Gout and Ketogenic Diet

Gout and Ketogenic Diet

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 can 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 can 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 will ultimately 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 meats and high fat dairy 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.

Posted by Spiro Koulouris

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  • Todd Jumper

    Reply Reply April 24, 2018

    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.

  • Max

    Reply Reply April 16, 2018

    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

    Reply Reply March 17, 2018

    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?

  • Corry Pynaker

    Reply Reply November 13, 2017

    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

      Reply Reply February 15, 2018

      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

    Reply Reply October 25, 2017

    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

    Reply Reply October 21, 2017

    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

      Reply Reply October 21, 2017

      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

    Reply Reply July 2, 2017

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

  • Megan

    Reply Reply June 27, 2017

    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

      Reply Reply July 10, 2017

      Thank you Megan

      • Bert

        Reply Reply November 24, 2017

        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

      Reply Reply July 29, 2017

      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

        Reply Reply March 2, 2018

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

    • Linda

      Reply Reply September 13, 2017

      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

      Reply Reply November 18, 2017

      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

    Reply Reply June 18, 2017

    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

    Reply Reply June 15, 2017

    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

      Reply Reply June 16, 2017

      Hi Pat!

      Thank you for your comment!

      Guys here is another dietary fad that has been now disproven –> http://www.bbc.com/news/health-40300145

      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

    Reply Reply June 9, 2017

    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

    Reply Reply June 8, 2017

    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 dietdoctor.com for more information as it is a great resource.

    • 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

        Reply Reply July 22, 2017

        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

        Reply Reply October 5, 2017

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

      • Maurice Peugh

        Reply Reply November 27, 2017

        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

          Reply Reply November 27, 2017

          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

          Reply Reply April 25, 2018

          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

      Reply Reply July 10, 2017

      Explained very well. Thank you, Megan!!

    • Brock S.

      Reply Reply August 16, 2017

      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

      Reply Reply January 14, 2018

      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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