The Atkins diet and gout. Will uric acid levels go up, or down, or stay the same?




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Referenced studies and study abstracts are listed on page 10 of the gout and Atkins section.

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This page about the Atkins diet and gout was last reviewed, or updated, on 6 April 2015.

URIC ACID – DOES IT GO UP OR DOWN ON THE ATKINS DIET?

The Atkins website (www.atkins.com) says that those Atkins studies that measured uric acid (UA) levels show they don't rise. This means that some science says the Atkins diet does not cause gout, except perhaps in the few cases where gout is triggered without an above normal UA level, or where the blood UA level does rise. The theory is that uric acid should fall because dieters are losing weight and, perhaps dieters excrete more uric acid because lowered insulin improves urci acid excretion.

Unfortunately there is not a lot of data about low carb diets and uric acid. In one meta-analysis (a study of studies) of 17 low carb diets, (24) about half of which were Atkins diets, uric acid had not been sufficiently tested. So data about it was not included.

What did Dr.Atkins say about uric acid?

He was never certain that the uric acid level would inevitably fall. But he was optimistic that it would. In his SuperEnergy diet book (1977) he reported that after doing “thousands of checks,” generally there was an improvement in the uric acid level with his diet plus his vitamins and minerals formula. By ‘improvement’ he must have meant ‘fall’ because he knew as well as any doctor that gout is usually caused by a high uric acid level (beginning at above 7.0 mg/dL in men and 5.5 - 6.0 mg/dL in women), and that it has to fall.

In the 1999 British edition of Dr.Atkins' New Diet Revolution and in the updated 2002 U.S. edition, words used about the uric acid level (UA) were "improving steadily," "will be normal," "should test normal."

Precise uric acid numbers were not stated. As far as a UA fall is concerned, these words are not ringing endorsements. The diet may bring down your uric acid level. But importantly, and as noted, the diet is not causing the uric acid to rise in the long term.

However, in the short term (a few weeks) uric acid may rise in tandem with the level of ketones. But after 6 - 12 weeks it should fall to the diet's start level, or below it. More details of this process are on page 3 of the gout and the Atkins diet section under the heading  "Raised uric acid caused by Ketosis."

And it has to be said that studies show losing weight by any diet does NOT always bring the uric acid level down. So Robert Atkins was right to be not completely certain.

Uric acid down with weight loss 

But to encourage you. In one study that used a low purine diet followed by a low carb diet, then back to a low purine diet, an average weight loss of 8 kilos (17.6 lbs) brought uric acid levels down by an average of 0.8 mg/dL in 80% of 15 participants. Some of them had gout. And the more weight lost, the more uric acid fell.(10)

Allopurinol on the Atkins diet for gout? 

Furthermore he did not say that you could not use allopurinol with his diet but did say you should discuss using allopurinol with your doctor, which is standard advice, diet or no diet. On the Atkins diet and gout forum on the Atkins website (see our
 Atkins diet resources page), a majority do not think that allopurinol slowed their weight loss. And he recommended (U.K.edition), that to normalise uric acid dieters should go to a higher level of carb intake in order that they slow weight loss to under two lbs a week. Fast weight loss could trigger a gout attack. And keep testing your UA level.

Large study reports on other Atkins-allowables which do well 

Other Atkins style foods which came out well (i.e. protective against gout) in Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men (7) (see this page for more details) were: low fat milk (whole milk not tested) - 
two milk proteins  are thought to lower uric acid; low fat yoghurt (yogurt) - but eat or drink small portions - they are quite high in carbs. And cottage cheese and ricotta cheese - both fairly low carb. No surprises here. These are low purine. Purine rich vegetables? No risk of gout, according to this study.

How much meat could you eat on an Atkins diet for gout?

And our thoughts on seafood intake which is useful for fish oil intake are on this page.

On the Atkins diet for gout - don't eat high purine foods.

A key factor with lowering uric acid levels is whether Atkins' dieters also avoid high purine foods.

When Dr. Atkins reported on uric acid levels on his diet (see above) he did not say whether low purine Atkins -acceptable foods were a focus on his diet. But this is highly doubtful. He wasn’t focused on gout, just on losing weight. Their inclusion on an Atkins diet would help uric acid reduction.

If Atkins’ dieters eat foods like offal (organ meat), sardines, anchovies, mackerel, and game (game meat) like pheasant and venison (deer meat), all allowable on the diet, plus the other Atkins-allowables on the high purines list, it would probably be harder for the Atkins diet to reduce uric acid and might well cause a rise.

And this of course goes for the low carb studies too, those that don't find that uric acid falls in their studies

Visit our first page about purines to view the high purine foods

Related links you might enjoy

Go to page 1 of 10 about gout and the Atkins diet, where I explain why it might be good for your gout.

Go to page 3 of 10 of our Atkins diet and gout section. What Robert Atkins himself said about his diet and gout.

Go to page 4 of 10 where where I explain our modifications to the Atkins diet for gout sufferers.

Go to page 5 of 10 The Atkins diet and the insulin resistance cause of gout.

Go to page 6 of 10  My Atkins diet success story.

Go to page 7 of 10  Meat and gout on the Atkins diet

Go to page 8 of 10  for free Atkins diet resources

Go to page 9 of 10. What has been said about ketosis and uric acid.

Go to page 10 of 10 which lists the gout studies, study abstracts, other relevant studies and books used as background whilst preparing the pages on the Atkins diet for gout.



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