Page 2 of 10 about The Atkins diet and gout.
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
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?
On the Atkins diet for gout - don't eat high purine foods.
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
Other Atkins diet and gout pages