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The Truth About Keto and Gout

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FACT CHECKED
  Published on November 7th, 2022
  Reading time: 6 minutes
  Last modified November 4th, 2022
Examination of ankle for gout

Nobody wants achy swollen joints and painful arthritis. Around 59 million people in the United States have arthritis—a rise of over 4 million since 2013-2015, according to the Centers for Disease Control and Prevention (CDC). [1]

You’ve probably heard that a ketogenic diet can lower inflammation and improve arthritis. Gout is a type of inflammatory arthritis, so how does a ketogenic diet affect gout? What about meat and seafood consumption and purines? What about sugar? Let’s look at the evidence and details surrounding keto and gout.

What Is Gout?

Gout refers to painful and sudden swelling and inflammation of a joint, usually in the big toe, though it can also affect other joints like the heels, wrists, and fingers. Gout involves higher levels of uric acid in the blood, leading to crystals forming in the affected joint. The condition is more common in men and older adults. [2]

What Causes Gout?

Meat has a possible connection to gout

The cause of gout isn’t definitive. Excessive meat consumption has been blamed for gout. Uric acid (found in higher levels in people with gout) is a breakdown product of purines. Purines are the building blocks of protein and are found in higher concentrations in certain foods, including meat. Some people claim the purines from meats lead to higher uric acid levels in the blood. While weak observational studies support this claim, other studies show no association. [3]

It isn’t exactly clear why the outcome of these studies differ, but one explanation could be the prevalence of metabolic syndrome and sugar consumption. Obesity and metabolic syndrome heighten your risk of developing gout. Other components of diet and lifestyle could account for these geographic differences. It’s tricky to differentiate between the effects of meat on gout compared to those of alcohol or refined grains and sugars. 

Epidemiological studies can’t prove meat directly increases the risk of gout. More research is needed. Many people adopt a keto carnivore approach and eat all or mostly meat and report no arthritis and better health all around.

Healthy user bias must also be taken into account. Outside of the paleo and keto communities, generally speaking, people who eat large amounts of meat as part of a standard Western diet also tend to engage in other unhealthy behaviors that could increase gout risk, potentially skewing the outcome. For example, weak epidemiological studies don’t consider that, in their cases, people with gout also ate more total calories, had hypertension, and drank more alcohol. [4]

Nutrition research can have conflicting results. One study revealed vegans had higher uric acid levels than fish and meat eaters. [5]

Almost everything you eat has purines, but some foods contain more than others. While meat is obviously high in purine, other foods are as well. For example, soy meat substitutes and soybean flour can contain more purines than some meats and fish.

Foods high in purines, like seafood, sardines, and grass-fed beef, are also particularly anti-inflammatory and nutritious, which could help counteract a tendency toward gout. On the other hand, if you’re having a gout flare-up or are concerned with persistent gout attacks, you might decide to limit your purine intake.

Some argue that humans have been consuming foods like meat and fish that contain purines for millions of years; however, highly refined and processed sugars, such as high fructose corn syrup, are a modern addition to our diet and more likely to cause problematic health issues.

What About Sugar?

Elevated uric acid levels, obesity, type 2 diabetes, metabolic syndrome, and gout all have a strong correlation. Studies conclude that excess sugar consumption, including consumption of foods and beverages with high amounts of fructose, hikes up serum uric acid levels. [6]

Sugary foods like donuts can contribute to gout

Fructose is a type of sugar known to increase blood uric acid levels. Consistent observational studies show an association between an increased risk of gout and fructose consumption. [7] [8]

Your body breaks down fructose, releases purines, and produces uric acid, which leads to the formation of crystals in the joints and fluids. [9] This suggests that your sugary soda may have a lot more to do with gout than your steak.

Many health researchers and experts claim that as sugar consumption spiked in society, so did gout. [10]

There’s also insulin to consider. Elevated blood insulin levels can increase uric acid levels, potentially by reducing the excretion of uric acid by the kidneys. Elevated blood insulin levels come along with a diet high in refined carbs and sugar. A ketogenic diet is known to stabilize insulin levels. 

So, Can Keto Improve Gout?

Dietary factors might only play a minor part (about 12% of cases) in the development of gout. By the same token, changing the nutrients you consume influences your cellular functioning. The ketogenic diet ditches that sugar burden, lowering inflammation and insulin levels. In 2017, researchers at Yale University examined how ketosis affects NLRP3 inflammasome—the protein complex that triggers the inflammation associated with gout. Human and animal studies reveal that following a ketogenic diet lowered the inflammation of the joints. [11]

Trans fats, refined carbohydrates, sugar, and alcohol are among the foods shown to promote inflammation, a key player in various chronic diseases and the degradation of bone health. [12] Optimal metabolic and bone health also requires nutrients like magnesium, vitamin K2, and healthy fats.

The ketogenic diet can work wonders for weight loss, which is one of the most effective ways to lower uric acid levels and prevent gout flare-ups. 

Short-term studies concluded there was a temporary rise in uric acid during the first few weeks of starting a strict low-carb diet; however, the effects disappeared after around six weeks. Countless doctors report their patient’s uric acid levels returned to baseline or lower after four-six weeks on keto. [13]

Research shows no drastic change in uric acid levels in people following a low-carb diet over several months or years. One study even showed uric acid went down significantly after six months on low carb, suggesting a reduced risk. [14] [15]

If you’re dealing with gout, you might choose to limit or avoid organ meats and be mindful of your purine intake in general. This doesn’t mean that eating meat causes gout. [16]

The bottom line? Purine intake alone isn’t enough to trigger gout attacks. Nutrients, minerals, and healthy fats found in purine-rich foods like seafood and liver could actually help prevent gout flares.

Moreoever, a ketogenic diet isn’t necessarily high in meat. Ketogenic and low-carb diets that are higher in meat are miles apart from a meat-heavy standard American diet. The quality of the meat and the diet as a whole matter.

The symptoms of gout can present without any crystals, so many people believe gout is more likely attributed to inflammation, liver problems, and fructose and sugar intake than meat consumption. If indeed sugar and refined carbohydrates significantly heighten the risk of gout, it stands to reason that a ketogenic diet could be a beneficial therapeutic tool to reduce that risk.

If you have gout or questions or concerns about gout, it’s always best to visit your healthcare practitioner.

To decrease your risk of gout, it’s best to:

  • Limit alcohol
  • Minimize sugar and refined carbs
  • Lose excess weight
  • Improve metabolic syndrome
  • Stay hydrated
  • Exercise

In conclusion, a well-formulated ketogenic diet could potentially reduce the risk of gout in the long run, but more research is needed. 

Have you been dealing with gout? Do you follow a ketogenic diet? Share your thoughts and experiences with the Keto community.

References

1.

Centers for Disease Control and Prevention (CDC). Arthritis is on the Rise: Take Action! Arthritis Is on the Rise: Take Action! (cdc.gov)

2.

 Zhu, Y., Pandya, B. J., & Choi, H. K. (2011). Prevalence of gout and hyperuricemia in the US general population. Arthritis & Rheumatism, Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007–2008 (wiley.com)

4.

Teng, G. G., Pan, A., Yuan, J-M., & Koh, W-P. (2015). Food sources of protein and risk of incident gout in the Singapore Chinese Health Study. Arthritis Rheumatol, 67(7), 1933-42. DOI: 10.1002/art.39115

5.

Schmidt, J. A., Crowe, F. L., Appleby, P. N., Key, T. J., & Travis, R. C. (2013). Serum uric acid concentrations in meat eaters, fish eaters, vegetarians, and vegans: A cross-sectional analysis in the EPIC-Oxford cohort. PLoS One, DOI: 10.1371/journal.pone.0056339

6.

Choi, H. K., Willett, W., & Curhan, G. (2010). Fructose-rich beverages and risk of gout in women. JAMA, DOI:10.1001/jama.2010.1638

7.

Li, R., Yu, K., & Li, C. (2018). Dietary factors and risk of gout and hyperuricemia: A meta-analysis and systematic review. Asia Pac J Clin Nutr, 27(6), 1344-1356. DOI: 10.6133/apjcn.201811_27(6).0022

8.

Stirpe, F., Corte, E. D., Bonetti, E., Abbondanza, A., Abbati, A., & De Stefano, F. (1970). Fructose-induced hyperuricaemia. Lancet, 2(7686), 1310-1. DOI: 10.1016/s0140-6736(70)92269-5

9.

The Arthritis Foundation. Fructose and Gout: What’s the Link? Fructose and Gout: What’s the Link? - Gout (arthritis.org) Fructose and Gout: What’s the Link? - Gout (arthritis.org)

10.

Rivard, C., Thomas, J., Lanaspa, M. A., & Johnson, R. J. (2013). Sack and sugar, and the aetiology of gout in England between 1650 and 1900. Rheumatology (Oxford), DOI: 10.1093/rheumatology/kes297

11.

Goldberg, E. L., Asher, J. L., Molony, R. D., Herzog, R. I., Iwasaki, A., & Dixit, V. D. (2017). β-Hydroxybutyrate deactivates neutrophil NLRP3 inflammasome to relieve gout flares. Cell Reports, https://doi.org/10.1016/j.celrep.2017.02.004

12.

The Arthritis Foundation. 8 Food Ingredients that Can Cause Inflammation. 8 Food Ingredients That Can Cause Inflammation - Arthritis Foundation

13.

Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., & Dashti, H. M. (2012). Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 28(10), 1016-21. DOI: 10.1016/j.nut.2012.01.016

14.

Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J…Stern, L. (2003). A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, DOI: 10.1056/NEJMoa0226

15.

Santos, F. L., Estevas, A., Pereira, C., Yancy Jr. S., & Nunes, P. L. (2012).Systematic review and meta-analysis of clinical trials of the effects of low-carbohydrate diets on cardiovascular risk factors. Obesity Reviews, https://doi.org/10.1111/j.1467-789X.2012.01021.x

16.

Chen, L. X., & Chumacher, H. R. (2008). Gout: An evidence-based review. J Clin Rheumatol, DOI: 10.1097/RHU.0b013e3181896921

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