The ketogenic diet or simply the keto diet is a low-carb, high-fat diet designed to put the body in a steady state called ketosis. This common diet has also been linked to changes in a number of medical problems, such as diabetes and heart disease, while being more commonly thought of as a way to lose weight quickly. There is some evidence that it can also tend to relieve gout. According to the Arthritis Foundation, gout is a form of inflammatory arthritis that affects four percent of all American adults. Here are more studies on the keto diet and gout that can help you determine if the keto diet is right for you.
What is Gout?
Gout is a form of arthritis caused by a painful buildup of uric acid crystals in the joints of joints, tendons and extremities – especially the joints of the hands and big toes.
Uric acid crystals form when the level of uric acid in the blood reaches abnormally high levels. This condition is known as hyperuricemia, and it is a major marker of gout risk.
However, it is important to note that gout is relatively rare: only 5% of people with uric acid above 9 mg/dL (considered hyperuricemia) develop gout.
Centuries ago, gout was known as “the disease of kings” and “the disease of the rich”. As it happens, the rich are the only ones who can afford sugar – a now well-documented risk factor for gout.
Gout affects about 1-4% of the population (3-6% of men and 1-2% of women). Worldwide, the incidence of gout has been rising, probably due to worsening dietary habits, lack of exercise, obesity and the rising incidence of metabolic syndrome. There also appears to be a genetic component to the risk of gout.
To treat gout, doctors usually prescribe drugs to reduce uric acid production or recommend a low-protein diet. But new research is shedding light on the causes of gout, and it’s becoming increasingly clear that there are better ways to get rid of gout than cutting protein.
The Risk Factors for Gout
Many factors have been found to contribute to uric acid build up. Here is a brief look at the most well-researched risk factors:
- Age. Men in their 40s and 50s and postmenopausal women are more likely to develop gout.
- Gender. Men are more likely to develop gout than women. This may be due to the effect of female sex hormones on lowering uric acid levels.
- Family history. If someone in your family suffers from gout, you may also be more likely to develop the disease.
- Diet. Consumption of meat and seafood has been found to increase the risk of gout. Diets that cause high insulin levels (i.e., high-calorie, high-carbohydrate, and high-sugar diets) also increase the risk of gout.
- Hydration status. Not drinking enough water and/or consuming enough electrolytes can make it more difficult for the body to excrete uric acid.
- Alcohol consumption. Regular alcohol consumption increases the risk of gout. More specifically, alcohol consumption was found to be associated with a 3-fold higher risk of gout in women and a 2-fold higher risk in men compared to those with no alcohol intake or ≤1 ounce of alcohol per week.
- Medications. Some medications, such as diuretics, cyclosporine, aspirin and niacin, can put you at risk for gout.
- Other health conditions. High blood pressure, high body mass index, kidney disease, thyroid disease, obesity, metabolic syndrome, high cholesterol levels, high triglyceride levels, sleep apnea and diabetes can all increase your risk of developing gout.
The impact of gout on other health markers must also be mentioned. In general, epidemiological studies have found that gout is independently associated with all-cause mortality and cardiovascular disease mortality. In other words, if you have this form of arthritis, you are at an increased risk of dying from a variety of causes, especially heart disease complications.
Does a Keto Diet Increase Your Risk of Gout?
During the first few weeks of a keto diet, you may see a short-term increase in gout risk. This is because high levels of ketones will prevent your kidneys from clearing uric acid properly.
But here’s the good news: after two to three weeks, you’ll become keto-adapted and uric acid levels will return to normal. In fact, the long-term risk of gout (as measured by uric acid levels) actually decreases on a ketogenic diet.
First, the ketogenic diet keeps your insulin levels under control. When you restrict carbohydrates on a high-fat keto diet, your blood sugar stays low – and when your blood sugar stays low, your insulin stays low. If you remember, low insulin helps your kidneys clear uric acid.
There are other mechanisms at work, too. On a ketogenic diet, your liver produces ketone bodies, of which beta-hydroxybutyrate (BHB) is the most important.
Recently, a group of researchers at Yale University found that BHB reduced the risk of gout attacks in rats. BHB, reduces inflammation by suppressing a part of the immune system called the NLRP3 inflammasome, which can reduce the risk of gout attacks.
How to Avoid Gout
Here’s how to avoid gout long term, using only lifestyle modifications:
- Minimize intake of sugar.
- Reduce intake of alcohol. Particularly avoid beer and other high-carb alcoholic drinks.
- Lose excess weight and reverse metabolic syndrome. Low carb is a good treatment, as is intermittent fasting.
- Avoid dehydration.
As a bonus, these lifestyle modifications have many other positive effects on weight and health.
The keto diet is a low-energy, high-fat diet. While this diet can have some proven health benefits, it is not for everyone. The work on its potential to reduce gout symptoms is encouraging, but more is needed. If you have gout, eating a healthy diet, reducing high purine foods, and maintaining a good weight and lifestyle is definitely the safest way to go. Your doctor will be able to help you decide on the right treatment strategy.