Gout and low carb

GoutIt’s occasionally claimed that low-carb or keto diets high in meat often cause gout. However, we are not aware of any evidence proving this to be true.

First of all, a low-carb diet is not necessarily high in meat,1 and even those that are high in meat are markedly different from the standard American diet high in meat.

Instead, since all low-carb diets are low in sugars and refined carbohydrates, there is a potential for them to reduce the risk of gout rather than increase it.

Keep reading to find out what gout is, how to avoid it, and how a low-carb diet may affect 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).2 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, as with all nutritional epidemiology studies, it is impossible to separate eating meat from observational healthy user bias, or from associated refined grains or alcohol intake. Therefore, epidemiology studies cannot prove that meat causes increased gout risk. In fact, one study showed that vegans had higher uric acid levels that meat eaters and fish eaters, thus potentially placing them at the highest risk for gout attacks.3

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.4

Some weak observational studies, especially those in the United states, show an association between meat intake and elevated uric acid levels.5 Others, such as one in Taiwan, show no such association.6 Why the difference? We don’t know for sure, but one explanation could be the prevalence of metabolic syndrome or the consumption of sugar. Therefore, the rest of the diet may matter more than the consumption of meat itself.

Sugar and gout

As there is a very strong connection between hyperuricemia, gout, obesity, type 2 diabetes and metabolic syndrome,7 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,8 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 evidence, showing that consuming fructose (a main component of sugar) increases levels of uric acid in the body.9

Since alcohol and fructose are metabolized in similar ways by the liver, it is possible that they also increase uric acid levels in the same way.

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.10

Studies show no significant change in uric acid levels in people doing a low-carb diet over several months or years.11 The exception is one study that actually showed uric acid going down significantly after 6 months on low carb, suggesting it may decrease the risk of gout.12  

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 do not notice a sharp increase in gout episodes even during the first time period.13 So if there exists an increase in risk during the first few weeks it is likely small or moderate.



How to avoid gout

Here’s how to avoid gout long term, using only lifestyle modifications:

  1. Minimize intake of sugar.14
  2. Reduce intake of alcohol. Particularly avoid beer and other high-carb alcoholic drinks.15
  3. Lose excess weight and reverse metabolic syndrome. Low carb is a good treatment, as is intermittent fasting.16

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.17

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.18


Meat or no meat?

Avoiding meat should not be necessary when it comes to gout prevention, especially if someone is otherwise following a low-carb diet.

Furthermore, please note that a low-carb diet is not supposed to be especially high protein or 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) could potentially reduce the risk of gout long term.19

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:

Can we blame gout’s resurgence on ketosis?

Here’s an entire chapter about gout, from the award-winning science journalist and low-carb expert Gary Taubes:

Tim Ferriss: Gout: the missing chapter from Good Calories, Bad Calories


More low-carb side effects & how to cure them

Common early issues

Less common issues


Low-carb myths



Improve this page

Do you have any suggestion – big or small – to improve this page?
Anything that you’d like added or changed? Any other problems you’d like to see addressed?

Comment below or e-mail me at andreas@dietdoctor.com.

  1. It’s even possible to eat a vegan low-carb diet:

    How to eat low carb as a vegan

  2. Arthritis & Rheumatology 2011: Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007–2008

  3. PLOS One 2013: Serum uric acid concentrations in meat eaters, fish eaters, vegetarians and vegans: A cross-sectional analysis in the EPIC-Oxford Cohort [observational study, weak evidence]

  4. Advanced Experimental Medical Biology 1980: The uricosuric action of protein in man. [randomized trial; moderate evidence]

  5. Arthritis and Rgheumatism 2005: Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. [observational study, weak evidence]

  6. Seminars in Arthritis and Rheumatism 2008: Dietary factors associated with hyperuricemia in adults. [observational study, weak evidence]

  7. American Journal of INternal Medicine 2007: Prevalence of the metabolic syndrome in individuals with hyperuricemia [observational study, weak evidence]

    Arthritis and Rheumatology 2015: Risk of incident diabetes in patients with gout: a cohort study [observational study, weak evidence]

  8. Journal of Clinical and Diagnostic Research 2013: Correlation of the serum insulin and the serum uric acid levels with the glycated haemoglobin levels in the patients of type 2 diabetes mellitus [observational study, weak evidence]

  9. Lancet 1970: Fructose-induced hyperuricaemia.[non-controlled study; weak evidence]

    In addition, observational studies show a correlation between fructose consumption and increasing risk of gout

    BMJ 2008: Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. [observational study, weak evidence]

  10. Nutrition 2012: Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. [randomized trial; moderate evidence]

  11. NEJM 2003: A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity [randomized trial; moderate evidence]

    Obesity reviews 2012: Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors [strong evidence]

  12. American Collage of Rheumatology 2014: High-Protein Diet (Atkins Diet) and Uric Acid Response [non-controlled study; weak evidence]

  13. This is based on consistent clinical experience of low-carb practitioners. [weak evidence]

  14. Sugar is likely worse than other carbohydrates because of the high concentration of uric acid-raising fructose.

    This study showed lowering the glycemic index of carbohydrates improved uric acid levels

    Arthritis and Rheumatology 2017: Effects of lowering glycemic index of dietary carbohydrate on plasma uric acid: The OmniCarb Randomized Clinical Trial[randomized trial; moderate evidence]

  15. 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.

    American Journal or Medicine 2015 Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study
    [weak evidence]

    If you want to drink alcohol, ideally choose options low in carbohydrates. This may still raise uric acid levels and the risk of gout, but possibly not by as much (this is not based on evidence but on potential mechanistic thinking):

    1. Low-carb alcohol
    2. Low-carb beer

  16. The American Journal of Medicine: Update on Importance of Diet in Gout [overview article; ungraded]

  17. Wikipedia: Allopurinol

  18. This is based on consistent clinical experience of low-carb practitioners. [weak evidence]

  19. Although we are not aware of any long term studies specifically on low-carb and gout, it makes empiric sense that reduction in sugar and improvement in metabolic syndrome would reduce the future risk of gout

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  1. Lacosta Hodges
    My husband has gout flare ups when he cheats. He has been lchf for 3 years. This year at the beach he had some refined sugar when we went out which triggered a gout flare up. I think it is his body's reaction to the spike in sugar. This just validates our commitment to the lchf lifestyle. If your body reacts that strongly to sugar when you are not used to it then its poison!
  2. Barbara
    I just cheated for several days while on vacation, came home, got back into ketosis and ended up with gout within a week. Never had it before. Terribly painful. Hobbled, couldn’t bear weight on my swollen red foot. I had been fat adapted for a long time previously and this certainly showed me how insulin resistant I truly am. I was uncomfortable taking the prescribed anti inflammatory and drank ACV and lemon juice instead, along w a pain med. Lesson learned. Hope I never experience this awful affliction again. My heart goes out to those who do.
  3. Arlene
    A few weeks I went much lower carb. I also increased my exercise levels considerably, and along with the heat (summer in Ontario, Canada can sometimes be brutal) ended up in ER with tachycardia.

    I take a 12.5mg thiazide diuretic for high blood pressure and this I believe was a factor as well in that I become quite dehydrated.

    Blood work indicated low potassium (3.2), low magnesium (.73mmol) and high uric acid (401 umol.)

    I had blood work done again to follow up on those results last week, and all this has resolved. My uric acid is down to 224 umol, and my potassium is normal at 4.5.

    For anyone taking diuretic medication for high blood pressure please be aware that there is a chance that this will additionally increase uric acid levels initially when significantly lowering carbohydrate intake and going into ketosis.

    In my case I am happy to report it was transitory and has resolved spontaneously.

  4. Linda
    About 3 years ago, I was on no particular diet, I had an episode of gout in my left big toe. When it didn't go away in a couple of weeks, my doctor gave me a prednisone shot. That did nothing. Then she prescribed allopurinol -- OMG - suddenly the gout became so much worse and spread to other joints including my left foot and ankle. I was unable to walk even to the bathroom and hubby had to push me in a wheelchair! I started researching and found that allopurinol should NOT be started during a gout outbreak. I called my pharmacist and he confirmed this was correct and to stop taking it immediately and call my doctor. She was very unconcerned! I hung up and determined to switch doctors right then and there. Further researching, I found an over-the-counter remedy on Amazon with a 90-day money back guarantee. I ordered it with 2-day shipping and started taking it. Literally in 3 days, my gout was so much better and in 6 days it was gone. I don't know if this will help anyone else, but the product is Urcinol. I'm just an ordinary customers (very satisfied customer) and have nothing to gain from putting this information out there. I would just be so happy if this helped others the way it has helped me. I recently had a blood test that showed my gout level was up a bit. I came home and checked the pills in my monthly pill case and found that I had inadvertently left it out when I filled it 2 weeks ago. I am convinced that it works for me and I hope it will help some of you. No one wants to deal with gout! I am on Week 2 of low carb and already down 5 lbs. and feeling so much more energetic and clear headed. Good luck everyone on your journey.
  5. JOHN
    normal keto does not brother my gout only after 3 continuous days of fasting brings it on. i just wonder if uric acid is stored in the fat cells that are getting burned? can not be in the food that i am eating because on a fast you do not eat anything. so where is the uric acid coming from? has to be in the fat cells. just my option, meat does not brother me, i ever eat liver a lot and it never hurts me, only fasting does
  6. Cyrus
    Interesting thread. I reduced my gout 90% when I fixed my gut health issues. There seems to be a relationship between gut bacteria and gout. Google "gut bacteria gout" to see the studies. Obviously, changing your diet and the foods you eat (protein, carbs, fat, fructose, etc.) will alter everyone's microbe different.

    My own healing moment came when I started taking GOS (Galactomune) which is a prebiotic that promotes the growth of bifidobacterium and lactobacillus. I believe GOS is technically a carb, but you don't have to take very much of it, or for very long. Food for thought for anyone struggling with this.

  7. Pekka Huttunen
    I have been on low carb diet now for five years. My gout episodes are basically non-existent. My arthritis doctor kept on telling me to avoid meat and fatty foods. I decided with advise from another doctor to do the opposite and also cut gluten off my diet. This decision basically saved my life!
  8. Brian
    I expect that liver function plays a predominant role in gout flare ups and often falls under the influence of various harsh inputs such as heavy carb loads, spikes in fructose, ketones etc. A livers function to cleanse out toxins, unic acids and ketones will be reduced if swamped by high carbs, fructose spikes, alchohol binges or large amounts of purines being converted.

    Non alchohol fatty liver disease diagnosis is a growing trend and likely a cause for my gout flare ups and triggered by generally flooding of it by rapid absorption spikes in fructose (including diet pop sweeteners that also wreak havoc), general over consumption of carbs and occasional binges of sweets or high purine meats.

    Don’t recommend anyone seek a single silver bullet solution to gout, such as tart cherries, but rather pursue the overall health of your liver to be the source of your blood level readings which are ultimately excreted by kidneys.

    The anti-inflammatory long term approach with herbs & meds as needed to boost should be paramount as well as avoiding of spike events to the liver.

    Staying well hydrated helps the body cleanse out toxins, uric acid crystals and ketones vs allowing them to settle in joints and causing inflammation.

  9. Burton Abrams
    While diet does affect the concentration of uric acid in the blood, it is not the principal factor. A much more important cause of excessive concentration of uric acid in the blood leading to gout is the reduction of oxygen in the body that occurs with sleep apnea, which is the frequent cessation of breathing for many seconds at a time during sleep. The intermittent reduced oxygen level in the blood causes all the cells to produce excess uric acid while it also reduces the solubility of uric uric acid in the blood, plus it gradually reduces kidney function so that removal of uric acid from the blood is slowed. The uric acid solution in the blood then becomes supersaturated, with the result that monosodium urate (MSU) crystals precipitate. When MSU forms in a joint, it activates an immune system response that causes the severe pain and inflammation of a gout attack.

    It is known that people with gout have increased risk for serious cardiac events and mortality, which are known consequences of sleep apnea. Increasing the dosage of the gout suppressing drugs allopurinol or febuxostat (Uloric) has been shown to have no beneficial effect on those risks. They are usually effective in suppressing gout attacks, but they do nothing to overcome the underlying sleep apnea.

    Sleep apnea has many known life-threatening consequences (eg, cardiovascular diseases, kidney disease, high blood pressure, diabetes, etc.) If it's left untreated for a long time, conditions leading to these consequences often become irreversible. But gout is an early warning of sleep apnea, allowing for its diagnosis and treatment before these irreversible conditions develop. It's ironic that gout sufferers are fortunate, in the sense that they have an early warning of the presence of sleep apnea. Overcoming the sleep apnea not only will prevent future gout attacks, but also will greatly reduce the risk for development of sleep apnea's serious consequences if treated early enough.

    Sleep apnea is readily treatable. The most important thing that a physician treating gout can do is send the patient for a sleep study, and prod the patient to follow the recommended treatment. The most important thing that a gout sufferer can do is insist on having a sleep study, and then follow the recommended treatment for it.

  10. Lyne Gagne
    I just saw my naturopathe and he told me cause he saw cristal in my urine and blood to reduce red meat, salt, cacao, and' sugar, process meat ( I dont eat them)'' what do you think? and he said to eat more celeri, celeri rave, cucomber, water, yellow apples, noix de grenobles, so wy would I have cristals if I dont eat frustose or sugar, I eat meat, keto veggies, keto fruits good fats and he also said that I still have low llymphocyte so he prescribed supplements thymus and manganese cobat for my anxiety, pvc, tremors and digestion, I add it in januray also from blood test, he checked my cholesterol and sugar all is good, thanks if you can help xox I cut all sugars 18 mounts ago
    Reply: #61
  11. Kristin Parker Team Diet Doctor
    Fruits, even keto friendly still have sugars.
  12. Constantina
    I had my first gout attack in October of 2018 after being keto for 18 months and low carb for two years (reversed diabetes and fatty liver, lost 50 pounds but want to lose 30-40 more. Also have lost a lot of muscle and slowed my metabolism, which is concerning). It resolved with the indomethacin my doctor gave me, but I did not want to keep taking that. When I had another attack a couple of months later, I bought some tart cherry capsules and it reversed even faster. A little bit of research revealed that better hydration and b vitamins can help. I haven’t read all the comments here, but I did see one that suggests gout is related to sleep apnea. I have a sleep study scheduled next month.
  13. Donna M Payne
    I am 57 yrs old and I am doing great on the Keto diet but after I drank some electrolytes I got a mild case of gout. I have never had gout before. It is not super painful but it is there. I am just starting my 2nd week on Keto and I am doing intermittent fasting because I am not hungry and I am drinking lots of water and adding salt to my diet when I eat. I have fasted about 18 hours on Thursday and I will be doing 18 hours today (Saturday). I am already down from 140 to 133 lbs. I feel great and I have more energy than I have had in a long time. I also have very little appetite. I eat maybe once a day or sometimes twice. I wanted to give you some back ground on what I have been doing.
    Once you have gout how long before it goes away?
    Reply: #64
  14. Kristin Parker Team Diet Doctor
    Donna, this is from the article and may help answer your question.
    "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."
  15. Michael
    I had not had a gout attack in literally years until, six weeks into the keto diet, just recently I developed bad gout in my right foot.

    I feel that advocates of the diet may be in denial about this side-effect – it is simply not correct to say that the keto diet does not cause gout – there is certainly nothing imaginary about the excruciating pain!

    That is not to say that, overall, I am critical of the diet – far from it – I have already lost 7 kg and very much want to continue on it but unless I can get the gout under control it will be impossible – the pain is simply too bad.

    My doctor warned me that Allopurinol can actually exacerbate the problem in the short term so I was interested to read, earlier in this thread, of another drug without this affect .

    I’ve also been told that drinking a ridiculous amount of water plus adding some vitamin C can help to flush out the kidneys and correct gout.

    Any other thoughts or observations would be most welcome.


  16. Lisa
    I see that people experience gout symptoms after starting keto. I finally took the plunge and started it. I've managed to keep to it for only a few days, feeling great, except - I started getting heel and knee pain. Every time I try to go low carb or keto something happens to me and I end up stopping. I would love to find something (whatever it is - water, supplements, certain foods...) to help me get to the point where the keto diet will start becoming "protective" instead of causing the pain!
  17. RG
    Never had gout before I started a LCHF diet with IF. 2 days into the fast I had horrible pain in my foot. I thought I had a broken bone! My whole foot was swollen and hot. Doc prescribed Prednisone and a week later I was back to normal.
  18. B M Dale
    My husband suffered badly with gout on and off for years. We eventually found the culprit from doing a food diary, sadly eating BACON gives him gout!
    He now takes Progout daily and has a script for another med if and when he gets an attack. He’s not had a gout attack for a few years now.
    He started the Keto diet (No bacon) about 6 months ago, has lost over one stone (8 kilo) so he has been able to stop taking half his diabetic medication! His Dr is very happy.
    I suggest to him to stop taking the medication for gout because he never eats bacon now but he is not willing to take that chance to go through all that pain again - as stopping the medication might bring on a gout attack??
  19. Joyce
    Working through my first ever very painful gout attach. "First ever painful" because I have experienced swelling and tenderness in my great toe joint before but it wasn't that bad I thought I was developing a bunion. My Uric Acid was elevated before I started Keto in Sept 2018.
    I have had wonderful results on keto (including a decrease in inflammation) for which I am so grateful but this has me totally confused and caught off guard. I eat less red meat now than before starting the diet, don't eat sweets, very seldom shell fish, no alcohol --in other words none of the triggers attributed to gout flares. I have heard of some cases of gout attacks occurring as uric acid level decline and am hopeful that is what I am experiencing. Has anyone experienced a gout attack this far into keto. I have been in solid ketosis for over 5 months.
  20. Phil Raffini
    I have battled gout for 20 years now to the extreme of being on crutches for six weeks and still to this day have no defined triggers. After Thanksgiving 2018 I went low carb to kick start weight loss. February 11th I then changed to Keto. I am doing great with wight loss being down 30 lbs. But in the past week I have experienced 2 high grade acute gout attacks on 2 different joints. I am on Prednisone and colchicine to knock it out of my system, but pain is severe. My doc also told me not to start the allapuronol until after a scheduled blood test in 4 more weeks as it can worsen the flare up. Hoping that this episode is due to me being about 4 weeks in to LCHF and then will subside after that. That when I will start allapuronol.
  21. Richard M
    I began Keto about 2 1/2 years after I acquired an autoimmune disease that left me in chronic pain. I already had mild arthritis for a decade or so before, mostly in my hands and knees, so I was prescribed Prednisone and Methotrexate. When I began Keto I also did intermittent fasting, but a couple of months in when I began an extended fast, on day 3 I was hit with severe hand and foot pain and so ended my fast, and the pain was gone the next day. After researching why this happened I found that uric acid can build up as the body gives priority to eliminating ketones while in ketosis, so uric acid can build up. I then uses a potassium electrolyte over a week and tested my uric acid levels with a test strip, and found it was now normal, and I was then able to fast for 5 days or longer with no further problems. Keto was able to get me off Prednisone, but the Methotrexate was still needed for my RA pain. After discovering magnesium and sardines, I was able to drop my Methotrexate a wee bit each month, but then in December of 2018 I began carnivore and in 2 weeks I was off Methotrexate, no RA pain. Several days later I began eating my Keto salads as I had previous and on day 3 my hand pain increased, and day 4 was much worse. That day I returned to 100% carnivore and the pain was gone in a couple of days. So until I can figure out what foods other than meat, eggs and cheese are causing me pain, I will remain carnivore.
  22. Joyce
    Your comments have been encouraging and helpful Richard my pain is just now beginning to stop and I hope to avoid further attacks. - Thanks for sharing-- I also didn't know there was a home test for uric acid.
  23. Rick
    I live and work in the heat of the Southern US and have suffered from Gout flare ups for over 20 + years. I can identify one main trigger in my experience is dehydration. If I maintain a healthy water intake each day I rarely have issues with Flare ups. One thing to be mindful of and has tripped me up in the past is drinking too much coffee, caffeinated drinks and alcohol because caffeine and alcohols are diuretics. A good indicator of your current hydration is the color of your urine. Dark indicating dehydration on down to clear indicating good Hydration. With all that said, one of the side affects of starting the Keto Diet is dehydration. Following the recommendations for staying hydrated and keeping your electrolyte levels up should help prevent flare ups. IMHO.
  24. kazbach
    Months before my triple bypass (Oct 2017), I had my first case of gout - causing severe pain in my right toe. I could not walk - even brushing the toe with a sheet was enough to wake me up. It was severe enough to leave behind an injury that can be picked up with an x-ray. It is still 'swollen' to this day. If I had to choose between the pain from cracking open my chest and gout ... I'd have to think about it.

    The advice I got was "don't eat purine foods". I haven't.

    I've been following a moderate LCHF.

    At the end of 2018 and into 2019, I had 2 other gout encounters, though they were not as bad as the first. With the first one, I had convinced myself that it was not gout (since I've not eaten 'gouty' foods) - it was just that I'd inflamed the injury (by walking) caused by the gout in the first place. It came on slowly over a couple days, hit me pretty hard over-night - then went away within a couple days.

    In Jan 2019 it came on again - and I was pretty sure this time it was in fact gout. Same run up - lasted overnight and was gone within a couple days.

    So, what happened in those days before the gout came on? Cheat days. I can track fairly closely to having a cheat day before each bout - my old nemesis apple fritters. I had them, on both occasions, on a Sunday. I'd say by about Wednesday is when the gout came on. I'm almost certain MY gout was caused by highly refined carbs, sugar. ( and suspiciously - the vegetable oil the donuts are cooked in) I also had a couple sugary coffees those days.

    In any case, I'm almost certain it is not meat or purine foods. It's carbs.

    - Log what you eat
    - Take conventional wisdom with a grain of salt

    Aaaand, :tears: no apple fritters. Sucks, I know.

  25. Dean Shulze
    Weight loss is a significant risk factor for gout flare up. I have had gout for 30 years and have refused medication, preferring diet and lifestyle. Whenever I get overweight, I will suffer when losing the weight. Being overweight itself is a risk factor for gout. A diet of meat, poultry and fish has a small risk for gout whereas plenty of water ( milk, water, coffee, tea, watermelon, etc ) conveys a beneficial effect.
    Keto molecules compete for space in blood solution, so uric acid can precipitate as crystals in body tissues at lower levels of uric acid in the blood. Uric acid crystals in tissue might cause minor discomfort, however it is the the immune response that causes agony. The immune system vigorously attacks the crystals causing swelling, tissue bruising and intense pain. I take Naproxen ( OTC drug ) at first sign of a gout attack and drink plenty of water. Keto diet is healthy for gout, just have to get past the initial weight loss.
  26. dmc
    A quick LOWERING of uric acid can also precipitate an attack. I think that's what's happening to me. Hang in there, and always have your uric acid levels checked. High levels are turning up as suspects in all sorts of misadventures. They used to be part of a standard blood count in the US. Why was it stopped?
    Of course, insulin levels need checking too. Sigh.
  27. Jeff B
    My trigger is MSG, Natural Flavor and all the different ways the FDA hides or mislabels MSG in our food. I think the biggest reason for the resurgence of gout is the over use of MSG and the hidden sources of MSG like Natural Flavor and Spices on the label.
  28. Kathleen
    I just completed DD’s two week keto challenge along with 16-8 intermittent fasting. I lost 2 lbs and gained two finger joints that are swollen and painful. The prequel is that almost 20 years ago I touched these two joints on a hot broiler coil. The joints have had scar tissue ever since that is occasionally achy with the barometer. But in all this time I have never experienced the inability to make a fist as I do now. I wonder if it’s the result of this diet (so much cheese, meat, and eggs), but especially taking chicken broth with butter every morning for “non-breakfast”. I’ll add that I drink wine, maybe 12 oz a night, which might explain the little weight loss, but I doubt the gout.
    Reply: #79
  29. Kristin Parker Team Diet Doctor

    I just completed DD’s two week keto challenge along with 16-8 intermittent fasting. I lost 2 lbs and gained two finger joints that are swollen and painful. The prequel is that almost 20 years ago I touched these two joints on a hot broiler coil. The joints have had scar tissue ever since that is occasionally achy with the barometer. But in all this time I have never experienced the inability to make a fist as I do now. I wonder if it’s the result of this diet (so much cheese, meat, and eggs), but especially taking chicken broth with butter every morning for “non-breakfast”. I’ll add that I drink wine, maybe 12 oz a night, which might explain the little weight loss, but I doubt the gout.

    The article above lists some good foods to eat/avoid to help alleviate the gout symptoms. I hope you are feeling better soon.

  30. 1 comment removed
  31. francis
    je fait des crisse de goutte depuis deux semaine et je suis cetogene depuis 4 mois je me demande quoi faire car tres douloureux et meme les anti-inflamatoire ne font pas effet pouvez vous m aider
  32. Sarah
    My husband is completely carnivore, and is totally fine with gout unless he has salicylates. Coffee, tea, mustard, hot sauce (peppers), etc. It's truly bizarre. Strangely enough, apparently lose dose Aspirin can trigger gout. So maybe that's why. But I can't find anyone, anywhere with the same issue with salicylate-containing foods. His last flare-up was so bad, that he missed two days of work. All he had was some mustard and hot sauce on a pot roast. Then a couple of days later (it's always delayed), the base of his toe turned red and started swelling horribly.
  33. William Straehl
    Occasionally I'll experience some gout, usually my big toe, but I think also in my knee. I have found through experience, that consuming lemons or real lemon juice seems to make it go away. I had read (while I had kidney stones) that the citric acid helps dissolve the crystals. It worked for the kidney stones, so I'm pretty confident that's what is helping the gout as well. I will also pay attention to how much meat I'm eating, and focus on eating anti-inflammatory foods.
  34. 1 comment removed
  35. Martin G
    I have succes controlling my gout and continuing in keto inter lomittent fasting diet. Gout only appers after eat hipoxantines and xantines rich food like animal meat.

    Cheease, almonds and eggs are safe food for eating protein and avoid gout.
    i eat meat every second day around 120 gr
    I feel great, i am not using medication anymore

  36. 1 comment removed
  37. Chris Buchtmann
    Chris B
    I am 67 years old and have suffered gout in all my joints, big toe, knees, elbows, wrists and fingers to name the common places since I was 20. Over a monthly cycle I would have been suffering from severe gout 25 days out of the 28 days. My gout has been labelled as acute by the rheumatism specialist.
    10 years ago my body went into shutdown due to the years of gout medication, typically progout and colgout. I ended up on daily blood transfusions for three months and taking 80mg of pregnisonol (Preg) daily which eventually fixed the shutdown and hid the gout, but I then started getting the large gouty nodules appearing allover my body, in joints, muscles and tendons. Preg has many bad side effects, such as brusing, cataracts, huge weight gain, loss of hearing, mood swings to name a few. I urgently needed to do something about the uric acid levels and get off Preg. I researched the causes of gout and drastically changed my diet.

    Today I am free from gout and take one tablet of Probanacid daily to encourage my kidneys to excrete the Uric Acid.

    A lot of what is said in the above article is total crap. The solution to reducing Uric Acid and minimising gout attacks is a follows;

    1. Eat NO Meat. Never eat meat or internal organs, it is THE MAJOR cause of gout.
    2. Never drink alcohol
    3. Do not eat green vegs
    3 Do not eat Eggs
    4. One serving of Salmon per week for protein doesn't affect the gout
    5. Eat as much fruit as you like as fruit contains no purine. This includes tomato and strawberries
    6. Eat as much berries as you can. Berries, especially CHERRIES, which contain an enzyme that excretes Uric Acid from your kidneys. You can buy frozen cherries and hence eat them all year around.
    7. Minimise your intake of rice and don't eat nuts except Almonds (max 3 per week)
    8. Don't eat Cauliflower
    9. Only drink milk in your tea or coffee, no more. Milk and its product contain purine and can cause gout.
    10. A lot of diet supplements contain milk products (purine) and will cause gout
    11. If you go on a diet, your body will metabolise your body fat which contains purine and you will then suffer a gout attack, so loose weight slowly.
    12. If you start exercising, you will break down gout crystals in the joints and then get a gout attack, so start off exercises slowly building them up.
    13. I find the best exercise is snow skiing, which looses belly fat quickly without a gout attack.
    14 Don't drink carbonated drink. For some unknown reason, carbonated drinks cause gout attacks

    People who regularly suffer gout attacks lack the Itpa gene on their chromozones or start Codon is turned Off on the Itpa gene. The Itpa gene codes to produce the ameno acid that then is turned intoInosine triphosphate pyrophosphatase (ITPA protein), which hydrolyzes deaminated purine nucleoside triphosphates, such as ITP and dITP, to their corresponding purine nucleoside monophosphate and pyrophosphate, which the kidneys are able to excrete properly. If you lack this protien, which all plant eaters lack, then you get gout attacks, it is as simple as that. Some of us have it and some of us don't.

  38. SteveM
    Re: Keto Diet and Gout Event. I went on a keto diet with a calorie restriction to lose weight. I maintained a vigorous fitness routine (weight training, aerobics) to maintain muscle mass and cardio health. So maintained a target protein intake of 100 gm / day with some fat and very little carbs. Unfortunately, less than 3 weeks into the diet, I came down with a wicked case of gout in my knee and index finger. So I can't weight train and can't do lower body aerobics.

    Question: If a gout attack occurs early in keto diet initiation, should the diet be modified to reduce the symptoms and time to recovery? Or is the best tactic to continue the diet as is and wait for the condition to resolve?

    Appreciate any guidance.

    Reply: #89
  39. Kristin Parker Team Diet Doctor

    Re: Keto Diet and Gout Event. I went on a keto diet with a calorie restriction to lose weight. I maintained a vigorous fitness routine (weight training, aerobics) to maintain muscle mass and cardio health. So maintained a target protein intake of 100 gm / day with some fat and very little carbs. Unfortunately, less than 3 weeks into the diet, I came down with a wicked case of gout in my knee and index finger. So I can't weight train and can't do lower body aerobics.
    Question: If a gout attack occurs early in keto diet initiation, should the diet be modified to reduce the symptoms and time to recovery? Or is the best tactic to continue the diet as is and wait for the condition to resolve?
    Appreciate any guidance.

    This excerpt is on the How To Avoid Gout section.
    "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."

  40. Ljh
    I do lchf most of the year except when I travel with family. After a mild head injury and extensive morphea, I took to prolonged fasting which resolved the morphea entirely, scars included, and improved my ability to focus. Two weeks in I developed extreme pain without redness radiating from my hips which responded to high dose NSAIDS and resulted in haemorrhagic gastritis. The concern was obviously sorting out my stomach than looking for a cause. Again this year I began a prolonged fast after several weeks low carb and developed the same incapacitating pain which responded to NSAIDS covered with taking a proton pump inhibitor and yoghurt. The pain resolved after two days. I was eating low carb, rather heavy on brassicas (brussel sprouts, cauliflower, cabbage, rocket). I felt fantastic and put in some hard work in the garden when I may have become dehydrated. I woke up with acute bladder pain and frank blood in my urine which continued for eight hours of swigging bicarb to alkalise my urine while trapped on the toilet, peeing one agonising teaspoon at a time. This clinical setting suggests that urate crystals formed in either my bladder or kidneys. I am not sure which was more painful, the urate crystals precipitating in my hips or my kidneys.

    Urate solubility depends on concentration (ketones compete with urates for excretion by the kidneys which is why urates increase in fasting not because of an increase in production but a decrease in excretion); temperature (why extremities are most likely to be affected, for me both bouts were in summer); urine pH( urate dissolves in alkaline urine but the brassicas all contain sulphur which ends up as sulphate in the urine, making it acid so that crystals form). I should imagine leafy greens like spinach and sorrel also contain phytates like oxalate which have a similar effect. So go easy on the greens and keep hydrated.

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