Gout

gout
(Christian Ross) #1

I’m in the middle of a major Gout attack. As I’ve become ‘more mature’, these attacks happen more frequently when I attempt to do Keto. In my ‘less mature’ days I never had a problem with gout. Although I know gout is caused by high consumption of foods that contain ‘purines’ Most of these foods are the foods I love on Keto. I can’t say I’ve been eating much meat, in fact it’s just the opposite. I’ve been rather conscientious about not consuming too much protein. I’ve been testing consistently between 1.0 and 2.0 mml Ketones twice daily for just over 2 weeks (lost about 14 lbs.), so I was hoping if anybody could give me advice on preventing gout or supplements that would help prevent gout so I don’t have to go through this pain in the future.

PS -I’ve been to the doctor to get the meds to reduce the Uric acid in my blood (Colchine). And the pain is slowly subsiding. I love eating Keto, and short of having to go on Alipurinol the rest of my life I was looking for an alternative.

(Guardian of the bacon) #2

Note from Steve Phinney: What this shows is that uric acid goes up promptly in the same time frame that ketones go up, but after 4-6 weeks, despite ketones staying up, uric acid starts to come back down. Based on these data and my clinical observations in thousands of patients, uric acid returns to or below pre-diet baseline within 6-12 weeks despite the person remaining is a state of nutritional ketosis. Thus, when I’m asked how long ketoadaptation aks, I generally respond that some aspects of it take 6 weeks or more.

http://www.meandmydiabetes.com/2011/05/30/steve-phinney-and-richard-johnson-sugar-ketones-fat-uric-acid-in-health-and-diseaseev/

(Christian Ross) #3

Thanks for the info! I’m going to have my uric acid levels tested in a couple of weeks after this attack is gone to see how I’m doing. I guess the answer (as it almost always seems to be) is:

Keep Calm and Keto On :grinning:

(Cheryl Violano Hofbauer) #4

I take 400 mg of Allopurinol daily (prescription med) that has been very effective at eliminating my gout attacks.

(Mark) #5

Eat celery and if you don’t like it plain put a little almond butter or cream cheese on it or in a salad or celery seed in a salad,or you can try cherry extract both good for uric acid,I add celery and celery seed to all my salads

(Arlene) #6

Thanks. I will read up about celery.

(AnnaLeeThal) #7

My husband had a severe gout attack about a month or so into Keto. He thinks he was eating way too much red meat. Like tons of burgers. He went on steroids, then heavy duty anti inflammatories, and was laid up for over a week.

He has since adjusted his Keto plan to less red meat, more poultry, less high purine food. I think eventually the gout won’t be a problem if he keeps Keto.

(Simon Saunders) #8

Your gut feel may be right.

It’s very important to ensure that you’re eating the right amount of protein in order to adapt into ketosis. If you eat too at the beginning you may find that you still end up running from glucose for energy and ketones never rise to therapeutic levels, and in that state vitamin C is still very important, but when you’re truly adapted, you’ll require less vitamin C and gout won’t be an issue.

Use a keto calculator and work out protein intake and weigh the meats intually to get a feel for what the protein intake looks like.

(Hugs & Bacon) #9

You could also take note of the foods you ate leading up to an attack (sometime hard to remember). While gout is prodominently exacerbated by high purine foods, some people can also be triggered by certain types in particular…like seafood or over consumption of offal which is high in purines but by cutting these out (or eating infrequently) can prevent or reduce future attacks and you can still enjoy other meats as desired. Need to biohack this shit!

(Kalansta K) #10

I believe I had my first gout experience.

Played basket ball, then decided after being strict keto, to go to sushi with my friends…
Got home at 10pm. I felt fine, after I threw up the sushi which was not agreeable to my stomach, bad fish versus carb overload?
By midnight, my left knee was starting to really hurt. I ignored it until it woke me up at 2am due to incredible pain at rest, which increased with any movement. I tried to stand and could not tolerate any weightbearing.
At first, I was trying to figure out how I hurt it playing ball; I could not identify at mechanism of injury.
I remembered hearing of people having gout flare ups when they go off keto.
So I looked up signs and symptoms, and I am 90% sure it is gout.
So I read everywhere I could online, including here, about home remedies. I tried most of what I came across. I need to leave for work by 5am and I have to be on my feet and lifting 8 of the 10 hours of my shift.
It is now after 4am and I can walk again. Pain is down from a 9/10 to a 2/10.
Here is what I tried.
First startied chugging water. (Unfortunately the day I picked to eat sushi was the same day I had little to know water. Mostly because I can be an idiot.)
I chugged 2 tablespoons of baking soda.
I took two adult doses of ibuprofen.
Applied KT tape. (Although I am not a firm believer in many of their claims, I figured it wouldn’t hurt to try.)
I have applied ice on for 30 min, off for 10, for the past 2 hours.
I applied an EMF device (Bemer, at level of 10 for 20 on and 10 min off.)
I have also been performing ankle pump exercises and active range of motion to my knee, as tolerated.
Lastly, I have prayed for this pain to leave and never return. (With the understanding I likely brought it upon myself by my poor choices. But who doesn’t want some form of divine mercy?)

At this point, I am confident it is under control and I can make it through the day!

Also, I have no idea which, if any, of the things I tried worked. Or if this would have been the normal course either way. However, here are a few ideas for anyone who may find themselves in a similar predicament.

Lesson learned, stay keto…

KT tape job if you are curious. Supposed to stimulate the lymphatic system…

IMG_0128.JPG2448×3264 1.43 MB

#11

I know this is an old post, but I thought I could add somewhat to the conversation. if I’m out of line in doing so I apologize.

Gout:

First, I have tophus gout. This is when it can turn deadly. Your kidneys and liver are affected, etc. In some cases, the doctors begin talking about cutting off a toes, or a foot, etc. I’m currently in a wheelchair - gout and spine related. This stuff can get really bad if not properly controlled. …

Second, gout is a genetic disease. Most only get it in their big toe. However for some of us it can travel to other joints - even the ears - that is painful. It may be triggered by many things. While certain proteins can be the culprit at times, other food groups may be too. I’ve tried many diets, and every home remedy available. In my case they did nothing - but not every case is the same. My doctor finally tried the combination of three gout meds at once - it worked (Uloric, Colchicine and Probenecid). These meds can be tough on the liver and kidneys.

Keto:

Third, it is better to control gout with a diet if possible. Keto may or may not work. My wife and I are just beginning it. From what I’ve read in the article below is that in the first 6 or so weeks of the Keto diet gout attacks can flare. But according to some studies after that time they should taper off. The article below can explain it better than I.

I hope this helps …

(Sorry for spelling errors. Fingers don’t work like they use too)

#12

My husband was already having a bit of a gout flare when he started low-carbing, and it only got worse. In fact, it got so bad, he was in a wheelchair for a while, and even opioids did nothing for his pain. This is, by far, the worst and longest flare he’s ever had. A course of prednisone was the only thing that brought any relief, and after a couple of weeks of reduced pain, it’s starting to escalate again.

We kept hoping he’d get relief around the six-week mark, but he’s been strictly keto for five months now, and his uric acid level just isn’t falling.

He’s on allopurinol, but the doctor doesn’t want to increase it until after the flare resolves (due to the risk of making it even worse), but that just isn’t happening. Colchicine, which used to reliably resolve flares, seems to do nothing.

Since he had episodes of gout prior to low-carbing, I don’t think this is the cause, but we know that ketones compete with uric acid for excretion, so it likely made it worse than it might have been otherwise. In fact, while we were looking for a rheumatologist to get help with this (his PCP is totally out of his league), we came across one whose website said, “To treat your gout, we might recommend a diet higher in carbohydrates.” My husband doesn’t want to give up low-carbing because it has produced otherwise fantastic health markers for him and nearly effortless weight loss. Backing off to a higher carb level, just out of ketosis, might help, but that becomes a slippery slope (and he’s terrified of regaining the 70 pounds he’s lost); and he’s also still hoping that, any day now, he’s going to suddenly reach the “promised land” of lower uric acid and reduced inflammation.

Anyway, I just want to give other sufferers the heads-up that they might not get relief after the oft-quoted six-week mark. We’re still plugging away, but we’re really in no-man’s land here. There are few, if any, genuine authorities on the dual topics of both ketosis and gout.

#13

On a side note, I have a history of kidney stones, so I was hoping to lower my uric acid, too. After four months of strict keto, it did, indeed, go down…from 8 to 7.9. And now, at six months (still strictly keto), I’m currently working on dislodging another stone. Maybe a trip to Disney World…
http://jaoa.org/article.aspx?articleid=2557373

(Art) #14

Hey Koda. :wave: I too take Allopurinol, and yes - the information says that it may temporarily increase the severity of gout attacks, so no surprise that the doctor doesn’t want to increase the dosage. I feel for your husband - the pain of gout can be so real in the worst way.

While I don’t know if this would be any help, how about trying to limit organ meats and certain shellfish (if consumed) - things that have the highest purine concentration? Or, more generally, perhaps really focusing on the high fat content for diet and keeping an eye on the protein, trying to limit the amount of uric acid produced in the first place.

I think continuing to plug away is the best course. Have had a lot of short-term odd effects - gout attacks when fasting or when again taking Allopurinol after not taking it for a few days - things are not always immediate nor linear as far as perceived cause-and-effect. Good luck.

(Arlene) #15

My husband has suffered from severe gout attacks for years. He started eating very low carb in January of this year. Suffered plenty of gout attacks for several months into this. Now it’s August and he has not had a gout attack for at least a month. He does not take any medication. Encourage your husband to stick with this way of eating. Make sure he’s not getting too many sneaky carbs or too much protein. I believe he will get over this very painful hump. Best wishes for a complete recovery!

#16

Why is that?

Going through what may be gout now. Cherry and Celery pills are helping. Been doing LCHF Keto and Fasting for over 3 months when it started. No deliberate cheats

#17

He doesn’t eat organ meats, and I was going to say that he doesn’t currently eat shellfish because he did have a couple of occasions when shrimp seemed to trigger him. But then yesterday he went out and bought some shrimp! I told him I don’t want to hear him complaining if he eats it and it makes him flare. He’s actually feeling pretty good today.

#18

That is very encouraging! My husband has had a couple of good days in a row now, so I’m hoping that the current flare has run its course.

#19

My dad has had three gout flares in last 3 or 4 months, had prednisone for first two, but third time was able to shorten duration of pain by drinking lots of pure cherry juice and really upped his water intake drastically. If you want to avoid sugar in the juice, they sell cherry extract capsules that contain the active ingredients. Its the first time he has ever had gout and thinks it may have either been to do with a diuretic he had been taking due to high blood pressure as one doc said it is a common side effect, or possibly been triggered by being on strong anti biotics for several months due to a stubborn infection from an ingrown toenail. Hopefully in time as his microbiome returns to its pre-antibiotic state and since he has ditched the diuretic, this painful and recurrent condition will not return. I feel for all those who suffer with it as it is terribly painful.

(jay) #20

I’m glad to hear your husbands condition has improved. It soundsa like he has been on keto long enough to be fat adapted enough that a fast, short or long’ may be worth testing. Basically exploring if it could help clear the uric acid. He would continue to burn his stored fat and release ketones but the total lack of extraneous protein sources might help to limit an attack. The thing is fasting ,once fat adapted, is relatively easy and also if his Dr. doesn’t object, probably safe to try.