Gout and low carb

Do low-carb or keto diets high in meat cause gout? This is an especially important question to ask, given that the conventional advice for gout-sufferers has long been to avoid excessive meat and seafood consumption. In this guide, we will explore the evidence on this topic, proving that there is significantly more nuance than previously appreciated.

First, it’s necessary to recognize that a low-carb diet is not necessarily high in meat.¹ However, low-carb diets that are high in meat are markedly different from a meat-heavy, standard American diet.²

Second, it is worth emphasizing that all low-carb diets should have negligible amounts of sugar and refined carbohydrate. This is critical because there is a growing body of evidence suggesting a strong association between sugar intake and the risk of gout. If this relationship eventually proves to be a causal one, then low-carb diets would be considered a therapeutic tool for reducing the risk of gout.³

Keep reading to learn the definition of gout, how to avoid it, and how a low-carb diet may affect it.

What is gout?

Gout is a sudden and painful inflammation of a joint, most often at the base of the big toe (see image). It may also affect other joints, like heels, knees, wrists and finger joints.

The cause of gout is elevated levels of uric acid in the blood, resulting in crystals depositing in the affected joint.

Gout is more common in people who are overweight and have metabolic syndrome. Given the increasing prevalence of those conditions in recent decades, gout now affects about 6% of adult men and 2% of women (it’s even more common in older people).⁴

Meat and gout

Gout has often been blamed on excessive consumption of meat. This is because the uric acid that causes gout is a breakdown product of purines – the building blocks of protein that are highly concentrated in meat.

Some weak observational studies, especially those in the United states, show an association between meat intake and elevated uric acid levels.⁵ Others, such as one in Taiwan, show no such association.⁶

Why the difference?

We don’t know for sure, but one proposed explanation is that a higher prevalence of metabolic syndrome or consumption of sugar may account for such geographic differences. If true, this could suggest that other components of diet may matter more than the consumption of meat itself.

It’s also important to consider that, as with all nutritional epidemiology studies, it is quite difficult to separate the effects of meat on gout risk from those of refined grains or alcohol.

Further, there is a real concern for healthy user bias in these studies, in that those consuming large amounts of meat as part of a typical Western diet may engage in other unhealthy behaviors that increase the risk of gout.⁷

Therefore, it’s important to note that epidemiology studies cannot prove that meat directly increases the risk of gout.

Further, we must acknowledge that nutrition research often yields conflicting results for the same topic, like one study showing that vegans had higher uric acid levels than meat eaters and fish eaters.⁸

Does this mean that vegans have the highest risk for gout attacks? No, we cannot conclude that based on these data, and the bottom line is that we must consider the results of nutritional epidemiology studies with a healthy dose of skepticism.

Sugar and gout

As there is a very strong connection among elevated uric acid levels, gout, obesity, type 2 diabetes and metabolic syndrome, it’s possible that they are all associated with and exacerbated by the same thing: sugar and other refined carbohydrates.⁹

In fact, there is a striking history of gout suddenly becoming common in populations just as sugar consumption started to rise sharply (e.g. in Britain during the eighteenth century, paralleling the birth of the country’s sugar industry).¹⁰

Mechanistically, there are clear explanations for the relationship between sugar intake and uric acid levels. Fructose (found in sweetened beverages, among other things) is well-known to directly increase blood uric acid levels.¹¹ In addition, elevated blood insulin levels – associated with a diet high in sugar and refined carbs – have been shown to increase uric acid levels, likely by decreasing the excretion of uric acid by the kidneys.¹²

Further, observational studies consistently show a correlation between fructose consumption and an increased risk of gout.¹³ Although these types of studies cannot prove that fructose causes gout, we believe that the combination of mechanistic and consistent observational data makes a compelling case for avoiding fructose to decrease the risk of gout.

Low carb, uric acid and gout

Short term studies show a temporary rise in uric acid during the first few weeks when starting a strict low-carb (i.e. keto) diet. This effect seems to disappear after about six weeks, with uric acid returning to baseline or even lower.¹⁴

Studies show no significant change in uric acid levels in people doing a low-carb diet over several months or years.¹⁵ The exception is one study that actually showed uric acid going down significantly after 6 months on low carb, suggesting it may decrease the risk of gout.¹⁶  

After dozens of high-quality studies comparing low-carb diets to other diets, there seem to be none noticing any obvious difference in the risk of gout, although no study has specifically focused on this question.

Doctors regularly treating patients with low-carb diets do not notice a sharp increase in gout episodes, even during the initial time period.¹⁷ If there exists an increase in risk during the first few weeks, it is likely small.

Meat or no meat?

Avoiding meat should not be necessary when it comes to gout prevention, especially when otherwise following a low-carb diet.

Furthermore, please note that a low-carb diet does not have to be especially high in meat anyway. Multiple other foods exist to achieve your protein needs.

A well-formulated low-carb diet that reduced sugars and refined carbohydrates could potentially reduce the risk of gout long term.²⁴

 
 

More low-carb side effects & how to cure them

Common early issues

Less common issues

 

Low-carb myths

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