Atkins and Gout. How gout sufferers should modify the Atkins diet.

Referenced studies and study abstracts, the numbers in brackets, are listed on page 5 of the pages about Gout and the Atkins diet.

The Gout and the Atkins diet articles are across five pages. Navigation for these pages - Use the links at the bottom of the articles to go to each page, or return to a formerly viewed page.

OUR MODIFICATIONS AND REMINDERS ABOUT THE ATKINS DIET FOR GOUT SUFFERERS

1. Be a wise OWL and use the Atkins Ongoing Weight Loss (OWL) phase to lose weight on 35 - 40 net carb grams a day. Be an owl.....and be a turtle on a beach. Adjust carb intake to lose two lbs a week, not more. This is true whatever your age, sex, and the amount you need to lose.

2. Eat foods reported to lower LDL cholesterol, (see below) within your daily 35 - 40 net carb grams budget.

3. If eating amounts of meat and fish helps you stay with the diet, then eat moderate amounts of meat, 3 - 4 ounces per serving, and a similar amount of fish but seafood not more than twice a week unless its medium purine fish. You won't find low purine fish. We explain the pros and cons of fish for gout here. There is a risk of gout from this amount of meat and fish, in many people's diets (7) but not if you are on the Zone diet. (See below). And perhaps not if you follow some natural remedies for gout. But I should say the Atkins diet is NOT about eating huge amounts of meat.

But using any diet (except crash diets) is more important than worrying about the number of moderate portions of meat and seafood you eat. Probably as long as it's not more than 3/4 times a week for meat (less for beef, lamb and pork), and twice a week for fish. This is because if these are favourite foods that help you to stay on a diet - that's the most important thing. There's a much bigger risk of gout if you aren't at your ideal weight; or if you have insulin resistance (including high uric acid) and metabolic syndrome; or if you simply have high uric acid (UA).

In a 2008 study, men with blood uric acid of just 6.5 mg/dL or higher had a 60% increase in risk of getting the metabolic syndrome compared to those whose blood uric acid was less than 5.5 mg/dL; in the same study with women the risk of the metabolic syndrome was at least "2 fold higher" (double) when blood UA was more than just 4.6 mg/dL.(11). In the study Relationship between hyperuricemia and metabolic syndrome (21) men who had hyperuricemia (usually defined as blood uric acid above 7.0 mg/dL) had a 1.634 fold (63%) increased risk of metabolic syndrome compared with men without hyperuricemia.

Women too In the same study, women with hyperuricemia (defined in this study as 6.0 mg/dL or higher) had a 1.626 fold (63%) increased risk of metabolic syndrome compared with those without hyperuricemia.

So I think doing a diet successfully is more important than not eating moderate portions of meat and fish because these are higher risk numbers, than those for meat and fish eating. And the higher the blood uric acid (e.g. 8.0 mg/dL or higher), the greater the risk. In the gout sufferers diet study (using the Zone diet) there was no change in meat and fish consumption and yet uric acid levels fell and so did gout attacks, to zero in some cases, after a year.(8) See page 1 of our Atkins and gout pages - link below). Furthermore, beef, lamb and pork are medium purine, not high purine. View these purines tables But, like some other foods that are low, or medium purine, there are people who think they have triggered their gout attack. Mushrooms are another example. Some mushrooms are low purine, but others have been found to be high in the two purines that cause most uric acid.

4. As usual, I regret to say, avoid/reduce alcohol, especially beer and spirits. There is hardly a relevant study that hasn't concluded alcohol causes gout, and subsequent gout attacks after you've had your first. Beer is the biggest cause, then spirits.

But it's not all bad news. A glass (or two) of wine can be fitted into your daily carbs budget, since wine is not high purine. Here are some examples. A 5 fl ozs glass of Burgundy has 5.46 carb grams; 5 fl ozs of Cabernet Sauvignon has 3.82 carb grams; 5 fl ozs of Merlot has 3.69 carb grams; 5 fl.ozs of white table wine has 3.82 carb grams; 5 fl ozs of Riesling has 5.54 carb grams. You can look up more wines in the USDA National Nutrient database. How? See below.

5. When you fry, use olive oil. Use extra virgin - it's the purest. Its monounsaturated fat is thought to aid weight loss and lower LDL cholesterol levels. And use olive oil as a salad dressing. You can use mayonnaise as a salad dressing because it's low carb. Check the amount on the nutrition label.

6. Avoid high purine foods completely.

7. Constipation may occur. To avoid this, boost fibre (fiber) intake. That means more fruits and vegetables or high fibre (fiber)supplements such as psyllium husks. And high fibre foods help reduce LDL cholesterol.

8. Take dietary supplements reported to lower blood glucose and LDL cholesterol. For blood glucose and LDL cholesterol - chromium nicotinate or chromium polynicotinate.

For LDL cholesterol and other markers of the metabolic syndrome –pantothenic acid (Vitamin B5).

9. If you can drink anything else after 8 glasses of water daily,(about two litres/liters) note that milk has been reported to lower uric acid levels. Two proteins in milk are reckoned to do it. (7) There are about 11.7 carbs in an 8 oz glass of reduced fat 2% milk fat milk. Same in 3.25% milk fat whole milk.

10. Take a good quality multi-vitamin at the frequency described on the bottle. This is not a modification. Dr.Atkins always recommended it.

Essential

You must drink plenty of water on the Atkins diet. At least eight glasses a day - about two litres (liters). Don't cheat. 35-40 grams of carbs a day means what it says. Or modify net carbs intake to lose no more than two lbs a week.

FOODS THAT LOWER LDL CHOLESTEROL

Nuts and seeds including flaxseeds, almonds, hazelnuts, macadamia nuts, peanuts, pecans, pistachios and walnuts.

If your LDL is fine, I want to say - and this will surprise many readers - that in The New Atkins For A New You, (see page 5 of the Atkins and gout section) the authors, who are no slouches in the nutrition business, do not think that saturated fats, including those in foods, pose any health risk when a low carb diet is used. That means, as long as you are controlling carbs correctly, you don't have to use low fat products.

The Atkins diet may reduce your LDL cholesterol (it does sometimes) but to take more precautions, research these foods and LDL cholesterol. The Condensed Encyclopedia of Healing Foods, publishers Simon & Schuster, New York 2006, describes in detail many foods which are reported to lower LDL cholesterol and discusses those backed by studies and not hearsay.

FREE ATKINS DIET AND GOUT RESOURCES

Carb and calorie counter

The free one on the Atkins website is an excellent carb counter, listing some foods you probably won’t find in carb counters you pay for. And there are net carb numbers too.

The Atkins diet and gout forum at www.atkins.com

Want to read what Atkins dieters, and who suffer(red) from gout, are saying about the diet? To read and join in the forum you need to register with www.atkins.com.

Once registered, find the gout forum by entering Atkins and gout into the search box. You'll read a huge number of opinions and experiences. At least over 200. Atkins and gout entries at the time of this writing. The forum is read, and contributed, to by an Atkins nutritionist, so the accuracy of this Atkins forum is likely to be the highest of all Atkins forums.

Other suggested searches on the Atkins website

Gout and ketosis. Atkins and uric acid. Atkins and ketosis. Atkins and kidney stones.

The website's nutritionist thinks the diet cannot cause gout because uric acid levels have not been found to rise on it, although of course on occasion gout is triggered at normal levels of uric acid (UA). From a small sample of posters to the forum who have (had) gout and experience of using the Atkins diet, there's a majority who don't think it caused or aggravated their gout. There's a minority who think the diet caused or made their gout worse.

The site's official thinking is also, as I do, a 35-40 net carb grams a day budget is better for anyone who has had a gout attack, to avoid crash weight loss which may cause a gout attack and to moderate ketosis. And that you may need 300 mg daily of allopurinol for UA reduction, if you have had a gout attack, although less is always better if less works. Animal, fish and vegetable protein sometimes gets blamed for causing gout on the forum, but protein does not raise the risk of gout.(7) If anything it lowers uric acid. (22-23).

The USDA National Nutrient Database.

This is a high quality nutrition database you can download free, courtesy of the U.S. Department of Agriculture. Visit our free gout resources page for an explanation and the free download link.

EATING CHERRIES AND DRINKING CHERRY JUICE ON THE ATKINS DIET?

This could be a problem. If you eat cherries 100 grams raw, sour, have 10.5 grams of net carbs; 14 of net carbs if raw, sweet. You could drink cherry juice within your carb budget, but the juice may cost you too many carbs, because for one quality brand, an 8ozs serving of tart (sour) cherry juice made from concentrate costs 19 carbs out of a daily allowance of 35-40. It may be difficult to fit 19 into 35-40, but if you believe cherries or cherry juice helps your gout you will have to do it.

Here's an answer. You can get tart cherry capsules which are low carb. Traverse Bay Farms in Michigan, U.S.A. quote the number of carbs of a serving of two tart cherry capsules on their website. It is less than one gram of sugar and carbohydrate in a two capsule serving. And you would take one serving a day. Less than one gram a day is irrelevant. Traverse Bay Farms deliver to the U.S., and internationally, quickly to certain countries - see their website.

But, if you eat cherries they are a low Glycemic (Glycaemic) Index food which is Atkins positive. Don't eat Maraschino cherries - they are very high in carbs.

Of course you can have your first gout attack on the Atkins diet, which has not caused by it. For example if you already have a high uric acid level and if you do one of the things that's a gout trigger. Think carefully of what you've eaten and done before you conclude it was the diet. Read our page about gout triggers.

WHAT ARE NET CARBS?

Net carbs are the number that matter and the number you count, because they are the ones that affect blood sugar. To obtain the net carbs number you deduct the amount of fibre (fiber) from the carbohydrates number on nutritional panels. (There are other carbohydrates apart from fibre (fiber) which don't count but they are unlikely to be on the nutrition panel). Or look up a carb counter if there is no nutrition panel. Thus, if it says six carbohydrates grams per serving and two grams of fibre (fiber) per serving the net carbs number is four. For foods that don't have nutrition panels you'll have to look them up in a carb counter or use the carb counter on the Atkins website.

Go to page 1 of 4 about gout and the Atkins diet, where I explain why it might be good for your gout.

Go to page 2 of 4 about the Atkins diet and gout. What Robert Atkins said about his diet and the uric acid level. And how much meat and fish can you eat?

Go to page 3 of 4 of our Atkins diet and gout section. Read more cautions about Atkins and gout, including what Robert Atkins himself said about his diet and gout.

Go to page 5 of 5 which lists the gout studies, study abstracts, other relevant studies and books used as background whilst preparing the pages on the Atkins diet and gout.

Want to read the menu and recipe ingredients for five courses of low/medium purine dishes which are also restricted carbohydrate?

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