The Atkins diet and gout. Will uric acid levels go up, or down, or stay the same?
Page 2 of 5 about The Atkins diet and gout. Referenced studies and study abstracts are listed on page 5 of the Atkins Diet and 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 17 March 2011.
URIC ACID - 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 cases where gout is triggered without an above normal UA level, or where the blood UA level does rise. The theory is that UA should fall because you are losing weight and, perhaps you excrete more uric acid because lowered insulin does not inhibit that excretion. So 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 the 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 5.5mg/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 numbers were not stated. As far as a UA fall is concerned, these are not ringing endorsements. It may bring down your uric acid level. But, importantly, as noted, the diet is not causing the uric acid to rise. And, it has to be said, unfortunately, studies show that losing weight does NOT always bring the uric acid level down. 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. On the Atkins diet and gout forum on the Atkins website a majority do not think that allopurinol slowed their weight loss. And he recommended (U.K.edition) to normalise uric acid go to a higher level of carb intake to slow weight loss to under two lbs a week. And keep testing your UA level. "Red" meat and seafood on the Atkins diet If you look at this table of high purine foods , you’ll see that beef, lamb, pork, plus "white" meat chicken and turkey - all allowable on the Atkins diet - are not high purine foods, they are medium purine. And that fruits and vegetables, many of which are allowable, on the Ongoing Weight Loss phase of the Atkins diet, are usually medium or low purine. Moreover, a large study found that purines-wealthy vegetables do not increase the risk of getting gout (7). Everyone knows you can eat high quantity meat on the Atkins diet. Some blame meat for causing gout attacks. I trust this is because meat is among the last foods they ate before their gout attack and the one with the highest purines.Salmon, trout and tuna have more purines than beef and pork and lamb. But when did you last hear of someone talking about salmon, trout or tuna causing a gout attack? And chicken breast has more purines in the table above than various cuts of beef but that doesn't stop chicken being more recommended for gout than beef. And in the study described on page 1 of the Atkins diet and gout pages, (8) meat consumption was not decreased, although participants already had gout. But in some cases in this diet-study, gout attacks had not been reported after 16 weeks on this diet (not the Atkins diet, not a low purine diet), and overall gout attacks' frequency fell. And after one year, five of nine patients had not had another gout attack and three had just one, whereas before the study began participants had at least two gout attacks in the previous four months. Meat had not caused gout attacks on this diet, at least in the five who had not had another attack, neither had the fish which you will recall if you read it, they were encouraged to eat four times a week. In Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men (7) the researchers tracked the diets of 47,150 men with no prior history of gout over a 12 year period. During this 12 year period, 730 men were diagnosed with gout. So the diets of men who developed gout were put under a statistical microscope. The researchers found that one serving of meat in general a day is associated with a slight risk of gout. Two servings increases the risk by 41% compared to people who ate slightly less than a serving a day. And an additional serving of meat daily increased the risk of gout by 21%. Among meat items the increased risk of gout was only from beef, pork and lamb. Specifically in this study, these meats were not associated with a risk of gout: sausage; salami; bologna; bacon (yes bacon despite the findings about pork - does a bacon cure eliminate purines?); hot dogs and hamburgers; chicken and turkey; and chicken liver and beef liver! Although all the purines tables I have ever seen say that liver is high purine! Perhaps we simply don't know enough about purines.Corned beef and ham were not explained. The risk of gout from seafood in general seemed to be a bit higher and tuna was one of the highest, along with what was described as dark meat fish. (Probably including sardines and mackerel, both high purine). A headline statement about this is... people eating above half a serving of fish a day (this is statistics - the researchers had to adjust for lower fish intake) had a 51% greater chance of getting gout than those who hardly ate fish in a day. All items of fish were associated with an increased risk of gout. These findings were more relevant among men over 40. The men who got gout, in fact the whole study population, were not on anti gout diets, nor using natural treatments for gout. So some of the other factors not included would have been water or alkaline water drinking, pH levels, vitamin and minerals intake, and eating gout positive foods. To put this another way.. If someone eating meat two times a day, (with other foods) also drank alkaline water, (or two litres of plain water daily to dilute uric acid) and took at least 500 mg of vitamin C daily and the flavonoid quercetin and ensured he/she had more than 140 mcg of folate in his/her diet every day, and ate cherries or celery every other day in some form, would his/her risk of gout be 41% above the person who did none of these things but just ate a single portion of meat daily? (Of course with other foods). And would an extra meat serving mean an additional 21% risk of gout? I doubt it, and I could give other and somewhat similar scenarios from other natural treatments for gout, but you get the idea. What do you think? But this study is telling you to be careful, (including all your dietary habits which include natural treatments for gout) with the type and amount of meat and seafood you eat. Other Atkins-allowables which do well Other Atkins style foods which came out well in this study (protective against gout) were: low fat milk - 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 pretty low carb. No surprises here. These are low purine. Purine rich vegetables? No risk of gout, according to this study. The Atkins diet and gout - don't eat high purine foods. A key factor with uric acid levels is whether Atkins' dieters were also avoiding high purine foods. If they were eating foods like offal (organ meat), sardines, anchovies, mackerel, and game like pheasant and venison (deer meat), (all allowable on the diet), plus the other Atkins allowables on the high purines list, it would be harder for the Atkins diet to reduce uric acid. Were they avoiding high purine foods? We don't know. But it isn't likely because very few of his dieters would have been gout sufferers. Dr.Atkins never discussed this point in his books. With the Atkins diet gout should have a better chance of being improved through falling uric acid levels if you also avoid high purine foods. Avoiding high purine foods may reduce uric acid by 1 - 2 mg/dL. And this of course goes for the low carb studies too, those that don't find uric acid falls in their studies. Were study patients avoiding high purine foods as well? It's not likely, and it's not said so.
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