Gout, Uric Acid and the Keto/Carnivore Diet: Everything you need to know
Ever heard that keto or carnivore diets could raise your uric acid and make gout worse? The truth might surprise you. Understanding how your body handles uric acid and inflammation on most versions of these low carbohydrate high protein diets is impotant to managing or even reducing inflammation and gout flare-ups.
What happens when someone with increased uric acid or gout adopts a carnivore or ketogenic diet? To understand the impact, let’s first explain what uric acid and gout are and how these conditions develop.
What Is Gout?
Gout, often called the “unwalkable disease,” was first described by the ancient Egyptians over 3,000 years ago. It causes severe pain, commonly in the big toe, but sometimes in the heel or ankle, even your knee and spine. Gout makes it difficult to walk. Historically, gout was known as the “arthritis of the rich” due to its association with indulgence in rich foods and alcohol. Gout arises when uric acid, a byproduct of purines found in certain foods, builds up in the body, leading to inflammation in the joints.
What Are Purines?
Purines are found in both plants and animals, but certain foods like shellfish, organ meats, and red meat are particularly high in purines. Beer, which contains yeast, is also high in purines. When we consume purines, the liver converts them into uric acid, which is then supposed to be excreted through the kidneys. Gout results either from the overproduction of uric acid or the inability to excrete it effectively, sometimes due to kidney issues. Purines are a kind of ‘4th’ category of food. The 1st three categories we are all well aware of, they include protein, carbohydrates and fat. Purines are the portion of food which includes the contents of the cell nucleus, that which includes all of our nucleic acids, DNA and RNA.
Purines are are in both plant and animal foods, however they are most densely packed in animal products and yeast. The recommendation used to be a significant reduction in animal products, however recent research and clinical observation has shown this may be the wrong advice.
The Role of Refined Carbohydrates and Fructose
In recent years, research has shown that refined carbohydrates, especially fructose (found in sugary foods and drinks like soda and processed foods), can also lead to increased uric acid production. High-fructose corn syrup is particularly problematic as it contributes to excess uric acid, not only raising the risk of gout but also elevating blood pressure.
Interestingly, individuals with high uric acid may experience elevated blood pressure even without the typical joint pain associated with gout. This is why monitoring uric acid levels is important for overall health, not just joint pain and inflammation.
Gout and Autoimmune Reactions
Recent studies suggest that gout may also have autoimmune components. When uric acid crystals enter the bloodstream and lodge in the joints, they can trigger an immune response that worsens the inflammation and pain. This overreaction of the immune system is similar to other autoimmune diseases.
Gout, Keto, and Carnivore Diets: What’s the Connection?
When transitioning to a ketogenic or carnivore diet, some people worry that their uric acid levels may rise due to the high intake of animal products. However, these diets often eliminate foods high in fructose and refined carbohydrates, which can significantly reduce uric acid production.
Still, there’s another factor to consider—on a ketogenic diet, insulin levels drop, which leads to increased sodium excretion. This is why people on keto or carnivore diets are often advised to increase their salt intake. If sodium levels drop too low, subclinical dehydration can occur, concentrating uric acid in the blood and potentially triggering a gout flare-up. Additionally, caffeine (which many keto dieters enjoy in the form of coffee) can exacerbate dehydration, further increasing uric acid levels.
It is important to remember that uric acid levels are based on concentration, the more diluted your blood the lower the concentration, so hydration and maintaining electrolyte levels is necessary.
What Can You Do If Gout Flares Up on a Keto/Carnovore diet?
- Stay Hydrated: Ensure you are drinking enough water and replenishing electrolytes, particularly sodium, to prevent dehydration.
- Sodium Bicarbonate: Consider using sodium bicarbonate (baking soda) to alkalize your urine, which can help reduce uric acid levels. Start with ⅛ teaspoon of baking soda in water on an empty stomach and gradually increase to ½ teaspoon. Avoid taking it with food to prevent gastrointestinal discomfort.
- Topical Solutions: Sodium bicarbonate lotions can also be applied directly to painful areas to reduce inflammation and provide relief.
By understanding how ketogenic and carnivore diets influence uric acid levels and implementing strategies like proper hydration and sodium bicarbonate, you can manage gout more effectively while reaping the benefits of these diets. Always monitor your uric acid levels, especially if you have a history of gout or other related conditions.
References
- Dalbeth, N., Merriman, T. R., & Stamp, L. K. (2016). Gout. The Lancet, 388(10055), 2039-2052.
https://doi.org/10.1016/S0140-6736(16)00346-9 - Choi, H. K., & Curhan, G. (2008). Soft drinks, fructose consumption, and the risk of gout in men: Prospective cohort study. BMJ, 336(7639), 309-312.
https://doi.org/10.1136/bmj.39449.819271.BE - Feig, D. I., & Johnson, R. J. (2003). The role of uric acid in the pathogenesis of hypertension. Current Hypertension Reports, 5(2), 162-169.
https://doi.org/10.1007/s11906-003-0011-x
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