Gout and the Atkins diet. Should you use it?Page 1 of 5 about Gout and the Atkins diet. Written by John Mepham of www.best-gout-remedies.com Referenced studies and study abstracts, the numbers in brackets, are listed on page 5 of the Atkins diet for gout 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 27 December 2011.
William Banting, said to be the first low carb dieter, and a successful one by his account, wrote his Letter on Corpulence (obesity) published in London in 1863. Just about 100 years before Robert Atkins M.D. first went on his low carb diet. It was a widely read booklet that sold 63,000 copies through many editions. "I have a very strong feeling that gout (another terrible parasite upon humanity) might be greatly relieved, if not cured entirely, by this proper natural dietary, and sincerely hope some person so afflicted may be induced to practice the harmless plan for three months (as I certainly would if the case were my own) to prove it; but not without advice." The proper natural dietary was his version of a low carb diet. He lost 46 lbs in 12 months between August 1862 and September 1863. At this time he was 65. He lived to be 81, a good age for that time. (A) The diet does not seem to have harmed him and he was delighted with its results. Click the link at the bottom of this page if you want to read his booklet. TO-DAY'S BEST SELLING LOW CARB DIET Gout and the Atkins diet is one of the hottest topics in natural treatment for gout. After all, the Atkins diet is the Western world's best known diet. So it's no surprise that so many people with gout wonder whether it should be used as part of natural treatment for gout and what kind of result they might expect. The answer is not straightforward and, as is common with all diets, there are the unknowns, the contradictory opinions from dieters and experts, the different results from clinical studies of the Atkins diet, and from other controlled carb diets (aka ketogenic diets). The Atkins diet and kidney disease Many people who suffer from gout have some degree of kidney disease, (aka renal impairment, renal disease). Dr.Atkins was emphatic in his books that anyone suffering severe kidney disease should NOT do his diet. If you have any stage of kidney disease, make sure you discuss the diet first with your doctor, and don't start it without doing so. Lack of gout and the Atkins diet, and gout and uric acid studies One major unknown is that there are no studies about gout and the Atkins diet. Another is there are few specific studies about whether the Atkins diet, or controlled carb diets, reduce or raise, blood (serum) uric acid (UA) levels. Very few studies of these diets take uric acid levels before they begin, whilst they are in progress and when they end. However, Robert Atkins did have a few useful things to say in his various books, about gout and Atkins, and uric acid levels, on his diet, and we'll look at what he said later on. And there are studies where uric acid fell, or didn't rise, on low carb diets. (14-17) And there's one where it did. (18). These pages about gout and the Atkins diet assume you know something about this diet - what it involves, why Dr.Atkins said it works for so many, the kind of foods you can eat, and how much and why. It's not an article about the Atkins diet per se. To follow it carefully you need to understand what carbohydrates are, which foods have them, how the body uses them for energy and what happens when they are controlled or restricted. If it's necessary to explain how something works on the diet from the viewpoint of its pros and cons in gout, for example the part played by lipolysis/ketosis, and what net carbs means, I shall do so. Learn the diet thoroughly But, of course, if you know little about this diet, and you and your doctor decide to use it for gout, it is essential you first buy the book - Dr. Atkins New Diet Revolution or the latest one The New Atkins For a New You and learn it from the horse's mouth, or in the case of the most recent one, from the three medicine professors/nutrition scientists who have written it - Dr.Eric Westman, Dr.Stephen Phinney, Dr.Jeff Volek. It includes new conclusions based on completed research since the publication of Dr.Atkins last book. Much of what Dr.Atkins said is not always repeated or interpreted accurately. When you really understand it ..... that's when you can look it up on the Internet where there are thousands of opinions about the diet, and a good number about gout and the Atkins diet. In these gout and the Atkins diet pages you'll learn where to find out where the gout-related opinions are. MY SUCCESS WITH THE ATKINS DIET I must declare an interest. I have used the Atkins diet and lost 90 lbs (6 stones 6lbs/41 kilos) in 18 months. I have my witnesses. Contrary to one of the things that are sometimes said about it - you only lose weight for a year - I continued to lose weight after one year. And of course it wasn't 90 lbs of water. Another frequent criticism of the Atkins diet is that you eat too much protein and fat. The critical bullfrogs' chorus is: "It's a high protein diet!" I did not eat any larger amounts of protein or fat. Actually my truth is I ate less protein and fat than before the diet, because as Robert Atkins says it does, my appetite fell on the diet. I ate "red" meat two or three times a week. So for me it wasn’t a “high protein” diet. And I did eat more fruits and vegetables. Unfortunately I didn't measure uric acid levels whilst on it. I feel enormously grateful to Dr.Atkins for this success and was saddened by his untimely death a few years ago. I could say more about my Atkins diet, but this article is about gout and the Atkins diet. I'll try to come up with a safe and workable possibility to this burning question of whether gout and the Atkins diet should go together, well, like eggs and bacon. And if you are sufficiently interested to want to know what I think, please ensure you read the whole section, across its five pages. Use the links at the bottom of this article, and the links on the other pages. Take your time. The pages will always be here. You could bookmark them if you wish. WHY COULD THE ATKINS DIET BE GOOD FOR GOUT? Let's begin by understanding why the Atkins diet could be good for gout sufferers. Later I'll explain why it may not be. Beating or controlling gout is all about reducing the uric acid (UA) level, so the real question about gout and the Atkins diet, is - can the diet reduce it? Losing weight on any diet usually reduces the uric acid level, but because of the absence of studies comparing this diet with others in this matter we don't know which is best. You would probably get better results on any diet if you also avoid high purine foods, which produce the most uric acid. I don't think avoiding high purine foods whilst using the Atkins diet is difficult. Just have a look. Surely you can cut them out? GOING THE DISTANCE Here's one reason for using the Atkins diet for gout. We all know that dieting is not easy. My impression from looking at many diet studies is that they usually show what Robert Atkins himself said about his diet. Because you can always eat something on his diet i.e. whenever you are hungry, and because quantities of food eaten are not limited by their calorie content (the energy they deliver), people are able to stay with it for longer than other diets that restrict calories or a single food diet fad diet, where hunger is a big issue and one reason why people fail. But studies show this isn't always so. Sometimes people can stay on other diets longer. The Metabolic Advantage Dr.Atkins said his diet had a metabolic advantage - a greater amount of weight loss per calorie consumed. I have the impression that studies usually (not always) show that more weight (and the all-important fat loss) is lost more quickly on the Atkins diet than on a low fat/low calorie, or low protein/high carb diet, or on another type of diet. At least in the first 6 months to one year. A 2006 meta-analysis (a study of studies) comparing carbohydrate intake, found that lower carb intake meant more weight loss than higher carb intake. (19). When compared to a low fat diet, dieters on a low carb diet dieters lost more weight over 6 months. (15). And in a meta-analysis comparing low carb diets with low fat diets, more weight was lost in the low carbers than in the low fatters after 6 months. (But after a year the results were about the same) (20). So many people will find the Atkins diet the easiest way to lose weight, although of course one of the basic truths of dieting is that you go with the one you find easiest to stay with. Crash diets are always the exception. I think of crash diets as those that recommend a single food or a single manufactured beverage type food. And of course not eating any carbohydrate would be a crash diet, so would it be if you remained on less than 20 carbohydrate grams a day for an extensive period. Or if you ate less than 1,000 calories a day. And if you have had a gout attack the chances of another on a crash diet would be much higher. If you have high uric acid, a crash diet might trigger it. THE ATKINS DIET, THE METABOLIC SYNDROME, INSULIN RESISTANCE AND GOUT There is a well-worn argument that the Atkins diet can also deal with insulin resistance and the metabolic syndrome. Dr.Atkins was emphatic that it does. So the Atkins diet could give you a double whammy advantage - you both reduce uric acid production through lost weight and improve its excretion if the metabolic syndrome is your cause of gout. So what is insulin resistance and the metabolic syndrome? On the road to an unfriendly place called gout-betes Insulin resistance and the metabolic syndrome is a pre type 2 diabetes, heart disease and stroke condition which some studies have shown also means high uric acid or a trend towards it, because, for one reason, high levels of insulin inhibit uric acid excretion.(1)-(6). Just about all markers of the metabolic syndrome have also been correlated with uric acid levels. These marker-signs on the road to gout-betes (and heart attack and stroke) are: obesity; high total cholesterol; high LDL cholesterol; high triglycerides (hyperlipidemia); high blood pressure (hypertension), insulin resistance leading to high insulin levels and high blood sugar (hyperglycemia), and a poor HDL/LDL cholesterol ratio.(Too little HDL, and simply put too much LDL). If you suffer from all this, or just three of them (there are actually two definitions, so discuss this with your doctor) you are not only more likely to get heart attack, stroke and diabetes, you also have a much higher risk of gout, and the latest disease on the march, non alcoholic fatty liver disease (NAFLD). In Low-carbohydrate nutrition and metabolism , a results summary of low carb studies between 2003 and 2007, (12) the researchers concluded carbohydrate restricted diets reduced cardiovascular (heart) markers of the metabolic syndrome. And they concluded clearly that low carb diets have been found to lower insulin, and insulin resistance. This is an important positive for the Atkins diet for gout. It is elevated insulin that impedes uric acid excretion, so this is an Atkins advantage. However, no-one has studied either the Atkins diet or low carb diets in gout, except the carbohydrate restricted diet, described below. Any doctor can arrange for blood tests for these markers and tell you what the results mean. If you have all, or three of these, and have had a gout attack, and don't drink much alcohol, this could well be your gout cause. As already mentioned, Dr.Atkins was convinced that his diet is good for insulin resistance and the metabolic syndrome. He explained that readings of these factors will go in the right direction i.e. fall, on his diet, although many studies of low carb diets do not find reductions in LDL cholesterol. LDL cholesterol may rise. If LDL cholesterol is one of these markers you need to reduce, I would research which kind of diet is likely to do this. There are plenty of medications to lower LDL if you wish to use that route. However, if there are stronger rises in HDL cholesterol, (very desirable) which is likely on the Atkins diet, the HDL/LDL ratio improves. But the dangerous LDL cholesterol (or to be more precise VLDL cholesterol - the tiny particles which get deposited on heart artery walls - atherosclerosis) - should fall too. This series of pages on gout and Atkins lists on Page 4 (see the link below), foods and vitamins reported to help lower LDL cholesterol, and which can be part of the Atkins diet if you use it, but you must discuss lowering LDL with your doctor. Dr.Atkins did not treat high LDL cholesterol only with his diet. He used vita nutrients too. A fall in the number of triglycerides in your blood (desirable) is also very likely on the Atkins diet. The Atkins diet isn't the only diet for insulin resistance and the metabolic syndrome, although for many it may be the best. Other diets (and not only restricted carbohydrate diets) deliver benefits against insulin resistance and the metabolic syndrome. THE DOCTORS EADES SAY RESTRICT CARBS AND YOUR BLOOD INSULIN LEVEL WILL FALL. In their books Protein Power and The Protein Power Lifeplan, the Doctors Eades noted that gout occurs in people with insulin related problems. They thought people with gout would benefit from their Protein Power diet. They reported that symptoms of gout improve, or go away, when weight is lost on their restricted carbohydrate diet. In fact, they noted improvements before much weight was lost - improvements due to metabolic changes brought about by cutting carbs. Two improvement examples are falling blood pressure and falling blood insulin. Like the Atkins diet, this diet restricts carbohydrates. When you restrict carbohydrates you get better control over insulin - less is made. And more insulin sensitivity - a better response to insulin. The Eades thought those who dieted at their Phase 1 Intervention level, 7-10 carbs per meal or snack, could reduce their uric acid. More details are in their Protein Power, and The Protein Power Lifeplan books. Recommended if you wish to pursue this further. Make sure you check with your doctor before you try this diet. BACK TO ATKINS Even if the Atkins diet does not lower your uric acid level, or by not enough to bring it down to the critical 6.0 mg/dL in men, and about 5.0 - 5.5mg/dL in women, the fall in the markers of the metabolic syndrome will definitely have made the diet worthwhile if they go in the right direction. The markers can improve even if there is no weight loss (unlikely). And if all these markers of insulin resistance and the metabolic syndrome improve, you will not have to take cholesterol lowering meds such as the statins. It may take six months for all markers to improve, but for some only a couple of weeks. Have studies shown that weight loss itself improves metabolic syndrome markers? Yes. Effect of Weight Reduction on Metabolic Syndrome in Korean Obese Patients (9) demonstrated this, and this study also found reductions in uric acid from weight loss. Simply losing weight on the Atkins diet may bring your uric acid level down. A GOUT DIET WHICH HAD SIGNIFICANT SUCCESS And now for something about what in my opinion is one of the best gout studies. (8) A specific test of how a diet performs on gout sufferers. In the gout sufferers diet study many of the frequently publicised gout diet rules were broken! Study participants ate purines without counting them - they were even encouraged not to eat some low purine foods - some high purine fish were eaten. Fish itself probably four times a week and meat consumption was not decreased. Intake of monounsaturated fat (olive oil, canola oil, certain nuts high in this fat and other foods with a high amount of this fat) was emphasised. However, they didn't drink much alcohol, but they weren't asked to avoid it. This is not the purines-in-foods route. The study's diet was significantly successful. Uric acid levels fell in all and so did gout attacks in 12 of the 13. At the end of the study only four had had a gout attack, in the previous six weeks. Other features of insulin resistance and the metabolic syndrome also improved. And they lost weight (median 7.7 kgs - almost 17 lbs - in 16 weeks) - only one didn't. But the researchers did not think the weight loss had caused the uric acid level fall. In this study, insulin resistance may have been the participants' cause of gout, and it may have led to high uric acid. They thought that an improvement in insulin sensitivity (i.e. the way insulin was working improved) was the factor that caused UA to fall. So why the improvement in insulin sensitivity? One of the diet's features was carbohydrate control, but a higher level was allowed than on the Atkins diet Ongoing Weight Loss (OWL) phase. They were allowed 1,600 calories daily, 40% from carbs, 30% from protein, 30% from fat. The proportions of protein, fat and carbs eaten may have accounted for its success. They ate 160 carbohydrate grams daily, and more protein (120 grams) than average. The researchers thought that increased proportional protein, the reduction in carbohydrates and the mono and polyunsaturated fats - all contributed to the improved insulin sensitivity. And protein has been reported in studies to lower uric acid levels (22-23), and not be a gout risk (7). Whatever it was, something had clearly worked. Why do I mention this ? To show that on this diet meat and fish were eaten and to explain that a non low purine diet, one which restricted carbohydrate, can work to improve insulin sensitivity and improve a gout sufferer's condition. So the metabolic syndrome (aka syndrome X), and insulin resistance leads to high levels of insulin, which means less uric acid is excreted and therefore uric acid level rises (1)-(6).
If this is your cause of gout consider using the Zone diet,
the diet used in this study. Or, if it isn't, note that this diet had a lot of success against gout.
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