Does Keto Diet Cause Gout

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What Is Gout A Brief Overview

Gout is one of the most common types of arthritis. According to data from 2007-2008, approximately 8.3 million US adults were affected by gout. It is much more common in people who are overweight and/or have metabolic syndrome, which is why the incidence of gout has been increasing over the past decade.

Gout is typically characterized by sudden and painful inflammation of a joint, most often at the base of the big toe. It can also affect other joints, like heels, knees, wrists and finger joints.

The sudden pain and inflammation are provoked by elevated levels of uric acid in the blood, resulting in crystals that deposit themselves in the affected joint. These crystals will then trigger the immune system, causing pain and inflammation.

Does It Increase The Risk Of Gout

It might. The keto diet is high in purine-rich foods. Purine is a chemical that the body breaks down into uric acid. Gout develops when theres too much uric acid in the blood.

Excess uric acid can form needle-like crystals in a joint, causing pain, tenderness, swelling, and redness.

The best diet for gout is one that is low in purines and includes fruits, vegetables, whole grains, and low-fat dairy products. Along with medication, a low-purine diet is recommended to reduce the risk of gout.

A 2012 study found that people experience an increased risk of gout when they first enter into ketosis due to an increase in uric acid levels. However, the risk is short-term and improves once your body adapts to being in ketosis.

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Inflammation As A Cause Of Gout Attacks

While high purine intake is associated with gout attacks in those who already have hyperuricemia, or high levels of uric acid in the blood, purine intake alone is not enough to trigger these attacks. In fact, uric acid levels are frequently decreased during gout attacks, sometimes to within the normal range. Another factor associated with gout flares is an increase in C-reactive protein and interleukin-6 , cytokines produced during numerous inflammatory conditions. These inflammatory cytokines are increased in the joint fluid and serum of patients with acute gouty arthritis.

Therefore, systemic inflammation is likely a key factor affecting the likelihood of developing gout flares, and as we know, diet plays a significant role in inflammation. While foods like grass-fed beef, sardines, and mackerel are high in purines, they are also higher in omega-3 fatty acids and low in omega-6 fatty acids. Since the omega-3 to omega-6 balance in your diet modulates the inflammatory response, a diet with sufficient long-chain omega-3 fats like EPA and DHA will reduce systemic inflammation and may reduce the risk of forming the uric acid crystals that cause joint pain.

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Howketo Alleviates Gout Symptoms

When you follow a keto diet, the ultimate goal is to knock off the unwanted pounds. But it comes with a host of benefits.

Some of the benefits of the keto diet include:

· Weightloss

·Reduced symptoms of diabetes type 2

·Reduced inflammation in the body

·Improves acne and other skin conditions

Ironically,tender and inflamed joints are among the symptoms of gout. Since the keto dietis known to reduce the level of inflammation in the body, it is unlikely thatit will contribute to gout.

According to a study published in the Cell Reports, the reason why keto diet relieves the symptoms of gout is due to the production of ketones.

When you follow the keto diet, and your body enters ketosis, your body starts producing increased levels of ketones.

It is the reason why you also experience fruity keto breath.

One of the ketones, in particular, called the -Hydroxybutyrate or BHB, is responsible for reducing the inflammation in the body.

This ketone inhibits the secretion of Neutrophil NLRP3, which primarily causes the inflammation in gout.

NLRP3inflammasome, when combined with neutrophils in the white blood cells, triggersIL-1B pro-inflammatory cytokine. When this happens, the attack of goutworsens.

The BHB levels in the body definitely increase when the body is undergoing ketosis due to the keto diet.

This is the reason why those who practice the keto diet experience less inflammation from gout and the overall body as well.

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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.

Can Keto Reduce The Risk Of Gout

The negative impact of sugar on the causation and proliferation of gout is significantly diminished with the use of a ketogenic diet. The high-fat, low-carb dietary protocol prescribed, turns off specific actions and activates other alkalizing functions in the body, helping to improve total health and mitigate disease.

Focus on eating healthy fats like avocado, fatty and affordable fish like mackerel, or add MCT powder into a simple fat-filled smoothieand, of course, omit sugar wherever possible to promote vitality and prevent disease.

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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.

Understanding The Keto Diet

The ketogenic diet is not new, even though its been making headlines now more than ever. The extremely low-carb, high-fat, moderate-protein diet has been used for nearly 100 years to help control seizures in children with epilepsy.

The theory behind a keto-like diet is that once the body has depleted its stores of glycogen the back-up energy in the liver and muscles it will look to the bodys fat stores as fuel, says Sophia Kamveris, MS, RD, LDN, a Boston-based nutritionist and author of The 28-Day Gout Diet Plan.

A result of this metabolic state called ketosis is decreased hunger and increased weight loss. Proponents of the keto diet believe that it can also be helpful in managing diabetes, Alzheimers, and more.

But does a classic ketogenic diet which is made up of around 70 to 80 percent fat, 20 percent protein, and 5 percent carbohydrates make sense for a person with gout, a type of inflammatory arthritis? While there is some interesting research on the topic, many experts say not so fast.

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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 , “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.”

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.

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How Ketosis Might Help Manage Gout

Researchers at Yale University looked at how putting the body into a state of ketosis can impact the inflammation that contributes to diseases like gout. When they fed rats a ketogenic diet and then induced a gout flare, the animals had less joint inflammation and swelling than they did when they were not on the keto diet.

But: We are not trying to say that a ketogenic diet prevents or cures gout, says Emily Goldberg, PhD, postdoctoral fellow in the departments of comparative medicine and immunobiology at Yale University. What this research did show, she says, is that it is possible to target the source of inflammation in gout to prevent acute symptoms of the disease.

Scientists have also looked, in test tubes, at the impacts that ketone production might have on humans. The results have been promising however, scientists say that further research is needed before they can recommend a keto diet to help keep gout under control.

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.

Continued

American Journal of Clinical Nutrition

Pagination

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