Gout and Atkins. Cautions and Criticisms....are they valid?
Page 3 of 5 about Gout and Atkins. Referenced studies and study abstracts, the numbers in brackets, are listed on page 5 of the gout and the Atkins diet section 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. This page was last reviewed or updated on 19 May 2010.
WHAT DR.ATKINS SAID ABOUT HIS DIET AND GOUT And now for cautions about gout and Atkins. Over the years in his books Dr.Atkins said a few things about whether people with a history of gout should do his diet. In his 1977 SuperEnergy diet book (which included the carbohydrate controlled diet) he thought for those with gout, or a high uric acid level, that the strictest level of his diet, as he called it then - it's now called the Induction phase - i.e. up to 20 carbohydrate grams daily - should not be attempted unless the person was on anti gout medication. And the doctor approved of the diet. (You might think that anyone who has had a gout attack is on medication, but many aren't. Some simply don't bother to make follow-up doctors' visits). No surprise about the gout part of that, but he also included those with a high uric acid level. How high is high? He didn't say, but usually above 7.0 mg/dL in men, 5.5 - 6.0 mg/dL in women. The anti gout medication he was probably referring to would have been allopurinol or probenecid, (a couple of brand names: Benemid, Benecid; there are more), both in use at that time. And he thought that those prone to high uric acid, (and I should add a genetic history of gout) could have a gouty flare up on his diet. Of course he thought that gout patients, and those who are prone to gout, must get their doctor's approval and remain under regular medical supervision whilst on the diet. One aspect of this is frequent uric acid blood tests. Another should be the direction of all the insulin resistance and metabolic syndrome markers discussed on our first page about gout and Atkins. Other points he made about his diet and uric acid are on page 2 of our gout and Atkins pages. Gout and kidney disease Many gout sufferers got it from kidney disease of some type. Dr. Atkins frequently warned that anyone with severe kidney disease should NOT do his diet. If you have any degree of kidney disease, discuss the diet with your doctor first, and don't go on it until you have. MEDICINE TO TAKE? This is my idea, not one explained in Dr.Atkins' books. You could obtain a prescription (RX) from your doctor for advance preventative or pain killer gout medicine (the medical word is prophylaxis) such as low dose colchicine or NSAIDS like indomethacin, ibuprofen or diclofenac sodium. This prescription (RX) is frequently written in conventional pharmaceutical gout treatment when patients are prescribed these to deal with an attack that falling uric acid often, and curiously, causes. Discuss this with your doctor. WHY CAN A LOW CARB DIET TRIGGER A GOUT ATTACK? Why might a controlled carbohydrate (aka a ketogenic) diet be another gout attack trigger in someone who has had a gout attack? One reason may be that low carb diets are dehydrating, especially in the first two weeks when some weight lost is water. Dehydration is a known gout trigger. And if falling weight reduces your uric acid that in itself, can be a gout trigger. On any diet. The answer of course is: 1. Drink plenty of pure water - at least the recommended amount of eight glasses daily. Water in other drinks like tea, coffee, and juices and in foods, does not count. 2. Make sure you do the diet correctly. Remember it does mean eating plenty of low carb veggies and fruit. Studies show their fibre (fiber) helps to lower uric acid and LDL cholesterol. They are also required to offset any loss of potassium, which may occur. Psyllium husks are high fibre (fiber) - about four grams per serving (depends exactly on the brand) - have no net carbs, but do not contain potassium. They also remove hunger pangs. 3.Fast weight loss on any diet can also cause a gout attack. If you avoid the induction phase of 20 carb grams a day, (actually net carbs - what net carbs means is explained on page 4 of our Atkins diet gout section) you do not have to lose weight fast. Two pounds a week is enough. This can be achieved on the Ongoing Weight Loss phase (OWL) of the diet. Lose five lbs or more a week and if you have high uric acid you could trigger a gout attack especially if you already have had one. So what you have to find out is how many net carb grams a day you can intake in order to lose just two lbs a week. My guess is 35-40 gms a day, but everyone is different and this is one number you will have to discover through self trials. WHAT ABOUT LIPOLYSIS - KETOSIS? Lipolysis means fat burning, and ketosis is the generation of ketone bodies caused by lipolysis. A central feature of the Atkins diet is that when the body is starved of glucose from carbohydrates, after a couple of days or so, it turns to burning fat for energy as its primary source of fuel. Hence the weight loss. The body, and the brain, use ketone bodies for fuel too. Ketones circulate in the blood and they are eventually excreted in the urine, (mainly) but also in perspiration and in breath. The lipostix or ketostix you can purchase from pharmacies (chemists) or online, measure the amount ketones your burning fat produces by indicating the amount in urine. The greater the volume of them in urine, the more fat you are burning. The ketosis test is easy to do. The beauty of the stix is that they tell you whether you really are limiting your carbohydrates sufficiently and should tell you in advance whether you're losing weight. They would also warn if you are "burning" too many ketones. If so they would be at their maximum purple colour (color), and you would probably be losing weight too quickly. They aren't expensive. Exercise makes the diet work more From my own experience of the Atkins diet on this Gout and Atkins page I learnt the lipostix/ketostix change of colour (color) is given a boost (i.e. more ketones are produced) when you exercise. This makes sense. Exercise means burning more calories and those calories on this diet will mainly come from burning fat, not using glucose. More fat is used, and more ketones are produced. And moderate exercise is good for gout. This is because the better the blood circulates, especially at body extremities like the big toes (where gout so often first flares), the less likely it is that crystals will be deposited. Exercise boosts blood circulation. Furthermore, when I lost weight (90 lbs in 18 months, witnesses included) my ketones never turned the stix to its maximum purple. I usually found my stix's colour (color) somewhere in the middle of the range. i.e. I wasn't burning nearly as many ketones as I could if I had been on a lower number of carbohydrates. I was on about 35-40 net carbs a day. So I wasn't in ketosis that much - middle of the range - and I wasn’t told I had bad breath. Raised uric acid caused by ketosis? One criticism of ketosis is that, like elevated insulin, ketones inhibit uric acid excretion which causes raised uric acid (UA). So are gout and ketosis connected? A study demonstrated raised uric acid among women on a fast, but the Atkins diet is not about fasting. In a low carb study where the uric acid level rose, the dieters were on less than 10 grams of carbs daily for eight weeks (18), figures shown in (19). Ten grams of carbs daily is not the Atkins diet. The Atkins website says that studies show the Atkins diet does not raise uric acid levels so if ketones raise UA, the rise is offset by something else such as perhaps, falling weight or the amount of protein. Dr.Atkins didn't report the blood uric acid level always rises. He thought it fell or remained the same. (See page 2 of our gout and the Atkins diet section).To make those statements he would have measured his patients' uric acid levels. He reported doing this in his SuperEnergy diet book (1977) - see page 2 of our gout and Atkins section. If rising uric acid on the Atkins diet happens to you, increase carbohydrate intake. i.e. a modified Atkins. And never use the Induction phase. Make sure you work closely with your doctor. If you have had a gout attack discuss using allopurinol (which Dr.Atkins recommended if you have gout) or febuxostat (Uloric, Adenuric). He did not recommend allopurinol if you don't have gout and in many (maybe all) countries allopurinol and febuxostat will not be prescribed only for raised blood (serum) uric acid. The use of allopurinol with the Atkins diet has not been studied, but it has been used by gout sufferers on the diet - see page 4 of our gout and the Atkins diet section - the Atkins' website forums. Bad breath Here's another criticism. Ketones give you bad breath. Ketones are expelled in the breath too. Well, if that does happen to you, what a small price to pay it is if the diet is working. There are plenty of ways of dealing with bad breath. If you want a natural way, chew parsley or take parsley supplements.
Parsley is an excellent food for a gout sufferer.
Another criticism. Ketones, which enter the bloodstream, cause ketoacidosis - over acidic blood. They have a low pH so the pH of blood falls too low. For ketosis to turn into ketoacidosis, which is serious, you would have to be an undiagnosed Type 1 diabetic unable to burn glucose and who therefore uses fat for energy. So you see your doctor before starting the Atkins diet. In at least the over fifty studies of low carb diets,ketoacidosis has not been found in anyone. The reality is that hundreds or thousands of Atkins dieters are not rushed to hospital daily suffering it. There was supposed to have been a case of ketoacidosis on the Atkins diet in 2006, which was highly publicised by the U.S. media.
If you wish to know more, and decide for yourself, read this judgement of that case.
There is much med-tech language, but enough plain English to get the gist.
The Atkins website says that ketones produced by burning fat do not change the pH balance, (aka the acid/base balance), but stay within a safe blood pH level as long as sufficient vegetables are eaten. Vegetables are usually alkaline. i.e. they raise pH levels (desirable). You can purchase alkaline boosting supplements.One study found that after 24 weeks blood pH fell slightly on a low carb diet. It also fell on a low fat diet(13). Dr.Atkins was adamant that ketosis is safe and natural. He called it benign dietary ketosis (or BDK). Burning our stored fat is natural because it's how humankind evolved. In times of food scarcity we needed this mechanism, and the stored fat, to keep going - at least for a while. Over a 40 plus years' career, he dealt with thousands of diet cases. From all this experience he did not report any difficulties with ketosis. Other criticisms of ketosis It causes heart problems; it depletes muscles and it causes breathing problems. Keep visiting your doctor on the Atkins diet if you have had a gout attack in the past (just one is enough), and obviously if there's any sign of these s/he will stop the diet. I can't find any studies confirming any of these. If you can, please let this website know using
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Here are two events I noticed on the diet. 1. Fatigue, but I was dieting in a very hot climate tropical country and can't say whether it was the diet or not. 2. Dizziness and the thought "I am going to faint". I had one episode of this, which I think was caused by low blood pressure. I sat down for a few minutes and it went away and did not return. Before I started the diet I had high blood pressure. No question that the diet brought it down, maybe too much, and I should have paid more attention to this. Most frequent complaints of Atkins dieters - constipation (take fibre/fiber supplements), energy loss, dehydration. * The New Atkins For A New You. Publishers: The Fireside Division of Simon and Schuster Inc., New York 2010.
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