Low Carb Uric Acid And Gout
Short term studies show a temporary rise in uric acid during the first few weeks when starting a strict low-carb diet. This effect seems to disappear after about six weeks, with uric acid returning to baseline or even lower.14
Sugar is likely worse than other carbohydrates because of the potency of fructose in raising uric acid.
This study showed lowering the glycemic index of dietary carbohydrates improved uric acid levels:
Beer not only contains alcohol, but also rapidly digestible carbs, raising insulin and thus lowering excretion of uric acid. Of less importance, beer also contains purines.
This study showed most types of alcohol, even in moderate amounts, increased risk of gout. However, it is likely that none of the participants were on a low-carb diet.
Does A Ketogenic Diet Increase Your Risk Of Gout
There is a short-term increased risk of gout flares when initially entering into nutritional ketosis due to the competitive inhibition of ketones on kidney excretion of uric acid . This is transient, and once one is through the keto-adaptation process, the long-term risk of gout decreases .
âDr. Stephen Phinney on ketogenic diets and gout
Very few people who are not prone to gout have an attack due to starting a ketogenic diet. The overall prevalence in the general population is about 1-2%âthis includes those who are prone and those who are not.
A well-formulated ketogenic diet has potent anti-inflammatory properties that we are just now coming to understand. The primary ketone in our blood, beta-hydroxybutyrate , is a regulatory signal that works inside white blood cells to reduce inflammation. Most recently, a well-known research group at Yale have studied the ketogenic diet in rats and in humans, and demonstrated that it actually has a protective effect against joint damage caused by gout . They’ve worked out the mechanism, and in the process demonstrated that BOHB can reduce damaging inflammation without reducing the benefits of inflammation such as healing and our defenses against infection. What this indicates that a well-formulated ketogenic diet may actually be beneficial in the management of gout.
What A Typical Day Of Eating Looked Like For Me
Like Janna, I ended up eating a lot of Caesar salad with chicken on the regular. Breakfast was all about bacon, eggs , spinach and avocado. On offer at lunch was usually more leafy greens, roast chicken , cheese and nuts. For snacks, I ate more nuts, more cheese, and sometimes Id even eat raw spinach out of the bin and call them keto chips. Blackberries were a green-lit treat, and very dark chocolate is also OK in moderation. I learned to like cream, and sometimes butter, in my keto coffee.
I also learned to drink so much water, and I peed on a keto strip every morning to make sure I was still in a state of ketosis. Being in the state of dietary ketosis is key to the weight loss benefits of the diet it means your body is no longer fueled by carbs and is instead running on stored fat , producing ketones, so your brain still gets the energy it needs. To enter ketosis, I had to deprive my body of carbs . The process took about three to five days, which is when I got whats dubbed the keto flu and lost seven pounds by day six.
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The Truth About Gout And Diets
Researchers say gout rates typically fall in times of hardship, such as during World War II, and rise in times of prosperity and indulgence. This means it would come as no surprise to many that gout rates are very likely increasing in the U.S. as the nation faces an epidemic of obesity.
“Gout tends to be associated with obesity and high blood pressure,” says John Klippel, MD, president and CEO of the Arthritis Foundation. “Those are two common health problems in this country, and obesity certainly seems to be increasing.
“If someone were to study it, that might mean that there might actually be more gout , but one would speculate that’s because we’re dealing with a society that is by and large overweight,” Klippel tells WebMD.
But losing weight too quickly might also increase the risk of gout.
“As you lose weight, you start to metabolize body tissues, and there is an increased flux of purines that the body has to deal with, which leads to increases in uric acid,” says Klippel. “Crash diets where people are losing weight very rapidly are going to increase the risk of gout.”
Nuki says that’s where the link to high-protein diets like Atkins comes in. Any diet that produces rapid changes in weight raises the risk of gout, but he says low-carbohydrate diets may carry an additional risk for two reasons.
Even so, Nuki says diet is only part of the picture.
American Journal of Clinical Nutrition
Can A Diet Give You Gout
Gout’s on the Rise, and Your Diet May Be to Blame
Jan. 23, 2004 — Once known as the scourge of the rich and gluttonous, gout may be staging a comeback. But is the popularity of high-protein, low-carbohydrate diets like the Atkins diet to blame? Yes and no, say experts.
Recent British news reports linking rising gout rates and the Atkins diet have stirred interest in a possible link between gout and diets. But experts say there is no real proof that any particular weight-loss plan can cause the painful condition.
“We have only anecdotal evidence from individual patients who have had gout in the past that going on an Atkins diet has exacerbated the problem and precipitated attacks,” says George Nuki, MD, emeritus professor of rheumatology at the University of Edinburgh in Scotland.
Researchers say there are logical reasons to believe that a high-protein, high-fat diet might increase the risk of gout in people already prone to the disease. But the real reason why gout appears to be on the rise may be old-fashioned overindulgence.
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A Concentration Of Acid/salt On A Ketogenic Diet Can Impact Gout
The concentration of the acid/salt is another contributory factor to gout and kidney stone formation during ketosis.
Think of soluble salt in water. As you add the salt to the water, it dissolves. But as you add more salt, a point will come when the salt no longer dissolves. Its at this point that we say the solution is fully saturated. If you continue to add more salt inside, the crystals will go to the bottom of the solution and precipitate.
Now imagine this occurring in your bloodstream. The undissolved uric acid crystals can accumulate over time and cause an inflammatory response. This mechanism is how gout takes place.
The Keto Diet For Less Pain Inflammation And Disease
Changing your fuel source from carbohydrates to fat can profoundly shift your metabolism. It can also reduce inflammation, stave off episodes of gout, and thwart most chronic diseases.
And the nutritional prescription couldnt be easier
Enjoy the fat-fueled diet of your ancestors!
Here are a few Ketogenic, Low-Purine Meal ideas to get you started:
Love comfort foods, but not the carbs? Check out Kelleys FREE new book Carb Lovers Keto with 100 recipes for all of your favorite comfort foods. From Chicken Parmigiana and Coconut Shrimp to Buffalo Wings and Pizza. Discover how you can indulge 100% guilt free!
Emily L. Goldberg, Jennifer L. Asher, Ryan D. Molony, Albert C. Shaw, Caroline J. Zeiss, Chao Wang, Ludmilla A. Morozova-Roche, Raimund I. Herzog, Akiko Iwasaki, Vishwa Deep Dixit. -Hydroxybutyrate Deactivates Neutrophil NLRP3 Inflammasome to Relieve Gout Flares. Cell Reports, 2017 18 : 2077 DOI: 10.1016/j.celrep.2017.02.004
Danve A, Sehra ST, Neogi T. Role of diet in hyperuricemia and gout. Best Pract Res Clin Rheumatol. 2021 Dec 35:101723. doi: 10.1016/j.berh.2021.101723. Epub 2021 Nov 19. PMID: 34802900 PMCID: PMC8678356. https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/gout/diet-gout
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The Problem With Following The Keto Diet For Gout
For now, its best to stick with conventional wisdom regarding food and gout that most diets high in animal proteins are risky for a person with the condition, says Kamveris.
We know that red meats and seafood are especially rich sources of purines, and when eaten in excess can raise uric acid levels, she says.
Research in humans supports this way of thinking. When people with gout ate a diet high in purines from animal sources over a two-day period, they were nearly five times more likely to have a gout flare compared with people who avoided purines, in a 2012 study from Boston University published in the journal Annals of The Rheumatic Diseases. A poor diet can absolutely lead to more gout exacerbations, even if the uric acid is fairly controlled with medication, says Randall N. Beyl Jr, MD, a rheumatologist in Albertville, Alabama.
As for following a keto diet that is also low in purines? Its not impossible, but sustainability is at the top of the list of criticisms diet experts have about the ketogenic diet and layering even more limitations on top of an already restrictive diet would prove especially challenging.
Whats more, the whole grains and starchy vegetables that a person on a ketogenic diet would need to stop eating can actually help with gout.
Research now demonstrates that foods that are rich in antioxidants like the ones abundant in the DASH Dietary Approaches to Stop Hypertension diet, helps to lower uric acid levels, says Kamveris.
Going Forward With Gout
So what should you eat when you have gout? I recommend copious amounts of whole grains, plant-based protein, fresh vegetables and fruits, daily nuts, legumes, low-fat dairy, oily fish, and chicken and eggs in moderation, says Dr. Beyl.
He suggests that gout patients avoid red meat, shellfish, high-fructose corn syrup, refined sugar, liquor, and beer.
Its important to remember that the right kind of diet can play an important role in managing gout, as long as its used with and not in place of prescription drugs. I always encourage strict compliance with our gout medications, but try very hard to emphasize the importance of diet to treat the patient as a whole not just their arthritis, says Dr. Beyl.
In other words, the diet that is sustainable, helps you feel great all around, and helps keep gout symptoms controlled is the way to go.
If you do decide to make a change in your diet for any reason, seek out medical supervision from your doctor or a registered dietitian who is experienced with inflammatory conditions.
Get access to our Gout Patient Guidelines by subscribing to CreakyJoints today.
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Acid Disassociation Constant Factor
Weak acids like uric acid can occur in two forms:
the ionized or disassociated form , and
the unionized form .
The type of uric acid depends on the pH of its surroundings .
The pH at which an acid occurs as half ionized and half unionized is known as pKa. The pKa for uric acid is normally 5.5. It means that at this pH, 50% of it is like crystal salt, and the other 50% is like dissolved salt.
Here is the chemical reaction that shows how urine gets the acid and salt contents:
KHCO3 + R-COOHR-COOK + H2CO3
In simple words,
Potassium bicarbonate + uric acidMono-potassium urate + Carbonic acid
The bicarbonate buffer reacts with uric acid in the blood to produce mono-potassium and mono-sodium urate .
When potassium bicarbonate reacts with uric acid, it produces mono-potassium urate and carbonic acid , which then undergoes a zinc-catalyzed reaction with the enzyme alpha-carbonic anhydrase to form water.
H2O is removed as urine, while CO2 is exhaled.
The same reaction will take place if the buffer is sodium bicarbonate , and of course, the product would be mono-sodium urate.
Increasing pH will result in a rise of ionized uric acid
Dont forget that the body controls the blood pH and keeps it between 7.3-7.4.
As the environments alkalinity increases, the more ionized the acid to base ratio becomes, and no crystals will form.
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What Causes The Condition Of Gout
Gout is the result of an excess of uric acid in our muscle tissue that leads to physiological disorders, as mentioned above, with associated symptoms like joint pain, swelling, redness, and inflammation.
With that being said, reducing our levels of uric acid in the body to avoid gout and other disorders is a worthy goal and one naturally supported by following a low-carb, high-fat ketogenic diet.
Fortunately, since certain lifestyle choices can make us more susceptible to gout, converse behaviors that reduce uric acid and boost alkalinity can effectively act as a non-invasive approach to mitigate the proliferation of this inflammatory disorder.
There are a few potential lifestyle triggers that may spike uric acid production. We’ll cover some points to consider to keep your acid levels balanced with lifestyle choices on a ketogenic diet, below.
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Putting It All Together How Diet Affects Your Risk Of Gout
After exploring the data from these studies, the potential for an ideal diet for gout sufferers begins to arise. Perhaps a diet that cuts out the sugar and alcohol, limits meat and seafood intake, and derives most of its protein from plants and dairy would be a good start.
On top of that, consuming coffee, supplementing with cherry juice and high vitamin C and folate foods, and limiting carb intake can help lower uric acid levels and gout risk further.
However, this ideal gout diet is only based on epidemiological data at this point. What happens when we put people on a diet that mimics many of the components of our speculative diet plan?
The Itis Diet May Help Ease Fatigue Joint Swelling And Other Ra Symptoms
Research presented at the 2021 American College of Rheumatology Convergence virtual conference found that the ITIS, or inflammation diet, which is based on the Mediterranean Diet but pinpoints specific foods known for their anti-inflammatory and pain-reducing qualities, helped study participants report less pain, swelling, and for some, about half the fatigue they typically experience while living with RA.
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But My Friend Followed An Isolate Diet With Keto And Had Kidney Stones
An increased level of uric acid in the blood is one of the significant consequences of the Metabolic Syndrome. And, during the ketosis state, excessive ketones are excreted mainly via the urine. However, our body also removes them via feces and the breath .
With that said, it is possible for someone on a keto diet despite containing low amounts of purines to develop kidney stones.
Clearly, there must be another contributory factor other than a diet rich in purines.
Such a scenario is especially noticeable in the early weeks of a ketogenic diet protocol which may contribute to gout or kidney stone. At this stage, the body cells dont have all the enzymes needed to use ketones as a source of energy altogether. As a result, some of the unutilized ketones are removed from the body.
Ketones are a little bit acidic and therefore tend to increase the acidity of urine. Leaving this condition unaddressed may lead to a gout attack at the early stage of ketosis, and uric acid stones may form in the kidney.
Now you know the reason why many people attribute a risk factor associated with the keto diet and kidney stones.