Gout and low carb
However, there may possibly be a temporary increase in risk of gout during the first six weeks on a strict low-carb diet. After this initial time period, a low-carb diet is likely neutral, or even protective, when it comes to gout.
Keep reading to find out what gout is and how to avoid it.
What gout is
Gout is a sudden and painful inflammation of a joint, most often at the base of the big toe (see image). It may also affect other joints, like heels, knees, wrists and finger joints.
The cause of gout is elevated levels of uric acid in the blood, resulting in crystals depositing in the affected joint.
Gout is more common in people who are overweight and have metabolic syndrome, and have thus become more common in recent decades, affecting about 6% of adult men and 2% of women (it’s even more common in older people).1 Historically, it was known as “the disease of kings” or a “rich man’s disease”, but now everyone can afford… sugar.
Meat and gout
Gout has often been blamed on excessive consumption of meat. This is because the uric acid that causes gout is a breakdown product of purines, a building block of protein, that is highly concentrated in meat.
However, avoiding meat seems to have little effect on the risk of gout, and even vegetarians get gout much more often than would be expected if this was the main cause.
Eating more protein (like meat) seems to increase the excretion of uric acid from the kidneys, through the urine, thus not having much of an effect on the blood uric acid levels… or the risk of gout.
Sugar and gout
As there is a very strong connection between gout, obesity, type 2 diabetes and metabolic syndrome, it’s possible that they are all primarily caused by the same thing: sugar and other refined carbohydrates.
In fact, high blood levels of insulin – a consequence of a diet high in refined carbs – has been shown to increase uric acid levels, probably by decreasing the excretion of uric acid by the kidneys.
There is a striking history of gout suddenly becoming common in populations just as sugar consumption started to rise sharply (e.g. in Britain during the eighteenth century, paralleling the birth of the country’s sugar industry).
There’s also experimental proof, showing that consuming fructose (a main component of sugar) sharply increases levels of uric acid in the body.
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 (i.e. keto) low-carb diet. This effect seems to disappear after about six weeks, with uric acid returning to baseline or even lower.
After dozens of high-quality studies comparing low-carb diets to other diets, there seems to be none noticing any obvious difference in the risk of gout, although no study has focussed on this specific question in detail.
Doctors regularly treating patients with low-carb diets apparently do not notice an increase in gout episodes even during the first time period. So if there exists an increase in risk during the first few weeks it is likely small or moderate.
Long-term uric acid levels tend to become low on low carb, along with other markers of metabolic syndrome4 and even patients that used to suffer from gout can potentially become gout free. However, it might take months or even years to completely reverse their insulin resistance and achieve normal levels.
How to avoid gout
Here’s how to avoid gout long term, using only lifestyle modifications:
- Minimize intake of sugar.5
- Reduce intake of alcohol. Particularly avoid beer and other high-carb alcoholic drinks.6
- Lose excess weight and reverse metabolic syndrome. Low carb is a good treatment, as is intermittent fasting.7
As a bonus, these lifestyle modifications have many other positive effects on weight and health. However, if they are not enough, the drug allopurinol is highly effective in preventing gout.8
Given that there may be a temporary rise in uric acid during the first few weeks on a strict low carb diet, people who’ve previously had troublesome gout attacks may want to consider using the drug allopurinol while starting low carb, starting taking the drug at least a week in advance, to minimize any risk of a new gout attack.
Meat or no meat?
Avoiding meat should not be necessary or effective when it comes to gout prevention.
Furthermore, please note that a low-carb diet is not supposed to be especially high protein or high meat anyway. An effective low-carb diet should be moderate in protein and instead high in natural fat.
A well-formulated low-carb diet (i.e. a low-carb, high-fat diet) likely reduces the risk of gout long term.
Do you have anything to add?
Do you have anything to add to this guide? Have you experienced any change in gout problems on low carb? Are you aware of further studies regarding gout and low carb?
Feel free to leave a comment below, we’ll read them all.
More about gout
Gout and ketosis sometimes get mentioned in the media. Here’s an example from 2019:
Here’s an entire chapter about gout, from the award-winning science journalist and low-carb expert Gary Taubes:
More low-carb side effects & how to cure them
Common early issues
Less common issues
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E.g. triglycerides, liver enzymes, blood pressure, glucose, abdominal circumference, and weight. ↩
Sugar is worse than other carbohydrates, even refined carbs, because of the high concentration of uric acid-raising fructose. ↩
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.
If you want to drink alcohol, ideally choose options low in carbohydrates. This will still raise uric acid levels and the risk of gout, but not by as much:↩