Gout and GAPS: Gut Flora, Food Choices and the Research

The GAPS approach to gout puts changing gut flora at the center of long-term care. In Gut and Physiology Syndrome, Dr. Natasha Campbell-McBride connects gout with particular gut microbes and the way the body handles purines and uric acid. Her food priorities are removing processed carbohydrates, sugar and beer while following the wider GAPS Nutritional Protocol.^[1]

This guide explains her position, the research she cites and the food choices that follow from it. It also separates everyday meal planning from an acute attack, a kidney restriction or a medication question. You can use the parts that match your situation without trying to change everything at once.

What Gout Is

The book describes gout as uric-acid crystals accumulating in a joint and causing acute inflammation. The big toe or thumb is a typical site in its account, although other joints can be affected. A joint can become intensely painful, swollen, hot and red.^[1][2]

Have a first episode assessed rather than diagnosing gout from a checklist. Sudden joint pain and swelling with worsening pain, fever or shivering, or feeling sick needs urgent medical assessment because a joint infection can look similar. That is a question about the painful joint now, separate from the long-term food work below.^[2]

Why the GAPS Book Looks at Gut Flora

Campbell-McBride writes, “I am convinced,” that particular gut microbes cause gout. She describes their toxins interfering with normal purine metabolism and uric-acid handling. In the official FAQ, she explains that idea through a blocked uric-acid detoxification pathway in the liver, followed by uric-acid salts depositing in joints. Her stated purpose for GAPS is to change the flora, bring those microbes under control and prevent attacks over the long term.^[1][3]

Purines, uric acid and urea are related terms, but they are not interchangeable. Purines are compounds broken down through metabolism; uric acid is the substance discussed in gout-crystal formation. Urea is a different waste product. The 2020 gout entry uses purine metabolism and uric-acid crystals to explain its argument. Keeping those words straight makes the book’s reasoning easier to follow.^[1][4][5]

What the Cited Microbiome Research Found

The book’s reference is Shao and colleagues’ 2017 study, which compared stool samples from 26 men with gout and 26 healthy men. It found differences in microbial communities and metabolites associated with purine metabolism, uric-acid excretion and inflammation. This gives a concrete research context for looking at the gut in gout.^[4]

The species Bacteroides caccae and Bacteroides xylanisolvens appear in that paper’s discussion of earlier research. The earlier study, by Guo and colleagues in 2016, found those species enriched in its gout group. Its main comparison included 35 people with gout and 33 healthy people, with a separate validation group. The correct species spelling is caccae.^[4][5]

These studies examine the relationship between gut microbes, their functions and gout. Neither is a trial of the GAPS Diet. Campbell-McBride’s recommendation also draws on her clinical position; the studies answer the narrower research questions they investigated. A bacterial name in a paper is not a diagnosis from someone’s symptoms or a reason to select a treatment for that organism.

Purines, Meat and Individual Food Choices

Campbell-McBride argues that most purines come from normal body metabolism rather than food and does not make avoiding meat the central gout strategy. The official FAQ answers a reader with recurrent gout, IgA nephropathy and reduced kidney function. She reports no problem with meats, meat stock and broth in her clinical experience and emphasizes carbohydrates, particularly grains and beer, as triggers in that account.^[1][3]

That is not a requirement for every reader to eat large amounts of organ meat. The same 2020 book recognizes people who feel better with low-purine white meats and fish and different proportions of animal and plant foods. The More-Plant GAPS guide explains that individual variation. Its entry conditions matter: diarrhea, especially with blood or mucus, or abdominal pain point to Intro before considering More-Plant.^[1]

If you have diagnosed kidney disease and an existing protein, sodium, potassium or fluid plan, keep that plan with the gout discussion. The FAQ’s clinical account does not give your individual laboratory results or a new allowance. The kidney foods and support guide keeps those restrictions and the source’s food guidance together.

The Foods and Drinks the Book Tells You to Remove

The gout entry names processed carbohydrates, sugar, high-fructose corn syrup and beer. Beer receives a particularly strong instruction: Campbell-McBride says people prone to gout should give it up permanently. She gives two reasons within her framework: its starch and other carbohydrates feed the implicated microbes, while its alcohol occupies the liver’s processing capacity. She also says excessive amounts of other alcohol, including wine, can start an attack.^[1][3]

Make that advice practical by looking at actual meals and drinks. Record packaged snacks, sweetened drinks, beer and other alcohol, including what you had between meals. You do not need to infer the cause of an attack from that list. Its first job is to show which of the foods named in the book are still present and which substitutions you need to plan.

Meat Stock, Fermented Foods and Where to Start

Keep Meat Stock Separate From Bone Broth

The older gout FAQ includes broth in its food discussion. The 2020 book gives the more specific timing rule: it does not recommend long-cooked bone broth for at least a year on GAPS, and for some people several years. Meat stock is the earlier preparation. A gout diagnosis does not remove that distinction. The meat-stock and bone-broth guide explains the ingredients, preparation and timing.^[1][3]

Introduce Fermented Foods Individually

In the FAQ about gout and kidney concerns, Campbell-McBride says fermented foods improve digestion and bring down pathogens, and that she is not aware of them aggravating gout. Keep this as her clinical experience, rather than a promise that everyone will tolerate every ferment immediately.^[3]

Use the preparation and amount that fit your GAPS stage and your own introduction. Intro begins with juices from fermented vegetables before the raw vegetable solids; dairy has its own sequence and tolerance requirements. The probiotic-food introduction guide explains those two tracks. When increasing a probiotic supplement, the book says to settle at a reacting dose until die-off symptoms disappear before increasing again; the gradual probiotic guide explains that method and its limits.^[1]

Choose Intro or Full GAPS From the Wider Picture

The book does not assign one starting diet solely because the word gout appears on a diagnosis. It allows people without serious digestive symptoms to begin with Full GAPS, while directing serious digestive problems toward Intro. Chronic constipation has its own Full-GAPS-first branch. Use the Intro-versus-Full comparison to review the actual starting situations and exceptions.^[1]

The broader coming-off guidance says most people should follow strict GAPS for at least two years, with individual recovery taking less or more time. That is the book’s general protocol duration, not a measured deadline for gout attacks to stop. Its gout entry describes long-term prevention without giving one recovery date for every reader.^[1]

The Kidney and Metabolic Connections

The kidney chapter discusses two different questions: damaged kidney function in the book’s gut-wall and protein-digestion model, and kidney stones in its mineral-handling model. It connects the latter with animal fats, vitamins K2, D and A, and gut-flora effects on nitrogen and uric-acid processing. Calcium oxalate and calcium phosphate stones are its common examples; uric-acid stones are another type. The kidney guide explains those distinctions.^[1]

A painful joint and a possible passing stone are not the same observation. The book places stone pain in the back or side, sometimes with nausea or feeling feverish. Symptoms alone do not identify a stone type or establish that a painful joint is gout. Record the location and the timing rather than treating every pain as the same uric-acid problem.^[1]

The book also names processed carbohydrates in its discussion of metabolic syndrome, including weight gain, type 2 diabetes, blood-pressure problems and chronic inflammation. The metabolic-syndrome guide covers that larger insulin and food discussion. Sharing a food theme does not make these conditions interchangeable or supply the same individual treatment plan.^[1]

What the Book Says About an Acute Attack

The acute-attack passage is separate from the long-term diet. Campbell-McBride recommends a water-only fast and bowel clearing, followed in some circumstances by a coffee enema. She explains these measures through her gut-toxin and liver framework. Those are the author’s acute-treatment recommendations, not ordinary meal-planning steps or a home procedure provided by this article.^[1][3]

The same passage discusses indomethacin and its potential to irritate a sensitive stomach. Campbell-McBride advises against aspirin during an attack and does not recommend long-term gout medication, preferring to address gut flora. These are the source’s positions. Keep the exact medicine, its formulation, existing kidney issues and the agreed attack plan with your treating clinician; do not stop a prescribed gout medicine or prescribed aspirin from a general diet article.^[1][3]

One practical detail is especially important: the way to take indomethacin depends on the preparation. Extended-release capsules must be swallowed whole, not split, chewed or crushed. Follow the prescription label and ask your pharmacist before changing how you take a dose. A general instruction about a tablet cannot be applied to every product with the same medicine name.^[6]

A Useful Record for Your Next Appointment

You can put the food and joint history on one page. Use what you know and leave an uncertainty marked as an uncertainty. For example, “pain began Tuesday morning; beer Monday evening” records a sequence without claiming that the drink proves the cause.

• The episode: which joint hurt, when it began, swelling or redness, and whether fever, shivering or feeling sick occurred.
• The surrounding days: meals, drinks, alcohol, new ferments or probiotic amounts, and any illness or treatment change.
• The medical information: the actual diagnosis, uric-acid results, kidney findings, medicine names and formulations, and the prescribed attack plan.
• The food question: which GAPS approach you are following, what is already tolerated and what you need help adapting.

This record helps separate three useful conversations: getting the joint episode assessed, understanding the medicine plan and organizing everyday GAPS meals. It is not a scoring system for diagnosing gut microbes or deciding whether to stop treatment.

Questions About Gout and GAPS

Does a Gout Flare Mean I Need to Rush Through Intro?

No. The gout entry does not give a fast-track Intro sequence. The book bases progression on digestive response and says to return to the previous stage if symptoms return with a new stage. Use the starting-point guide for the diet choice and keep an acute attack with its own assessment and treatment plan.^[1]

Can a Food Log Show Which Microbe Is Responsible?

No. A food log can show what you ate and when symptoms appeared. It does not identify Bacteroides species or reproduce a research microbiome test. The studies describe group patterns; your notes describe your own experience.^[4][5]

Your Next Step

For an ongoing food-planning question, start with the Intro-versus-Full comparison and choose one familiar meal to review. Check its stock, ingredients, alcohol and processed-food additions, and the ferments already introduced. If kidney restrictions are part of your care, use the kidney food guide alongside that plan.

My Care Team Log is listed in the WFLI Shop for keeping episodes, reports and appointment questions together. A notebook can hold the same dated information now. Bring a specific question, such as which food changes fit your current kidney and medicine plan, rather than feeling you need to solve every part before asking for help.

References

1. Campbell-McBride N. Gut and Physiology Syndrome. 2020. “Gout”; “Kidney problems”; “Metabolic syndrome”; “The More-Plant GAPS Diet”; Introduction Diet entry and progression; “Meat Stock and Soups”; probiotics; “Coming off the GAPS Diet.”
2. NHS. Gout. Symptoms, first episodes and urgent joint-infection signs. Accessed October 19, 2026.
3. Campbell-McBride N. Official GAPS FAQs. “Diseases and Symptoms,” questions 8, 12 and 65.
4. Shao T, Shao L, Li H, Xie Z, He Z, Wen C. Combined Signature of the Fecal Microbiome and Metabolome in Patients with Gout. Front Microbiol. 2017;8:268. doi:10.3389/fmicb.2017.00268.
5. Guo Z, Zhang J, Wang Z, et al. Intestinal Microbiota Distinguish Gout Patients from Healthy Humans. Sci Rep. 2016;6:20602. doi:10.1038/srep20602.
6. MedlinePlus. Indomethacin. “How should this medicine be used?” Formulation-specific administration. Accessed October 19, 2026.