then transition to phase IV. Otherwise experiment with keto, low(er) carb, carnivore, or other strategies to see if you can improve further. |
| Phase IV | Lifetime | Adjust your diet to maintain weight and body composition. Explore adding some foods back in or increasing dietary fat to maintain weight. Very occasional indulgences in alcohol, or processed foods may be possible. At this point you should have a good feel for what foods and dietary patterns work well for your body. |
IMPORTANT NOTE: If you have Type II Diabetes, Kidney Failure, or are on medications you need to consult with your doctor about the impact a low-carb diet may have.
Phase I – Easing In, Fat Adaptation (1-2 Months)
Easing in is all about helping you not feel hungry all the time, transitioning away from highly processed foods and added sugars. Put another way, its about getting your body to (re)learn to power itself from fat instead of carbohydrates. Don’t worry about scale weight, which may or may not improve at this stage. Just worry about cutting the so-called foods found at the center of the grocery store and getting comfortable with eating good fats. The process of fat adaptation can take a month or more so take your time and do the work needed to eliminate dietary garbage.
It is important to note that initially your body will not know how to power itself from fat. As it transitions and (re)learns how to do so there may be increased protein turnover in your body causing a temporary gout flare. Know this may happen and be prepared with your medication to get over this period.
Learn More: Easing In and Fat Adaption in Depth
Phase II – Feasting Windows (6-12 Months)
After you have eased in and have improved your metabolic ability to burn fat for fuel we want to introduce feasting windows. You may also hear about fasting windows or intermittent fasting. These are really all the same thing but feasting window is a bit more psychologically positive. In this phase aim to get to an 8 hour feasting window (with 16 hrs not eating). You can ease into this slowly if that’s what suits your personality or simply dive straight in.
The primary reason to use feasting windows is to allow the body to burn through glucose in the blood stream, allowing insulin to fall, and doing so on a regular basis. The combination of decreased feasting window and elimination of dietary garbage in Phase I should go a long way to reversing any fatty liver and improving liver and kidney function.
Learn More: Feasting Windows In Depth [LINK COMING SOON]
Phase III – Optional Refinements (Months to Years)
Phase I & II are the big levers to fixing metabolic syndrome permanently. However, you may find that eliminating dietary garbage and standard eating windows aren’t enough. In this, optional phase, you might want to consider dietary changes that accelerate healing the damage from gout, can lead to improvements in your body’s ability to handle very very occasional garbage in the diet, or may drive skeletal muscle growth and bone density improvements.
In this phase you might choose to experiment with very low carbs (like sub 20g/day), carnivore (zero carb), select supplements, high protein diets, etc.
This phase is more about learning what your body really needs to progress further, and some of the ideas are not without detractors. There is science to support experimentation with these but you will need to determine for yourself if they add value, make you feel better, and are net positive in your PERSONAL labwork.
Learn More: Dietary Refinements in Depth [LINK COMING SOON]
Phase IV – Maintenance (Lifetime)
Have you gotten your uric acid below 6, kept it there for a year or more, eliminated gout flares and even the sensation that one is coming on? Awesome! Now to maintenance…
In theory, maintenance is really straight forward. Focus on eating real, whole foods and avoiding the dietary garbage most everyone else is eating (and unhealthy as a result). Recognize that the health of your metabolism is what drives retention vs excretion of uric acid. The occasional alcohol, pizza, or beer should be unlikely to cause a problem at this point. I’d suggest you define occasional as 1-2 times per month at max. Occasional is definitely NOT 1-2 times per week.
I’d also suggest testing your uric acid (with a lab, not an at-home kit) once every three months or so with a goal of keeping SUA under 6 and catching any bad dietary habits that start to creep back in.
Learn More: Dietary Maintenance in Depth [LINK COMING SOON]