How Gout and the Ketogenic Diet Affects You

A ketogenic diet is a diet with extremely low or no carbohydrates diet which makes the body go into a state known as ketosis. When the body is in the state of ketosis, the carbohydrates levels are low and this causes the blood sugar levels to drop and the body begins to break down fat to produce energy. Normally, the body relies on dietary energy sources as well as on the stored energy, which in most cases is always in the form of stored fats.

When the body is exposed to ketogenic diet, it implies that the dietary carbohydrates will be kept very low, thus leaving the body to rely on stored fats to provide the primary source of fuel, a process which also ends up producing ketones from the stored fats. It should be noted, therefore, that a ketogenic diet is a high fat diet and not a high protein diet as has always been portrayed.

Studies have suggested that high fat low carb ketogenic diet may help to alleviate the symptoms of gout. Gout symptoms are normally triggered by the NLRP3 inflammasome with the aid of neutrophilis. What happens is that the NLRP3 activates the 1L-1B pro-inflammatory cytokine which then leads to bouts of intense pain at the joints, fever, as well as the destruction of the joints.

According to the studies conducted on rodent models, researchers induced gout in rats by injecting 1.25mg of monosodium urate on the knee, after which the knee’s thickness was measured and pathology analysis performed on the menisci and the ligaments.

Human subjects were also used during the research where steroid free adults between the ages of 18 and 45 years and adults above the ages of 65 years. All the participants in the studies were not fasting at the time when there peripheral blood was collected.

The studies concluded that ketogenic diet had the ability to raise the levels of BHB in the body. BHB in turn inhibits NLRP3 inflammasome and consequently alleviating the symptoms of urate crystal induced gout. This happens without the immune system being impacted negatively or without hindering its ability to fight bacterial infections.


NutriGout Dietary Supplement for Gout

Additionally, the studies concluded that BHB had the ability to block 1L-1B in both humans and mice subjects irrespective of the age and since 1L-1B is responsible for the bouts of pains experienced during gout attacks, it can effectively be concluded that ketogenic diets may help alleviate gout pains.

The conclusions of the studies thus promotes the notion as well as the adoption of ketogenic diets are a means of alleviating or providing relief to gout sufferers. Previously, there have been debates all over about the safety and the efficiency of the diet, especially in weight loss, but all the studies and researches have continuously pointed to the fact that it is indeed a viable method to lose weight safely, since all you will be avoiding is the use of diet carbohydrates as source of energy for the body and instead relying on the stored fats to provide the energy. It is during the breakdown of fats that ketones are produced which then sets off a chain reaction that may help in alleviating gout pains.

It should, however, be noted that, there may be a temporary increase in risk of gout for the first six weeks when you resort to ketogenic diet. But after this period, the diet may be protective as described above when it comes to doubt. A lot of studies is still on going with regards to the effects of ketogenic diet on gout, but until conclusive results are in, it is safe to say that low carb diet may help in alleviating gout pains in gout sufferers.

But Is This Safe And Should Gout Sufferers Use It?

In my opinion, no gout sufferer should use the ketogenic diet due to the fact that it is not a healthy diet. We all fall prey to quick fix wacko diets but the truth is that there is no quick fix! Eating mostly complex carbohydrates as in fresh vegetables, beans, legumes, whole grain breads, pastas and rices with very little protein and fat is what will keep you healthy long term. Not some fad that will last couple of years and die off until everybody moves to the next one on the list.

Yeah sure, it may alleviate gout pain but at what cost? Besides losing weight quickly in such a diet can spark more gout attacks and inflammation. There is no way that a diet that asks you to consume more meat and foods high in fat, is good for you as a sufferer from gout. Stick to my gout diet plan as outlined on this website and my book and you’ll see optimal results as many of my readers have found and testified.

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    62 replies to "Gout and Ketogenic Diet"

    • Pierre Yves Piazzoli

      Bonjour, quel regime adopter contre le diabète et la goutte ? malgré un traitement de colchiqueplus , pour une crise de goutte qui a duré 4 mois ! je conserve des “micro douleurs” au niveau des orteils. de plus j ai eu avant des douleurs terribles au poignet et j ai appris que la goutte pouvait aussi atteindre d autres articulations. les regimes diabetes et goutte “superposés” peuvent nous faire croire que l on peut plus rien manger. avec le ceto on prends beaucoup de graisse animale alors que la viande rouge serait totalement interdite ! . que faire ? merci de votre reponse.

      • Spiro Koulouris

        Essayez de consommer 80% de vos calories quotidiennes sous forme de glucides complexes tels que des légumes frais, des légumineuses, des fruits, du pain 100% à grains entiers, des pâtes et du riz. Mangez principalement des haricots pour les protéines.

        10% de vos calories quotidiennes peuvent être des protéines telles que la poitrine de poulet, la dinde, le poisson, le bœuf rouge maigre et l’agneau. Évitez le porc, les viandes transformées comme les saucisses et les hot dogs, évitez tous les fruits de mer ainsi que le homard, les crevettes et le crabe par exemple.

        Enfin, consommez 10% de vos calories quotidiennes sous forme de matières grasses comme le lait, le fromage, le yogourt, le beurre, les œufs, etc.

        Ne buvez que de l’eau, des tisanes et du café.

        Évitez les aliments transformés comme les barres de collation, les biscuits, les céréales, etc.

        Ne faites pas frire vos aliments. Faites-le bouillir ou faites-le cuire au four uniquement. La viande barbecue est bien aussi.

        Cuire uniquement avec 100% d’huile d’olive extra vierge. N’utilisez pas d’huile de maïs, d’huile végétale, de canola ou d’autres types d’huile toxiques pour votre santé.

    • Rashad

      I was on the keto for about 8 months. Lost weight, and extreme mental clarity. I took advise from all the Keto Gurus including Dr.Eric Berg & Dr. Ken Berry and took their advise about keto and gout. Unfortunately the repeated gout attacks had me to tap out. I can be good for about 30 -40 days, then all of a sudden the gout come out of nowhere.

      From the advice they were giving, it seems that gout was a normal process in the beginning. This is totally false. I’ve tried the advice of drinking 6 lemons (juice) per day with ACV to prevent gout attacks and this did not work. Just about every month I had to go to the doctor for steroids and meds because the inflammation was so bad.

      My doctors was definitely concerned with the repeated gout attacks that it could damage my kidneys and other issues.

      I finally decided to go to a all Vegan diet, only because I’d rather live a life gout free than a quick weight loss.

      Although I do have some gut issues with vegan, it’s still better than gout issues. Potassium citrate from sweet potatoes and plants helped a lot. I was really adamant about the keto that I promoted it and made videos on YT about it.

      So in conclusion, I don’t recommend keto for gout sufferers.

    • Kyrstin

      Uric Acid competes with ketones for reabsorption, so this is how it works for gout, or in any joint.. your levels will lower, and you will feel better. It is not a quack diet, and goes back a very long time.

    • diet for gout sufferers |

      […] Gout and Ketogenic Diet […]

    • Keto Diet Gout - Fat Loss Fast

      […] Is the ketogenic diet good for gout?. How gout and the ketogenic diet affects you. A ketogenic diet is a diet with extremely low or no carbohydrates diet which makes the body go into a state known as ketosis. […]

    • Don

      I have suffered regular gout attacks for 12 years. I am 58 years old and I take good care of myself. I’ve learned to be careful with what I eat and to stay hydrated, but it didn’t matter. There are times when I literally need a cane to get around. I started eating keto a month ago. I was concerned the increase in meat would kick off an attack. I will tell you this: I have not had a gout attack nor have I experienced the regular arthritis pains in my feet and ankles. I am blown away by the results so far. I eat fat, protein, and leafy vegetables. I am drinking vodka/club soda/lemon wedge 2 times a week. I have cut out all sugar, and am eating maybe 25 – 30 net carbs a day. I am surmising that sugar and complex carbs is the trigger for me. I also drink about 2 1/2 liters of water with electrolytes a day. That’s it. Oh yes, I’ve lost about 5 lbs of fat in 30 days. I’m not only walking without pain, but I’ve started running again. Anyway, that’s my story and I’m sticking to it!

      • Don

        Quick update. Shrimp was a huge no-no for me. If I ate any shrimp at all, BAM! The next day I could hardly walk from the pain. Over the last 10 days I’ve eaten shrimp 3 times just to see what would happen. I have had no gout attacks at all. I am floored (in a good way!). Once again, I have to believe it’s the high glycemic carbs and sugar which are the gout triggers for me. Just reporting in and hoping my experience may offer hope and relief to someone.

        • JL

          The doctor told me i can consume shrimp once in a while. I had a salad with three little shrimps. Damn! My knee got swallen. This is really pissing me off badly. i have been good for my whole life. I don’t drink alcohol and soda and never like meat but I still get gout.

    • Dave

      I just read this on Business Insider–>

      This diet is not safe for gout patients, it causes uric acid levels to rise and causes kidney stones. Do not attempt this diet if you suffer from gout. Listen to Spiro Koulouris, he is right! Ignore the other yo-yo’s that say it’s good for you.

    • Uriah

      I’ve been suffering from gout in my feet and ankles for about 14 years now, with slowly increasing frequency and severity of attacks over time. Consequently, I’ve made progressively more restrictive choices in my diet to keep it manageable.

      The number one most effective thing is drinking a lot of water. I’m 6’7 and obese so my requirements are more than most people’s, but I drink about 6 liters a day, and find that an attack is much more likely if I consume less than 4. If I go more than a couple days without peeing clear I will almost certainly have a flare up, so I make sure that doesn’t happen.

      The second thing is avoiding alcohol entirely. Even moderate consumption seems to lead to flareups, beer especially.

      Third is sugar. All sweets, all fruit juices, but especially sugary treats are a serious threat. I have had issues from eating more than about a serving a day of fruit, and while cherries and cherry juice doesn’t seem to trigger attacks, it also doesn’t really seem to protect against them or alleviate symptoms for me. I may try tart cherry extract supplements.

      Next is gluten. I have one of the genetic markers than can incline you toward celiac, so it may be more specific to me than general advice but it does seem to be a trigger. My hypothesis is that one type of inflammation triggers others, so a mild allergy might trigger the gout. I also often get gout at the site of tendinitis, though that may have to do with restricted blood flow due to the inflammation rather than a systemic problem.

      Coffee seems to be an issue for me. I suspect it is due to the diuretic properties, but I don’t seem to have the same problems drinking tea as I do coffee. I love coffee and caffeine highs but after a period of adjustment I can get most of what I’m looking for from just a cup of green tea in the morning and one after lunch.

      The last thing I’ve eliminated is carbs. I know you’re all about the complex carbohydrates and severe fat restriction but I have been on a low carb high fat diet for the last 5 months and literally the only flare-ups I’ve had were following monthly (still gluten free) cheat days, which is about an 80% reduction in gout for me, despite high consumption of fatty meats and cheeses, and decidedly more protein than strict keto. Now, I don’t know how good this diet is long term, as it’s definitely way too strict for me (hence the cheat days), but for right now I am loving the health benefits; the weight loss, the not feeling like I’m about to have a heart attack during exercise, the consistent focus and energy throughout the day, the not wanting a nap after eating. Giving my kidneys a break from the NSAIDs is nice too. I plan to experiment with a less restrictive low carb diet, likely primal, in combination with intermittent fasting, which I’ve used to good effect this year. Given that my weight loss seems to be more related to when I’ve incorporated the fasting than just the low carb alone, I’m thinking that I may be able to get the results I’m looking for with potatoes, carrots and rice reincorporated. If I get more gout though, even if the weight loss continues, it’s back to the strict diet.

      I’ve tried whole foods plant based low fat diets in the past, but I didn’t find them sustainable for more than a couple months– at calorie levels necessary for weight loss my hunger was persistent, I was miserable, had low energy, and wasn’t totally gout free as I am during ketosis, though it definitely reduced the frequency and severity. Worse, once I went off the diet I gained a ton of weight back very quickly, which studies have shown is less common with low carb diets.

      • Erick

        You and I have the same issue. I broke my toe and that triggered gout attacks (3 in the last month since).

        I am convinced that the sugar, alcohol, and carbs contribute to gout. I marginally agree with Spiro on the fruits, veggies, some carbs in potato/ sweet, little rice, but the bread and grains are out.

        The rule I am following is 4 parts vegetables to 1 part protein. I am hoping this works moving forward.

        As for the keto diet, it is largely bullshit and a weak attempt at fasting. Fasting gets you to the keto state, lowers the inflammation, and generally resets everything in your body. Too fast of weight loss may increase gout but this has not been my experience.

        Fasting needs replacement of electrolytes and lots of water. If you do these two things you lose loads of fat and not suffer.

        • AJ

          Uriah- most people with gluten sensitivity will cross-react to both coffee and ibuprofen, so staying off those may be a good choice

    • Andrew

      “In my opinion, no gout sufferer should use the ketogenic diet due to the fact that it is not a healthy diet. We all fall prey to quick fix wacko diets but the truth is that there is no quick fix! Eating mostly complex carbohydrates as in fresh vegetables, beans, legumes, whole grain breads, pastas and rices with very little protein and fat is what will keep you healthy long term. Not some fad that will last couple of years and die off until everybody moves to the next one on the list”

      Completely ignorant!

      Stay off the grains if you have gout – even whole grains

      Fat is healthy in the long term – especially the long term but you don’t need much to stay satiated

      • Spiro Koulouris

        There is downtrend with the fad keto diet, many studies are coming out that show it’s not a healthy diet to follow long term. See this latest study–> and also personal trainer celeb Jillian Michaels agrees with me and tells her fans now to avoid the keto diet, check reasons why in the article–>

        • Dale

          Keto is not a fad diet. I bet if you look to see who funded the studies you would see it’s either big Pharma or big food companies. And Jillian doesn’t know anything about nutrition.

        • Stephen

          Somehow it’s hard to take seriously a 4 day study based on a handful of people. Ketosis is not achieved in 4 days, and it discounts the proven benefits to strength training. Further if there is substance to eliminating gout without spending tons of money on medications and wrecking your liver in the process it is worth a college try.

        • SarSin

          The 1st study you quoted was done in 4 days,4 days..
          You will not get into ketosis let alone be keto that stage you will feel tired because the body is in transition, as the study rightly showed.

          As to what Jillian said, I can agree with her only on the fact that if you exercise, then you will be able to manage your weight

        • Ted Hu

          Keto with vegs is not a fat diet. Esp now with options like beyond meats which curb purines and methionine and uses bean and pea protein that is high lysine. Ironic thing is I can eat lamb belly fat but not that much lamb meats.

          Pork belly isn’t much of a problem given its higher fat ratio. Lamb has omega 3s and 9s antioxidants that help ameliorate. But there is nothing that beats grass fed keto fats and organic farm grown vegs we’ve delivered to our house courtesy of covid-compelled ecommerce.

          There is no way in hell I’m stopping keto. With heavy dose of farm vegs in hand, coupled with keto, I’ve lost 30 lbs and have never felt better. If anything, the problem is I haven’t gone fatty enough but with help of bromelain and quercetin, that will help address the balance. Even if we disagree, enjoy the website, great content and perspective.

      • Suzy Sturm

        I would have to say follow basic rules about what works for most peopler for gout prevention and treatment and different strokes for different folks as far as diet goes. I can’t handle wheat and starch (blood sugar issues). I ate a piece of bread I bought for my week-end guest and my feet swelled up so much I could not put my shoes on. I’ve just had my first gout attack at age 76 and have been eating a modified keto for years with no problems. It was when I went on a 10 day Green Smoothie cleanse with tons of spinach and flax seeds daily (and rhubarb) that I got the gout attack. My sister in another state was on the cleanse with me and and she also had a gout attack!! Now I understand we are going to be at risk to have more. How our gout diet sifts out in the future is still up in the air but it won’t have wheat or starches.

    • Richard

      Wow! I was surprised to read such an article. I can tell you from experience that I started the ketogenic diet at 285 lbs for weight loss. I also had other issues such as high cholesterol, gout, migrains, etc. but those aren’t the reasons why I started the keto diet. I told my doctor that I was planning to do this before I started. Not much was known about this diet and he advised against it. I was just tired of his diet which was going nowhere. He did monitor me through the process though.

      As I continued through the diet my doc had called me saying that they mixed up my lab samples. I had to return for more blood work. They called me back a few days later saying that they needed to see me at the doctor’s office because the results were odd. The doctor said that my cholesterol levels showed no problems whatsoever. It was as if I never had high cholesterol. My weight was dropping, my energy increased, borderline diabetes was gone and more!

      There was one problem though! I had begin to have absence seizures. There was a reason for this. What I didn’t catch in the diet was that you have to consume enough electrolytes. Low levels of electrolytes can cause seizures and even death. Now back to my lab results and my doctor visit. My doctor said they never, ever tell anyone to consume more salt, but I am the first. That took care of my seizures. I learned one thing from this diet read the damn book. Period!

      My doctor couldn’t believe my results. We started my mom on the same diet and she was diabetic. Blood sugar levels above 500. She fought me for the first couple of weeks and after that she loved it. She started telling all her friends and family about it. Her blood sugar levels went to normal and was no longer on insulin. She lost weight, her cholesterol levels were normal and she wouldn’t stop talking about her energy.

      The doctor now uses that diet for other people on diabetes and high cholesterol. As for my Gout… What gout? I don’t have that issue no more!

    • Luis Geigel

      Certainly the debate of the ketoans vs. the vegans, or the LCHF vs. WFPB is interesting to say the least. As of today , the ketoans have gained the momentum with the documentary A Magic Pill that has left the Fork over Knives one in the background somewhere. Went to my local Barnes and Noble and it was keto all over the place. No longer diabetes books or cookbooks, it was Keto by itself in a designated area. And it makes me wonder, what happened to balance and moderation? Where are the books on Mediterranean, Paleo and Dr. Atkins now? Where will we be tomorrow?

    • Regina Gradys

      All I can say is that the gout on my big toe vanished after a month on keto. Also, I don’t see nutrition being a problem. Keto is not a “high protein” diet. I eat veggies with every meal, and that’s more than I was eating before. It’s not dietary fat causing the health problems in this country, it’s the carbs.

      • Dan Allan

        Please go watch “The Magic Pill” on netflix. Of course that is completely contrary to what the author of the article just advocated. Watch it. I even shed a tear at the end I was so happy for the people involved.

    • Joan

      I have just been diagnosed with gout and scouring the internet like a sponge .

      My problem : I am good with giving up meat almost entirely but I have been following a pre-diabetic diet for almost 10 years and my diet is already high in vegetables … however I eat protein ( zero carbs and blood sugar increase ) and now will stop and fill in with complex carbs which raise glucose levels e and high on gyclemic index .

      My toe was like a 10 out of 10 in pain. How do I reconcile the two diets?

      • Spiro Koulouris

        Hi Joan!

        Best you seek the advice of a qualified nutritionist to balance your diet between the 2 diseases. The only tweak I see if with fruit regarding complex carbs since you are also diabetic. Try and avoid it and eat mainly fresh vegetables. Breads, pastas and rice must be 100% whole grain and limited to a certain extent.

    • Todd Jumper

      Not only is this article biased, but inaccurate old way of thinking as well. Ketosis is not a “fad” In fact my dietician and family doctor and chiropractor all highly recommended it to me. Also it is not “unhealthy” At least for me the diet you recommend with the carbs causes the weight gain and gout to begin with.

      • Joan

        I kind of agree with Todd. Eating a high protein and vegetable diet has helped me maintain my weight for years and also with lots of exercise . Gout diet is a different way of thinking and I am up for trying it . But no or low protein from animals has to be substituted with carby foods .

        • Psilo

          I agree with Todd as well. Just one minor point in that a ketogenic diet is moderate protein, not high protein. If one eats too much protein it will kick them out of ketosis.

      • Mike Surber

        I just came to say the same thing. There is real science behind the ketogenic diet and this archaic “food pyramid” thinking is what caused the obesity epidemic.

    • Max

      Hi Spiro,

      Stumbled upon your website today. I was a gout sufferer, and got cured completely with a whole food, plant-based diet. It is great to know that you are advocating the same diet as well.

      I found 1 study from the Japanese Journal of Nutrition about “Urine alkalization facilitates uric acid excretion” (link below) Got my pH checked, it was significantly more alkaline than before. 5 days after changing my diet, the gout disappeared. It has been 3 years and it never returns.

      In regards to Ketogenic diet, I agree with you, that diet is unhealthy. Most similar to Ketogenic, maybe are the Inuits or the Maasai. Their life expectancy is incredibly poor, and also the incidence of CVD and Stroke of the Inuits is 2.4 times higher than Denmark (which is not a great standard for stroke in the first place). Not to mention high incidence of hip fractures as well. There are so many studies out there, even from 1927, that a high fat diet will impair arteries within hours and will cause insulin resistance within just 2 days. The journals are out there so do our own research.

      I had benefited from your website and saw you being bullied in this particular comment section, so I just want to give my support. Truth will prevail, keep it up!

    • Mike Johnson

      It seems to me that you are confusing Atkins with Keto.
      Keto is 1g protein per kg lean body weight.
      That protein does not have to be meat.
      Also you say not enough vegetables. Every explanation of keto I’ve seen says to eat loads of veg.
      As for the BBC and the AHA. I don’t trust either.
      Wasn’t it the AHA that vilified an eminent heart surgeon for stating that it’s not cholesterol that’s the heart problem, but inflammation from refined carbs?

    • […] being impacted negatively or without hindering its ability to fight bacterial infections. (source: that those are out of the way—let’s talk a bit about the benefits of the diet: […]

    • […] Author: Spiro Koulouris Author URL: Original Article Location: […]

    • Corry Pynaker

      Take off that last paragraph please, which does not fit and this blog provides a good summary of the benefits of a keto diet.

      There is plenty of evidence for a keto diet, cutting out unhealthy sugars, processed foods together with wheat and starch. Read the research and inform yourself.

      Keto benefits weight loss, reduces inflammation including gout, ADHD, Alzheimers, Parkinsons, kidney stones, cholesterol thereby benefiting heart and blood vessels too. By eating high carbs (and low fat) inflammation and ill health results.
      Babies are in ketosis when born, breastmilk is 60% fat = keto.

      Keep up the healthy keto diet.

      • Patrick

        To make an off-hand remark like the keto diet “is not a healthy diet” calls into question the validity of the rest of the article, sadly. I’ve been keto for 4 months now and am fully fat-adapted, without a single hint of gout in that time. Yes, I’ve lost about 27 kg, but much more importantly my blood pressure has dropped dramatically, my fasting blood sugar levels, total cholesterol levels, and triglyceride levels are all significantly lower than they’ve been in years. After reviewing my blood work with my doctor, the only apparent issue I have is marginally low potassium, due to the diuretic effects of ketosis. My doctor has wholeheartedly endorsed the diet for me and recommends me to stay with it for as long as possible.

    • Matt

      I respectfully disagree. Your seem to ignore genetic variability. Some of us have very different biochemistries thanks to our genome. Research is showing that for some genetic variants, ketogenic diets, which use the appropriate ratios of the different kinds of fats and a have high vegetable fiber content (thanks Megan) and sparingly include meats, may be the ONLY healthy diet. See the research published by Dr. Dale Bredesen on reversing Alzheimer’s in APOE4 positive patients. Even reversal in patients with 2 copies of the APOE4 gene who have a 90% lifetime chance to develop AD. Of course, it is important to also note that there is probably no single diet that is healthy for everyone. However, Ketogenic diets will become a way of life for those whose thrive on it due to their personal biochemistry.

    • Frank

      New to Gout, some great insight on your blog!

      I wondered if a car accident could have brought on first ever gout attack (uric acid) in my knee? Obviously diet may play a role too leading up to it.

      I am 52, in pretty good health, pretty active, maybe a little high cholesterol, and have up to this point have never taken anything except vitamins in my life. It happened almost overnight and this has been an eye opener! Almost a month after twisting my knee in a car accident (ankle, wrist, shoulder too) I woke up to excruciating pain in right knee, far beyond the bruising the accident had caused a month earlier and it was gout according to my doc.

      Diet may have played into it, as over the last month since accident I was eating a lot of comfort foods, meats, gravy, sushi and beer. My knee was drained and they put me on “Crycols”, started a low uric acid diet and 2 weeks later the swelling came back and I had to take “Prednisone” for 5 days which worked.

      It has been 2 months now and doc says I need to be gout free for 2 weeks before going on Allpurinol, however, I have fallen off the diet a few times, put a hamburger in the mix with veggies, had breads with butters occasionally etc. but have lost almost 25 pounds getting close to my idea weight, but the flares in the knee have not gone away for more than 3 or 4 days in the last 2 months. I clearly need to stay away from certain foods and get on Allpurinol, and I will be documenting foods as you had suggested that cause flares, but from what you have heard from other folks…. is it common to have that same flare from original gout attack reoccuring for long periods of time, even on Crycols? Also, have you heard of a dramatic event leading to gout a month after the fact in an injured area?

      Thanks for you opinion! – Frank

      • Spiro Koulouris

        Hi Frank!

        Thanks for your comment and question.

        Yes it possible to get flare-ups while the medication is melting the crystals, some gout sufferers experience that. It is also very common to experience a gout attack in the same spot where you previously had an accident or injury.

    • Anna O'Byrne

      Awesome to see more advocacy for a plant-based diet.

    • Megan

      Yes, I would like to comment again and reply. I am still learning as much as I can and I think it’s great to share information! 🙂

      I think where people misunderstand the ketogenic diet is that it is high protein. It’s actually not! 🙂 (LCHF might be, but that’s what makes “Keto” different from low carb, is that it is moderate to low in protein (depending on the individual needs.) The ketogenic diet is moderate protein and the amount is based on 1g of protein to kgs of lean body mass. Protein is very aging, and too much of it is inflammatory, will stimulate IGF-1, the mTOR pathway which is cause for growth and proliferation in cancer, and too much will also turn to sugar! I am very familiar with the blue zones, I love ’em! I bet many of them haven’t lost their ability to burn fat for fuel. They don’t eat as much, they eat high quality animals & fish etc, they eat healthy carbs, and not as much protein (which would be ideal for keto).
      The ketogenic diet is used as a metabolic therapy to help cells learn to run on ketones for fuel, and once this is achieved, then one can incorporate more carbs into their diet and still maintain this metabolic flexibility for the long term. (Epileptic individuals only have to follow it a short time and then remain seizure free for pretty much the rest of their life. (This ability to burn fat has been lost my most older people because of the push to eat mostly carbs, esp highly refined, eat 6 meals and day and go low-fat. Kids have an easy time going into ketosis than let’s say older adults.

      When someone is using a ketogenic diet as a metabolic therapy for their mitochondria, they might experience more gout episodes for the first 6 weeks depending on the individual due to the production of ketones and the time it takes for the body to transition over to using it as fuel, but then after that actually have the gout be suppressed. Betahydroxybutyrate is a ketone used for fuel for the cells, but it does so much in the area of epigenetic expression too. One of its roles is inhibiting NLRP3 inflammasome, which is associated with gout flare ups.

      “As the researchers explain, these flares are triggered by the NLRP3 inflammasome. With the help of neutrophils – the most common type of white blood cell – NLRP3 activates the IL-1B pro-inflammatory cytokine, leading to episodes of intense pain, fever, and the destruction of joints.” (from one of the websites cited below)

      Betahydroxybutyrate blocks this, which is awesome! There are many benefits they are discovering with the role of these ketone bodies on tumor suppression, apoptosis of cancer cells, and many wonderful anti-inflammatory benefits.

      I would consider high insulin as a contributor to gout because it’s linked to uric acid levels and also it’s very inflammatory to the body.

      You are smart to question things! I wouldn’t want to promote something I thought was harmful. You might like doing some good research on this!

      Here are some pages you might like to check out:

      • Sandra

        Thank you Megan

        • Bert

          Great explanation Megan, thank you for that. It sounds like you are well-educated and well-trained in diet & nutrition. It seemed odd to me that the first part of this article seems to explain that a keto diet is a sound avenue toward good health, then at the end the author tries refute it with some very questionable dietary information. The way it reads to me is that if in following that information, it would just lead to diabetes and more gout. Thank you for your contribution.

      • Mabel

        Very good info, Megan. Thank you for that great explanation. I don’t agree with the author about Keto being a fad diet. It’s actually quite sustainable and is saving many of our lives. My cholesterol has dropped 57 points in 5 months and I am no longer prediabetic and hypertensive. No more meds for me. Keto is here to stay no matter what the resistance says.

        • Ashutosh Roy

          Megan is keto helpful for the people who having uric acid 8.5

      • Linda

        Thanks for those links,Megan.
        Ketogenic eating has been around since the 1920’s. Hardly a fad! For some reason, after a somewhat informative article. Spiro seemed to go off the rails in last couple of paragraphs!
        10% calories from fat?? He has lots more research to do.
        Ketogenic has changed our lives, pounds dropping (slowly!), blood pressure dropping (quickly) & is our new BFF.

      • Richie

        The trouble with “fad” diets is that there are so many of them. Also people tend to take hear say as the truth. For many, the fact that a friend knew somebody that had amazing results with the latest fad diet is enough for them to try it themselves. People just don’t have either the time or the inclination to do proper research on diets. They simply know fats are bad and carbs are good right?

        The more radical sounding a diet is then the more likely it will be viewed as a passing ”fad”. Therefore when you are told that all we have known for a very long time, most of us all our lives, is based on very poor and corrupted science, it is easy to see why many would frown and dismiss it. The result being that the truth of a life changing, healthy diet gets overlooked by many. The truth is Megan is 100% correct. The ketogenic diet is scientifically sound and proven with emerging studies that back it up every day. The high sugar/carb, low fat diet is quite literally a killer. With respect to the author of this post the last paragraph should be ignored or rather the reader should be objective and go and research the facts surrounding low carb, moderate protein high fat lifestyles. Not general google research but proper academic studies carried out by experts and decide for themselves.

    • Andrew DeMario

      I had gout for eight years. My attacks increased over that time until I was getting at least one major attack every month. I quit all alcohol, stopped eating honey and became a lacto/ovo vegetarian. I also took 1/2 teaspoon of baking soda in 6 ounces of water every night before I went to bed. The result is that I didn’t have an attack for over a year. I began to eat as much meat and fish of every variety I wanted to every day. It is now six months and I have had no attack. It is my belief that my high uric acid forming crystals came about from the large amount of sweet red wine and honey that I consumed daily, i.e., high fructose, and not purines from meat and fish. I will let you know if I suffer an attack again, but I am confident that I have beat gout.

    • Pat Kenyon

      Hi Spiro
      I have to agree with Megan, HFLC can be good and no need to go overboard with the meat and animal fat. I also agree about fad diets. Low Fat high carb, … Fad since the 1970s? Ancel Keys, hero or villan?.John Yudkin? definitely a hero! Now people are fatter and sicker! Before that low carb was the tried and tested weight loss method. Spuds- Fattening! (what about Banting in the 1800s) Plenty of places where high fat low complex carbs and long life rule! too(sometimes the same places – depending on the reviewer). Whatever the diet, I think the best rules are: Real+unprocessed and low sugars (even from fruit). On hflc I have cut down my allopurinol dose a bit and lost a stone in weight (no gout attack). In my opinion HFLC is better for inflamation and health. I am a little unconvinced about going totally ketogenic though.

      • Spiro Koulouris

        Hi Pat!

        Thank you for your comment!

        Guys here is another dietary fad that has been now disproven –>

        Fat should only consist of 10% of your daily calories, it doesn’t matter what fat you choose from salmon to avocados to coconut oil. That’s it! Any more can harm your health down the road. Let’s not look at the short term benefits, it’s the long term benefits that count.

    • Jason

      I am a long time gout sufferer (16 years), and have tried every diet out there to try and fix my gout. I have had bad reactions to prescription meds in the past so that was not really an option for me, so diet and lifestyle changes had to be the answer.

      I am happy to report I seem to have finally found a diet that works for me. I want to reiterate, for me. Everyone is a little different. But it might work for you too.

      Without going into all the history and details of how I got here, my diet is simple, Very low gluten, very low fructose. Without the scientific analysis, I think the fructose , especially high fructose corn syrup and other artificial sources cause similar and possibly worse liver issues than alcohol. That and the mild inflammation I get from gluten react together to give me gout attacks. As of 6 months ago, very severe ones. Since then when I tried this combination, I have been the longest without an attack in 10 years.

      I’m not celiac or allergic to gluten, so the amount in soy sauce or other trace amounts is fine. Fructose is similar in the sense that there seems to be a level I need to stay under to keep the gout away. A couple granny smiths a week in my juice or a handful of berries and cherries in my smoothies seems to be fine. I mostly avoid things with high fructose corn syrup like ketchup, bbq sauces, etc. In general I also keep my sugar low because sucrose is 50% fructose. Mostly I look for glucose such as brown rice syrup and white rice in general as well as potatoes, yams, legumes etc. and the occasional corn product.

      Hope this helps someone. There was a lot of personal trial and error to get here and I have no agenda. Just what worked for me.

      PS, on this diet I eat all the meat, red, white or other I want and drink as much as I want as long as it isn’t beer. Beer is almost an instant trigger.

      Cheers and thanks for making it this far.

    • Megan

      The ketogenic diet is not a wacko unhealthy diet. In fact it’s very healthy. It consists of mostly plants, non starchy vegetables, moderate amounts of high quality proteins, and healthy fats. Because fat contain twice as many calories as protein/carbs, it doesn’t take much to make it most of your calorie needs. Fats to not really stimulate an insulin response, so it’s a great way to nourish your body, give your body your cholesterol needs for cells and hormones without contributing to hyperinsulinemia. Someone on a ketogenic diet may have raised cholesterol, but what’s important here is that the blood lipid tests show BETTER ratio of HDL to LDL, and the LDL turn to be more of the good “fluffy kind.” In the end, because the ketogenic diet is more appetite suppressing, one can lose weight, and not be hungry at all, and in the end be eating less, so it’s a lot easier to do intermittent fasting to reverse diabetes/obesity and starve cancer. Healthy fats are a prefered fuel source for our mitochondria – it’s a cleaner fuel than glucose (which drives more inflammation.) Ketones also turn off inflammatory cytokine, NF Kappa-B. Your body receives more energy per oxygen molecule when running on ketones and so your body becomes very efficient. It’s anti-aging as your mitochondria product less reactive oxygen species, but still the ketones help to oxidize cancer cells (which feed on fermentable glucose alone). I don’t think that healthy carbohydrates are bad at all, but we are learning in science more and more that the biggest contributor to longevity is your body being able to burn more fat than glucose over a period of a lifetime. I do think that a diet high in glucose but LOW in fat is very dangerous and causes more inflammation, more insulin, higher IGF-1, low cholesterol (which is not a good thing as your body needs it), on and on. I recommend you research this more on the benefits of fueling your mitochondria with fat. Good books you might start with are: “Fat for Fuel,” “Eat Fat Get Thin,” and research for more information as it is a great resource.

      • Spiro Koulouris

        Hi Megan!

        Whenever I write about diets, I always get long comments who argue against my opinion the matter but this diet is not ideal for gout sufferers but the diet consists of eating mostly fat and protein then vegetables unless you have a different approach to the ketogenic diet. Lots of protein and fat is what harms gout sufferers, since the organs of the body take a much longer time to break down protein and fat then complex carbohydrates which burn clean and quickly in the body. The ketogenic diet will raise uric acid levels, I know it, that is why the research only talks about helping gout sufferers only when experiencing pain and inflammation during a gout attack or flare-up.

        Following this diet will make it worse for gout sufferers long term, that is my point here. Insulin levels is not something that really concerns gout sufferers more or less, it is uric acid that concerns more and following this diet will raise it without a doubt! As with the Atkins diet which is also high in fat, this diet can lead to other health problems. It’s just amazing how people change from diet to diet every few years based on supposedly sound research and then fade away cause many people will try it and see it doesn’t work. It’s a whole new business industry that needs something new to continue to thrive. I want to see long term health studies on this diet and see what results come about it. I’d bet that the ketogenic diet wouldn’t stand to do that well at all. If you look at the so called blue zones where people live the longest, it’s all about eating complex carbohydrates mostly and some protein and fat. That’s my take on it!

        • Chiungyi Tseng

          Hi Spiro,
          I’m a beginner of ketogenic diet. Today I got the number of my Uric Acid 12.9. Extremely high, which had never happened in my personal medical records. I searched on web and found a lot of articles talking about high uric acid in the first 2-3 months of high-fat diet. But it will eventually return to normal. What is your take on this? I’m just being curious and of course a little bit worried about my number.

        • Glendacrook

          There are many ketogenic diets for different health conditions,roughly about 8 different ones
          would never recommend atkins ever,really unhealthy.

        • Maurice Peugh

          Hello Spiro,
          Considering that gout is considered another part of Metabolic Syndrome and that gout has been linked to other serious illness like diabetes and increased cardiovascular risk, everyone with gout needs to be concerned about insulin. Metabolic syndrome typically has high insulin resistance, high blood pressure, low HDL, and high LDL (specifically the vLDL particles).

          I know that Mark Hyman who is the head of Functional Medicine at Cleveland Clinic does a great job talking about nutrition in Eat Fat, Get Thin. I lost 50 pounds by changing to a low carb, high-fat diet with reasonable protein. My triglycerides were cut in half and my HDL levels were the same. Triglycerides / HDL is a better predictor of heart attack risk than LDL if one cares to research it. Cutting out sodas, grains, and sugar has done great by me. Yes, I am speaking first-person. I am not speaking about what I have heard about any friend.

          • Maurice Peugh

            Hello Spiro,
            I forgot to mention that I was pre-diabetic. My blood sugar was 73 at my last physical. The results are very difficult for me to argue with for the low carb diet bordering on keto that I am on. The numbers are also much better for my wife with diabetes as well. Her numbers are in the 115-130 range now. They were in the 200-220 range.

          • Andrew

            THANK YOU! It really comes down to metabolic syndrome and the best way to reverse it is by lowering your insulin. This usually involves a low carbohydrate diet with some form of fasting.

      • Daphne

        Explained very well. Thank you, Megan!!

      • Brock S.

        Hello Megan, I’m curious on your thoughts on exogenous ketone? I’ve been planning on starting the keto diet and will be starting shortly. As a 26 year old male who has gout attacks every other month the medicine is obnoxious. It helps, but I want to be more natural if possible. There’s other reasons I wanna do keto, such as weight loss and the mental and health benefits.

      • Jeanie Haupt

        Thanks for your comments, Megan! I have been eating a ketogenic diet for nearly a year and this is the first time that I’ve ever been able to stick to a particular way of eating for an extended period of time. On the occasions where I have eaten more carbs than normal, I typically have lower energy & sometimes need a nap. That’s the reason I started seeking out information and came across the keto lifestyle. For me, this is a lifestyle and not a ‘diet’. I’ve also added intermittent fasting which has been easy now that I’m fat adapted. It sounds like Spiro’s concern with keto is that he seems to believe we don’t eat many vegetables. In fact, vegetables (particularly leafy greens) are a huge staple in my diet and should be for others doing the ketogenic lifestyle. If people do a search on Youtube for Dr. Berg, you’ll come across many videos that discuss the HFLC lifestyle and he strongly advocates at least 6-7 servings of vegetables per day. Since I only eat 1-2 meals per day that can sometimes be harder for me but I can at least get 4-5 servings in. I’ve never felt better! My moods are better, energy level is consistent all day long. I came across this article in researching gout for someone else. It got me fired up. Lol.

        Anyway, I sincerely hope people will give keto a try. It’s not a fad. It’s been around since 1920 when it was developed to treat epilepsy. It also has been found to aid in all of the other serious diseases you and others have mentioned.

        AS for the question about exogenous ketones that someone asked, I’ve tried them but I don’t really see any results.

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