A common objection to the carnivore diet is that high meat diets are known to cause gout. Gout is painful swelling caused by deposits of crystallized uric acid in joints. Meat is high in uric acid, however, under normal healthy conditions any excess is excreted by the kidneys.
It's well known that gout is a symptom of insufficient kidney function. This is why it's also recommended to avoid alcohol if you suffer from gout- alcohol is not high in uric acid, it simply inhibits kidney functions other than alcohol excretion. There's no reason to give up a good thing (meat) when we can instead address the root cause.
So what inhibits normal kidney function? You guessed it- sugar. Specifically, high insulin. The kidneys are responsible for about half of the body's work load clearing insulin after it's been used (Frankel & Kazempour-Ardebili, 2016). This is why poor uric acid clearance in the kidneys is strongly linked to insulin resistance (Perez-Ruiz, Aniel-Quiroga, Herrero-Beites Chinchilla, Erauskin & Merriman, 2015).
On a carnivore or any low-carb diet, insulin will be drastically decreased and it's expected that kidney function will quickly improve. If eating meat causes gout to flare, it may be beneficial to start with a low-carb ketogenic diet that can limit meat while the kidneys recover before transitioning to carnivore. Dr. Andreas Eenfeldt of Diet Doctor notes that there might be an increased risk of gout for only the first six weeks of a low-carb diet and that doctors that treat their patients with low-carb diets do not see overall increased occurrences of gout and even see their patients who suffer with the disease eventually become gout-free (Eenfeldt, 2019).
A gout analogy
I liken recommendations to limit meat consumption to avoid gout to a clogged drain.
Imagine nothing will go down the drain of your sink and when you turn on the faucet, it quickly overflows and spills water on the floor. You pay a plumber to come to your house and remedy the problem. The plumber inspects the drain and tells you, "It's clogged. You'll have to stop using it. That'll be $100."
"But can't you fix it?" you ask.
"No, this is a better solution. If you just don't use it, you won't have water spilled on your floor!"
We don't have to essentially stop using the kidneys when they are struggling to perform. We can address the real problem.
The history of gout and sugar
Gout used to be so strongly associated with affluent society that people desired it. Several decades later that had changed. This all points to the real root cause of the disease.
From A concise history of gout and hyperuricemia and their treatment:
"Throughout history gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. In some eras gout was perceived as socially desirable because of its prevalence among the politically and socially powerful... A comment in the London Times in 1900 [reads], "The common cold is well named – but the gout seems instantly to raise the patient's social status", and to another in Punch in 1964, "In keeping with the spirit of more democratic times, gout is becoming less upper-class and is now open to all ... It is ridiculous that a man should be barred from enjoying gout because he went to the wrong school." (Nuki & Simkin, 2006)
The prevalence of gout in different societies correlates to the availability of sugar. At the turn of the century, sugar was a luxury that could still only be afforded by the wealthy. By 1964 and today, sugar is available to everyone.
References
Eenfeldt, A. (2019, January 10). Gout and low carb. Retrieved February 25, 2019, from
https: //www .dietdoctor.com/low-carb/side-effects/gout
Frankel AH, Kazempour-Ardebili S (2016) Effect of Insulin Resistance in Chronic Kidney Disease. Endocrinol Metab Syndr 5:255. doi:10.4172/2161-1017.1000255
Nuki, G., & Simkin, P. A. (2006, April 12). A concise history of gout and hyperuricemia and their treatment. Retrieved February 25, 2019, from https://arthritis-
research.biomedcentral. com/articles/10.1186/ar1906?
fbclid=IwAR1dkYBSZKecKx5mBacP1gGf0f5JuBzOwcqhiRrRet8sxjg4JNv69u67Bqk
Perez-Ruiz F., Aniel-Quiroga M. A., Herrero-Beites A. M., Chinchilla S. P., Erauskin G. G., Merriman T. Renal clearance of uric acid is linked to insulin resistance and lower excretion of sodium in gout patients. Rheumatology International. 2015;35(9):1519–1524. doi: 10.1007/s00296-015-3242-0.