You’re not alone if you have a lot of questions about the ketogenic (keto) diet — it was the most Googled diet of 2018. But can eating a keto diet help control the symptoms of gout, as some recent headlines would have you believe? Before you jump on the keto bandwagon, here’s what you need to know about keto and gout.
Understanding the Keto Diet
The ketogenic diet is not new, even though it’s been making headlines now more than ever. The extremely low-carb, high-fat, moderate-protein diet has been used for nearly 100 years to help control seizures in children with epilepsy.
“The theory behind a keto-like diet is that once the body has depleted its stores of glycogen — the back-up energy in the liver and muscles — it will look to the body’s fat stores as fuel,” says Sophia Kamveris, MS, RD, LDN, a Boston-based nutritionist and author of The 28-Day Gout Diet Plan.
A result of this metabolic state — called ketosis — is decreased hunger and increased weight loss. Proponents of the keto diet believe that it can also be helpful in managing diabetes, Alzheimer’s, and more.
But does a classic ketogenic diet — which is made up of around 70 to 80 percent fat, 20 percent protein, and 5 percent carbohydrates — make sense for a person with gout, a type of inflammatory arthritis? While there is some interesting research on the topic, many experts say not so fast.
The Role of Diet in Gout Management
Gout is a common form of arthritis. It develops when too much uric acid builds up in the body, forming painful needle-like crystals in the joints. Treatment of gout is centered on medications that help control uric acid levels, as well as anti-inflammatory drugs that can ease the pain of acute gout attacks.
Diet can also play a role in managing gout. Foods like liver, anchovies, trout, turkey, and bacon are high in substances called purines, which your body breaks down to form uric acid.
“For decades, eating a low-purine diet has been administered as a part of the gout treatment plan to help lower uric acid levels,” says Sophia Kamveris, MS, RD, LDN, a Boston-based registered dietitian and author of The 28-Day Gout Diet Plan.
A ketogenic diet is typically high in purine-rich animal protein foods, which makes keto a counterintuitive choice for managing gout. However, there has been limited research that flies in the face of long-held beliefs about diet and gout, suggesting that keto might help in managing painful gout symptoms — but more research is needed.
How Ketosis Might Help Manage Gout
Researchers at Yale University looked at how putting the body into a state of ketosis can impact the inflammation that contributes to diseases like gout. When they fed rats a ketogenic diet and then induced a gout flare, the animals had less joint inflammation and swelling than they did when they were not on the keto diet.
But: “We are not trying to say that a ketogenic diet prevents or cures gout,” says Emily Goldberg, PhD, postdoctoral fellow in the departments of comparative medicine and immunobiology at Yale University. What this research did show, she says, is that it is possible to target the source of inflammation in gout to prevent acute symptoms of the disease.
Scientists have also looked, in test tubes, at the impacts that ketone production might have on humans. The results have been promising; however, scientists say that further research is needed before they can recommend a keto diet to help keep gout under control.
The Problem with Following the Keto Diet for Gout
For now, it’s best to stick with conventional wisdom regarding food and gout — that most diets high in animal proteins are risky for a person with the condition, says Kamveris.
“We know that red meats and seafood are especially rich sources of purines, and when eaten in excess can raise uric acid levels,” she says.
Research in humans supports this way of thinking. When people with gout ate a diet high in purines from animal sources over a two-day period, they were nearly five times more likely to have a gout flare compared with people who avoided purines, in a 2012 study from Boston University published in the journal Annals of The Rheumatic Diseases. “A poor diet can absolutely lead to more gout exacerbations, even if the uric acid is fairly controlled with medication,” says Randall N. Beyl Jr, MD, a rheumatologist in Albertville, Alabama.
As for following a keto diet that is also low in purines? It’s not impossible, but sustainability is at the top of the list of criticisms diet experts have about the ketogenic diet — and layering even more limitations on top of an already restrictive diet would prove especially challenging.
What’s more, the whole grains and starchy vegetables that a person on a ketogenic diet would need to stop eating can actually help with gout.
“Research now demonstrates that foods that are rich in antioxidants like the ones abundant in the DASH — Dietary Approaches to Stop Hypertension — diet, helps to lower uric acid levels,” says Kamveris.
Choosing quality carbohydrates rather than avoiding them altogether in a keto diet, may be a better route to take. Eating plenty of low-glycemic carbs — think legumes, dairy, and some fruits — was linked with reduced uric acid levels in a 2016 study from Johns Hopkins University School of Medicine. Lower carbohydrate diets that were also higher in protein and fat increased uric acid.
Going Forward with Gout
So what should you eat when you have gout? “I recommend copious amounts of whole grains, plant-based protein, fresh vegetables and fruits, daily nuts, legumes, low-fat dairy, oily fish, and chicken and eggs in moderation,” says Dr. Beyl.
He suggests that gout patients avoid red meat, shellfish, high-fructose corn syrup, refined sugar, liquor, and beer.
It’s important to remember that the right kind of diet can play an important role in managing gout, as long as it’s used with — and not in place of — prescription drugs. “I always encourage strict compliance with our gout medications, but try very hard to emphasize the importance of diet to treat the patient as a whole — not just their arthritis,” says Dr. Beyl.
In other words, the diet that is sustainable, helps you feel great all around, and helps keep gout symptoms controlled is the way to go.
If you do decide to make a change in your diet for any reason, seek out medical supervision from your doctor or a registered dietitian who is experienced with inflammatory conditions.