Keto Diet or Febuxostat for Uric Acid Control?

[Phillip Ooi]

I was using allupurinol.. but legs feel tingly and such. But after starting to use Febuxostat, it went away.

I believe I have gout for say maybe even 10-15 yrs now with no symptoms until last 2-3 years where I got gout attacks. Medical also show my UA to be around 7.5-8+.

How long and how much do I need to take febuxostat 40mg (need to take 1 or 2x a day and in the morning to evening for it to be more effective?).

I know I probably have to take this for life but I am wondering do I need to be also on a low carb (keto like diet) or no soda/ coke type of drinks? it sucks to have to consume food with low purines. I know it is impossible to eliminate it all… suggestions?

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Which is your febuxostat (Feburic / Uloric) dose?

[Bob Bertles]

Hello…from a chronic gout attack sufferer..I will share my experience. I had it bad, finally at 58 years old my reg doc sent me to a rheumatologist. I have had surgery on both my feet to have uric acid crystal build up on the inside of both big toe joints. I thought I had bunions..nope gout. I was having attacks thinking it was from bunion pain. My Rheum stopped me of all meds and gave me steroids to make it through the attack. then she put me on 400 mg Allopurinol..I took it in the morning. She told me to cut out red meat, shellfish, high fructose corn syrup and alcohol. I did 3 of them but still enjoyed my vodka. I still was getting pounded with gout, toes knees wrist feet ancles etc…wouldn’t stop! So I stopped drinking any alcohol period..that didn’t work. I had started with 9 uric acid level and we got it down to 4.5 but my rheum was determined to get my acid level lower. I would take a taper of prednisone for about a week then it would come right back. She decided to switch me to Uloric after my currant attack was gone then start the Uloric at 80mg. I didn’t feel I was going to have any window to switch from Allopurinol to Uloric because my attacks were coming and going like every other day or two, it seemed. I went on another frantic internet search looking for a trick to stop the attacks. In the mean time I sampled a couple margaritas, and I sure paid for that!! My knee developed gout and tophi was aspirated from the joint. My rheum had said I would have to find my triggers..I found one… Searching for a solution to my attacks, waiting for a break so I could switch to Uloric, I read a couple testimonials about a couple guys who stated when they stopped all fructose..sugar fruit anything with sugar their attacks stopped. Ok I did that and they stopped. I got a few days in without pain and switched to 80 mg of Uloric..no problems had my blood work done and my acid level was still at 4.5 but was gout free. Went in for a check up and shared my “sugar free” diet with no flare ups and my rheum said to stay off sugar for now and upped my Uloric to 120 mg a day…I am now still gout free waiting to have my kidney, liver and uric acid level checked to see if my uric acid level dropped I will have my blood work up Nov 15 2017 to see where I’m at. She indicated I may be able to start to eat fruit again, if we can lower my uric acid level..not sure about that yet! For now it’s no alcohol (little over 1 year) red meat shellfish or any type of fructose off the menu..boring!!! Sorry I was a desperate person looking to get my life back..not there yet but a least gout free. I hope at least one person can help themselves rid the pain with my story..thats how I found the way, someone else’s story. Will update again.

[Keith Taylor]

Hi Bob,

I hope you can see from my reply to Phillip that there are different phases during gout recovery. Because, until you reach the maintenance phase, you need to manage gout differently.

So, your rheumy is right to recommend you avoid inflammation triggers. Because you are at risk of gout flares until most old uric acid crystals have dissolved. Also, science now tells us that the complex processes that trigger gout flares are often related to inflammatory foods. But this often has a genetic component. So the trigger could be sugar for one person, fatty acid imbalance for another, or both to varying degrees.

Once you reach the gout maintenance phase, you can often relax diet restrictions. But always try to keep diet generally healthy – or else you just replace one disease with another.

[Keith Taylor]

Hi Phillip,

You need to take febuxostat according to your prescription. Because a good doctor will prescribe febuxostat to match your target uric acid in 3 phases:
1) Starting phase – start with lowest practical dose and test kidney function and liver function after 2 weeks. If all OK, increase dose until uric acid is at best target for debulking (dissolving old uric acid crystals).

2) Debulking phase – maintain highest practical dose until you’ve gone 6 months without a gout flare and without uric acid rising above 6 mg/dL (5 is better and even lower uric acid will speed gout recovery).

3) Maintenance phase – usually for life, maintain the dose that gives uric acid below 6mg/dL (below 5 is better). Get liver function and kidney function tests with each uric acid test. Test uric acid at least once per year. Liver function test is especially important with febuxostat.

Febuxostat and diet
Febuxostat makes all foods low-purine. So no need to worry about that. Except too much animal protein is bad for general health. So I recommend Mediterranean style eating. However, if that diet does not provide enough meat for your personal taste, the DASH diet is also relatively healthy. I recommend these diets for the sake of your general health. Because febuxostat will control your uric acid effectively. But, it seems pointless to stop your gout only to fall ill to heart disease or another metabolic syndrome disease.

Normally, I would advise gout sufferers to avoid ketogenic diets because they raise uric acid. However, febuxostat removes that risk. However, I’m not convinced that keto diets are particularly healthy. But, I’m prepared to be convinced if evidence is available.

Coincidentally, I’m preparing a report comparing Mediterranean Diet with a ketogenic diet[*]. So, I’ll be sure to consider the health benefits of both diets beyond uric acid control.

* Castaldo, Giuseppe, Luigi Monaco, Laura Castaldo, Giovanna Galdo, and Emanuele Cereda. “An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity.” International journal of food sciences and nutrition 67, no. 6 (2016): 696-706.
Subscribe to my Gout Facts update to see when I publish the report

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[Eric Bolvin]

Gout, Low Carbs Diet, Old Uric Acid Crystals

Hi; I am trying a low carb diet and wonder if it can affect gout. I am not really eating more red meat, just chicken and fish but no fruit, bread, pasta, etc. So more veggies. There may be a bit more fat in this diet, but not much, but there is more protein.
The thing is I think I am starting an attack and my Uric levels are low 3.6. I took colchicine and indocin and already feeling better.
So maybe it’s “old crystals” that I have been reading about? How long do they take to dissolve? Is colchicine the drug that eliminates them?

Thanks!!~
Eb

[nobody]

Old crystals can take years to dissolve though they are often eliminated in less than a year. The longer you’ve had untreated gout, the longer the cleaning process is likely to take.
Colchicine doesn’t eliminate the crystals. It only makes them less troublesome.

Low carbs diets seem to cause problems for gout sufferers. Perhaps you could try a less extreme diet.
Stuffing yourself with bread is not recommended while eating lots of veggies is. But you can overdo carb-watching. Eating some fruit is recommended (they’re not all equally carb-heavy). I don’t think you have to eat grains but if you’re avoiding grains, I think you should make sure you’re getting a decent amount of carbs from veggies and dairy.
Chicken and especially fish can be worse than red meat for gout sufferers but that should be irrelevant if your uric acid tests at 3.6 mg/dl. Are you sure it’s that low?

[GoutPal Arthritis]

Keto diet triggered pins & needles, numbness in calves & feet

Hi Keith,
I’m new to the forum and looking for relief for potential uric acid flareups after being on the Keto diet for a week per Dr. Eric Berg’s protocol. I am trying to get off Keto and onto a more Mediterranean eating plan, however every time I eat, I am getting flare-ups.

I will contact my doctor on Monday for a blood test to confirm my suspicion of high uric acid. In the meantime, I’ve been trying “hacks” of pickle juice, sauerkraut, cherry juice, lemon juice, apple cider vinegar and potassium citrate supplements to try and keep the pins and needles/numbness from my calves and feet. I’ve also got cold spots in my fingertips, and some numbness in the left arm and shoulder.

When I eat, I feel immediate flushing into my left calf and foot, especially.
To complicate things, I developed gastritis after using the Apple Cider Vinegar and lemon juice, which Dr. Berg recommends to keep the uric acid crystals under control.
I suspect I’ve had fairly high uric acid levels that have been undetected for many years, suffering from fibromyalgia symptoms on an off since my early 20’s (now 53).

I appreciate all of the information you have compiled and will be back in touch when I have blood test results from my doctor. If you have any suggestions in the meantime, I’d appreciate them. I don’t want to overdo the hacks, and I’m also feeling desperate from the pain!
Gratefully,
Juliah

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Why is Ketogenic Diet Bad for Gout?

[nobody]

Hi!

Your symptoms do not sound like typical gout symptoms to me but your test results will be an important clue.

Suggestions in the meantime:
-take something for the pain
-drink lots of water
-eat something nutritious and soothing to your stomach (in other words don’t wreck your health with dubious diets)

[GoutPal Arthritis]

Hi!

I appreciate your insights. Yes, lesson learned the hard way on this one… 🙁

Blessings to you for everything you’re doing to share your knowledge and help people!

Juliah

[GoutPal Arthritis]

Hello again,

My Uric acid results came back as 4.1, so you’re right that wasn’t the issue. Turns out I was very high in Vitamin B12 (1397 pg/mL. normal range – 213 – 816 pg/mL) and possibly B6. I have stopped all supplements and I’m waiting for the B6 results.

Fortunately, the symptoms have begun to subside already.

Thanks again for your insights.
Blessings,
Juliah

[Author]

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