Keto and gout

[Kurtis Hughes]

I’ve been suffering with frequent gout flare ups despite taking colchicine regularly for over a year now. I decided to try a keto diet this year as I thought it would help with inflammation and through reducing sugar, wheat, gluten, and alcohol intake it would have a positive effect. I found so far that my gout has been changed so that I now have regular discomfort in my feet but now I’ve found for the first time I’m getting a flare up in my ankle. I’m not sure if this is related to my new keto diet or not but I’m surprised I haven’t seen more positive results. I am 41, exercise daily, drink plenty of water daily, and eat relatively well and have started taking some supplements and taking more of an interest in my overall health but I can’t seem to crack the code of what I need to do to get this gout under control. It’s veru frustrating as I am very active in general but I’m hindered and very concerned this is going to get worse and cause some permanent damage.

Any information out there on the impact of keto on gout?

[nobody]

The most important thing in your post is that you say don’t know how to get gout under control.
Does that mean you aren’t controlling your uric acid? Or that you don’t know how to tell whether it’s controlled well enough? That ought to be your priority!
Sure, reduing sugar and so forth might help some people. Reducing alcohol in particular should help most people. But in most cases, that’s basically window-dressing because that’s not going to fix most cases of gout.
In most cases, inflammation isn’t reduced through fad diets but by addressing the root cause. Sure, if you are allergic to gluten then quitting gluten would be the sanest way to address that. But that’s a rare cause of noticeable inflammation… and that’s certainly not a cause of ankle inflammation! If you’ve got a bacterial infection for instance, you might need antibiotics. And if you’ve got gout, you need to control uric acid well enough that it dissolves and doesn’t come back out of solution.

Gout starting in the feet and then moving on to the ankle is a pretty typical development regardless of diet. And it typically doesn’t stop there. This disease gets worse if you don’t treat it properly.

Keto isn’t a magic word. The impact on gout will depend on the actual diet. Obviously we can make assumptions about what a typical keto diet would look like… and that wouldn’t be a good diet for a gout sufferers. But you’re not other keto dieters so what is YOUR diet like?
Likewise, you can in principle do keto safely even if most dieters are reckless. But the practice is dangerous enough that I think the obligatory warning is in order: unless you have a compelling reason (such as some forms of diabetes) to do keto, don’t. And don’t do it without medical supervision.

Colchicine is also dangerous. I wouldn’t do that for many months on end. How dangerous obviously depends on the dose but how much do we know about the effects of constant use? Have you seen any studies? If you don’t understand the effects of a drug and there’s no compelling reason to keep doing it, don’t!

[Keith Taylor]

Hi Kurtis and thanks for your story.

First off, I think you need to spend some time thinking about all the points that nobody has made. Then perhaps you can get a clearer picture by discussing them with your doctor or exploring them further in this topic.

As far as cracking the code is concerned, I believe most of it is revealed through the appreciation of how uric acid “works” in gout.

Excess uric acid causes crystals. Everyone has a different crystallization point.

Crystals form over time and get locked away as your immune system engulfs them. Again, people have different reactions. But when uric acid is not controlled, crystals spread to cause increasing discomfort and damage.

Uric acid treatment is the only long-term solution. Whether through diet, drugs, herbs, or a mix. But when treatment starts to become effective it often exposes old uric acid crystals as they dissolve. So pain relief or prevention is important. However, except for some ‘edge cases’, gout pain control has to be managed as part of a uric acid control plan (if that’s not clear, we can discuss why I think this way).

When you understand that, and have a plan for managing uric acid and gout pain, then you can start to assess the part that diet can play.

[Kurtis Hughes]

I really appreciate the feedback and it’s given me a lot to think about and explore. In the past I would get a gout flare up and then it would go away and not see anything again for at least a year. Recently I’ve had some pretty severe attacks and they don’t seem to go away or return pretty quickly until I stayed on colchicine. A lot of the information out there centres around diet and foods to avoid so I thought I’d try keto as I was interested in this diet for a number of other reasons and thought it lined up well with helping with gout as well. I didn’t think it would rid me of the problem but I thought the reduction in sugar and alcohol would have a positive impact. I have also been mixing in intermittent fasting as well as lots of water daily.

I definitely have a lack of understanding of what and how much I’m eating as well as activity level (I’m a daily gym-goer) is affecting my uric acid levels. When I’ve had gout flare ups and through my doctor had blood and urine samples taken, most times my levels are normal (in the higher part of the “normal” range sometimes). Is there a good at-home test out there that can provide results so I can journal what I’m eating and record the changes to better understand what affects me most negatively? What are some methods to better understand my uric acid levels? To your point, I’d like to get to the root cause and I would imagine it defers by person.

I had been waiting to talk to a rheumatologist as my doctor referred me to one but I just found out that referral was rejected so I’ll be visiting my doctor in the next few weeks. I have been taking 0.6mg of colchicine daily and I’ve found that has helped keep the attacks away but I get what you are saying, it’s not meant as a long term solution so I will be bringing that up with my doctor. My doctor has suggested allopurinol but I’ve been reluctant to start on a drug that is required for life but am definitely open to it at this point.

Again, thanks for the feedback as it’s hard to find good information out there. IF you have any suggestions on what I can do to help find my own root cause(s) I’d really appreciate it.

Thanks!!
Kurtis

[nobody]

The first thing you need to do is to call your doctor’s office and get the actual values for the past levels of uric acid in your blood. “Normal” is useless. If you’ve had several doctors or have stayed in a hospital, you might want to call all these places.
I don’t know of any good home testing kit. That’s not to say there’s no such thing but I wouldn’t bother if you can get several lab values.
What you may not realize is that advanced gout would make it difficult and more importantly very slow to tell how what you’re eating and doing affects the amount of uric acid in your body. Even if you had a precise and reliable way to measure the amount in your blood, that value would be quite noisy on account of all the uric acid elsewhere in your body.

Finding the root cause is most likely going to be the same task as ascertaining the diagnosis is correct: if your problem really is gout (it sounds like it is considering you’re describing a typical development of the disease but I don’t know that you have proof), the cause is probably a metabolic issue that will be impractical to solve without lifelong medication now that the disease has progressed so much and that you’ve become older. Dietary tweaks can make a big difference in some cases, but rarely enough to actually fix the problem. So your best bet to avoid lifetime medication is probably to take the same drug a few years and try to replace it with lifestyle modifications once your gout is cured. But I must warn you that the chances of a successful lifestyle fix would be higher if you moved to Japan or were allowed to join a hunter-gatherer tribe in the jungle… so sticking to the daily pill might well seem like a much more reasonable option once you’ve got used to it.
That’s all premature speculation anyway because your actual uric acid numbers would be necessary to make an informed guess as to the causes of and potential solutions to your troubles.

You could research the facts about how what you eat affects uric acid but a much quicker alternative would be for you to post your diet. We’d tell you how gout-unfriendly it is (though we’d probably disagree to some extent).

I have also found a little colchicine every day helps keep the symptoms mild (though a bit more colchicine worked better for me). But I don’t think I’ve ever taken colchicine daily for more than 2 months (it was probably a good bit less than that, actually).
You can also take colchicine after symptoms appear in order to give your body breaks from its effects but in that case, I would recommend combining colchicine with a fast-acting anti-inflammatory. But that’s something your doctor should approve beforehand.

[Keith Taylor]

I’ve used home uric acid test kits in the past. The main problem is getting consistency. Because a pinprick of capillary blood is not necessarily representative of your true level. After a lot of trials and meticulous attention to a consistent testing regime, I gave up. But other people have found them beneficial.

I don’t think you can make a quick decision about home testing. Because it’s largely irrelevant without a proper plan that acknowledges full medical history. Including test results from “official” blood tests.

I don’t want to say much more on this until I know some history of blood tests so far. Because options that seem reasonable when uric acid is 6 – 8 mg/dL are pointless if it is 9 – 11 mg/dL

[nobody]

At the stage of the disease described, I’d say 8 warrants the same short-term strategy as 9. It’s a shame doctors allow gout to get so bad. They delay UA-lowering dugs because they’re “lifetime” when in many cases it’s that very delay which makes them lifetime.
But yeah, if Kurtis averaged 7 in spite of a gout-unfriendly diet there would be alternatives…

[Kurtis Hughes]

Thanks again for getting back to me so quickly and for the additional information. I have an appointment with my doctor in 2 weeks and I will try and get a listing of my previous results and request a new one as well and let you know what I find out. I won’t explore home testing if it’s not consistent and won’t lead to some actionable results.

I’m not opposed to a drug like allopurinol but it was my limited understanding that if you start it, that it’s difficult to come off so my intention was to try and avoid it unless it was necessary. I feel now that it’s definitely something that I need to look closer into. I have been relying on colchocine until I was able to meet with the rheumatologist but as I mentioned that referral was rejected for some reason. I have tried to stop taking colchocine but I find after a couple of weeks off, I get a flare up. I tend to rely on indomethicin for pain management when I do get a flare up. Right now, I don’t get full blown pain too often but my feet are in a state of discomfort most days and are often stiff and crack when off them for a little while.

As for diet, as I mentioned I have been trying keto since the start of the year so I have increased my fat and protein. Most of my diet consists of meat (mostly chicken and some beef and fish), nuts (macadamia, almonds, walnuts), veggies (broccoli, brussel sprouts, peppers, squash), and small amounts of fruit in smoothies, hard cheeses, no bread, no pasta, no rice. I also have some dark chocolate for a treat. I do drink a little still with low carb beer and whiskey on the weekends. My normal diet isn’t that much different with the exception of adding back in bread and pasta for the most part and some moderate sugar intake through fruit mostly. I do intermittent fast 6 days a week doing 8/16 eating windows each day. I drink lots of water each day and a couple cups of coffee.

[nobody]

That sounds like a seriously gout-unfriendly diet, as one might have guessed. How unfriendly depends on the amounts you eat but in any case there is significant room for improvement. And as you probably guessed by now, quitting grains and fruits to make your diet ketogenic must have made worsened your uric acid problem (though that of course depends on what other foods you ate in larger amounts to compensate).
The trouble is that the reason people so often find it hard to quit allopurinol and the like isn’t that you get addicted somehow but as I hinted at above that once you’ve allowed your gout to fester, recovery will likely take a very long time and you may never get back to the situation you were in when your gout started. In other words, even if the right diet would have prevented your gout or fixed it if you adopted it right away (which is by no means a given!), chances are it’s now too late for that.
But let’s see what story the numbers tell because they might be surprising…

Indo isn’t for pain management by the way. It prevents damage so if a dose you tolerate stops your pain, great: you’re actually perventing damage (the pain was merely an alarm bell of sorts). But you can also use it to deal with painless swelling as well as to prevent flares. Normally you’d use colchicine for that (especially if, like me, you tolerate it better than indo) but if you are luckly enough to tolerate indo well, you could stop colchicine for a while and rely only on indo. Indo is also a dangerous drug but has different side effects than colchicine. Ideally, you would avoid prolonged use of either drug but if you need to take at least one every day, not taking the same one for too long might be prudent.
It might be advisable to take a PPI if you take a lot of indo which is one of the reasons I wanted you to check with your doctor before going down that road but if your doctor has already approved regular indo use…

[the dude]

i had a very similar diet with very similar results. until i stopped eating one thing on your list -beef. no problems since.

[kyiv stoner]

A also have the same problems.

[Richard G Paxton]

I have been on a carnivore diet for just over 2 years which helped my gout tremendously, although I stopped drinking at the same time (with a couple exceptions). I was on a keto diet for about 5 years before that. Because I stopped drinking, I am not sure if it was carnivore, drinking, or a combination of both. All I know is I went over a year without any serious gout flare ups. I did have a flare up back in June last year, when I introduced honey and berries back into my diet. Very painful attack in my right wrist and hand that took almost 2 months to resolve. I eliminated all carbs and had no issues until just a week ago. I had starting drinking again over the holidays. Just a few shots of cognac a night for about 4 weeks. Now I have a severe gout flare up in my left hand. My point of all these details is that I do believe the keto/carnivore diet is a very beneficial diet to help control gout, but there other factors that can contribute. My theory on this recent flare up is that alcohol was the main factor, that dehydrated me and made my uric acid go up. Unfortunately, I wasn’t monitoring my uric acid levels, so its just a theory.

I just came across this forum yesterday and have spent several hours reading a lot of information. As a 20 year gout sufferer, I wish I had found this forum 10 years ago. My gout started in my big toes 20 years ago, but was fairly mild and I just suffered through it. I was a heavy drinker during that time period up until 2 years ago, I think a lot of my issues where alcohol leaving me in a constant state of dehydration. My gout was manageable/tolerable until about 6 years ago. it started moving to my knees and then my wrists/hands. I am assuming due to years of crystal build up.

Based on my experiences with gout, I am a firm believer that it can be controlled through diet/nutrition and exercise. But, monitoring and controlling Uric Acid levels makes a lot of sense. I just ordered a home test kit so I can start testing monthly. For now, I plan to go back to carnivore, no alcohol, and ensure I drink a gallon of water a day. My goal is to stabilize and get my uric acid to 5 mg/DL and see if this regimen will eliminate the gout permanently. I will post results on this forum for those interested.

[nobody]

Hello Richard,
I have read people claiming that sustained ketosis was fine but that going in and out of ketosis was the problem. That sounds plausible. I never tried sustained ketosis but failing to eat enough carbs for a day or two certainly seems to be an inflammation trigger for me… perhaps if ate even fewer carbs for longer periods, my body would adapt to that. Do you think it’s possible that the energy contained in the alcohol you drank might have taken you out of ketosis briefly?
There’s one problem with your theory however: one does not go from controlled uric acid for years to an “attack in my right wrist and hand that took almost 2 months to resolve” overnight (or even over a few weeks). It sounds like your uric acid wasn’t controlled but that symptoms were in remission (that sometimes happens without an identifiable cause). There’s no way to know for sure (for one thing, we don’t know for a fact that this attack was gout). But if your diet contributed to this remission without lowering your uric acid, while it could be beneficial for gout sufferers, it should be used in addition to and not as a replacement for uric acid control. That’s because excess uric acid is going to get people prone to gout in trouble sooner or later (though later is sometimes as good as never and in any case better than sooner!).

[Richard G Paxton]

Hi,

Yes, my uric acid was not controlled. But my theory is that the alcohol was dehydrating my body, thereby increasing Uric Acid levels. I was not drinking enough water either. I was drinking zero carb alcohol as well. Now that I have a uric acid test meter, I am going to start tracking this much better. All of the anecdotal evidence I have seen seems to show that people that are on a Keto or carnivore diet tend to see their gout symptoms go away.

I would encourage people to look at this video by Dr Ken Berry on gout. Its pretty good.

Read the comments as well, some pretty good anecdotal evidence from real gout sufferers. After reading them, I am convinced Gout can be controlled by diet.

More comments welcome.

-Rich

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