If you eat meat, fish, or organ meats, you may be wondering: do these keto-friendly foods increase your risk of developing gout?
After all, conventional wisdom claims that high protein intake and high-fat diets are behind gout attacks.
Though there’s logic behind this theory, there’s very little research to support a link between animal protein, healthy high-fat intake, and gout risk.
However, there are other causes of gout — and eating a high-quality diet is one of the best ways to prevent or relieve gout.
Gout is a form of arthritis caused by the painful accumulation of uric acid crystals in joints, tendons, and extremities — particularly the joints in the hands and big toe.
Uric acid crystals form when blood levels of uric acid reach unusually high levels. This condition is called hyperuricemia, and it’s the main marker for gout risk.
It’s important to note, however, that gout is relatively rare: only 5% of people with uric acid above 9 mg/dL (considered hyperuricemia) develop gout[*].
Centuries ago, gout was known as “the disease of kings” and a “rich man’s disease.” As it happens, rich people were the only people who could afford sugar — a now well-documented risk factor for gout.
Gout affects about 1-4% of the population (3-6% of men and 1-2% of women). Worldwide, the prevalence of gout has been rising, likely due to worsening dietary habits, lack of exercise, and increasing rates of obesity and metabolic syndrome. There also appears to be a genetic component to gout risk[*].
To treat gout, doctors typically prescribe pharmaceutical drugs that decrease uric acid production, or they suggest a low-protein diet. But new research is shedding light on the causes of gout, and it’s becoming clear that there are better ways than cutting protein to get rid of gout.
Gout happens when uric acid crystals form as a result of too much uric acid in your blood, build up in your connective tissue, and cause pain, swelling, redness, and inflammation. To get rid of gout, you want to decrease your uric acid production.
There are a few potential culprits that drive up uric acid production:
Protein and Gout
Doctors often suggest low-protein, low-meat diets for gout.
Their reasoning is that most sources of protein contain in compounds called purines that are precursors to uric acid.
Purines make up the genetic material in DNA and RNA, and when you digest purines, your body breaks them down into uric acid. The richest sources of purines are meat, fish, and organ meats.
The theory is that decreasing your purine consumption will decrease your uric acid levels, and in turn, decrease your risk of gout.
However, the science on protein consumption and gout is mixed.
For example, one observational study linked meat and seafood consumption to increased gout risk[*]. But in a more controlled study, researchers found that six months of a high-protein, low-carb diet actually reduced uric acid levels in 74 overweight or obese participants[*].
The authors concluded that “the Atkins diet (a high protein diet without calorie restriction) can reduce [serum uric acid] levels despite substantial purine loading.”
Other data indicates that vegans have higher uric acid levels than meat eaters[*], which suggests that there’s more at play than just protein consumption.
More recent research found that when you eat a high-protein diet, your kidneys have no problem excreting the uric acid they make from purines.
In other words, more purines in, more uric acid out[*]. As long as your kidneys are working well, protein doesn’t appear to increase your risk of gout.
Dairy and Gout
Since dairy has lots of protein (and purines), some worry that eating milk, cheese, or yogurt increases gout risk.
But in a large study that followed 47,150 people over 12 years, researchers found the opposite: dairy consumption was inversely correlated with gout risk[*]. While this study doesn’t prove cause and effect, it seems that dairy is in the clear when it comes to gout.
Sugar and Gout
Sugar is a much more likely contributor to gout than protein. In particular, fructose, the sugar common in fruit and corn syrup.
Fructose increases uric acid production, while simultaneously preventing uric acid clearance.
Your liver processes fructose differently than it does other sugars. If your liver gets loaded up with fructose, it can interfere with protein metabolism and deplete ATP (cellular energy).
When your ATP drops, your uric acid production increases[*] — and as you read about before, high uric acid is the leading risk factor for gout.
The second reason to avoid fructose involves the excretion of uric acid. When you eat a lot of fructose long-term, it reduces your kidneys’ ability to dispose of uric acid.
But it’s not just chronic consumption — even a single dose of fructose decreases uric clearance[*].
The most common source of fructose in the modern diet is high-fructose corn syrup. You’ll find it in everything from soda to cookies to cereal. Make it a point to avoid high-fructose corn syrup; you’ll feel a lot better without it.
Insulin and Gout
Sugar — fructose or otherwise — also increases your risk of gout by manipulating your insulin levels.
When you eat lots of sugar, your blood sugar rises. In response, your pancreas releases insulin, your blood sugar controller, to mop up excess blood sugar and get it into your cells, where you can turn it into either energy (for immediate use) or fat (for energy storage).
But if you eat a lot of sugar on a regular basis, your blood sugar stays chronically high, and insulin stops communicating with your cells effectively.
This condition, known as insulin resistance (or metabolic syndrome), causes your pancreas to pump out more and more insulin to do the same job.
High levels of circulating insulin decrease uric acid clearance[*]. To keep gout at bay, you want to stay sensitive to insulin. The best way to do that is by cutting sugar out of your diet.
Alcohol and Gout
Alcohol is a well-established risk factor for developing gout, and also increases the risk of gout attack if you already have the condition.
In one prospective study, researchers followed 47,150 men with no history of gout over 12 years. They found that drinking beer, and to a lesser extent, spirits, was strongly and independently associated with gout risk. Interestingly, wine was not[*].
Another group of researchers asked a different question: for those already suffering from gout, to what extent does drinking alcohol increase the risk of recurrent gout attack?
They found that all types of booze, including wine, were linked to increased risk of a gout flare-up in the 24 hours post-imbibing[*].
Avoiding gout comes down to restricting the real causes of elevated uric acid listed in the prior section. Meat, fat, and protein don’t seem to contribute to gout much.
Instead, cut down on fructose and alcohol to maintain healthy uric acid levels and reduce gout risk. There’s fructose in fruit, but the main source of fructose is high-fructose corn syrup. If you want to do one thing to reduce your gout risk, cut high-fructose corn syrup out of your diet.
Another risk factor for gout, metabolic syndrome, is also linked to sugar consumption. If you have metabolic syndrome or type 2 diabetes — if you have high blood sugar, high insulin, obesity, and high blood pressure — you’re at greater risk for gout.
Fixing metabolic syndrome and insulin resistance won’t happen overnight. But low-carbohydrate diets (like the ketogenic diet) have been shown to keep blood sugar low, improve insulin sensitivity, and stimulate weight loss[*].
The ketogenic diet is a great option for preventing gout.
You also want to stay hydrated to avoid gout. Be sure to drink enough water. When you’re dehydrated, your body stops excreting uric acid, which means uric acid crystals are more likely to form on your joints[*].
Finally, a handful of medications — most of them diuretics that can cause dehydration — have been linked to increased gout risk. And researchers have also found that low doses of aspirin can disrupt kidney function and impair uric acid clearance[*].
The first thing to do if you have gout is consult a doctor. He or she may put you on medications called xanthine oxidase inhibitors to lower your uric acid levels.
Beyond that, you’ll want to think about lifestyle changes, particularly when it comes to diet and exercise.
What To Eat If You Have Gout
Certain foods and supplements have been shown to protect against gout, and potentially reduce gout symptoms. These include:
- Vitamin C — makes your kidneys excrete more uric acid[*]
- Olive oil
- Dairy products
- Cherries — shown to reduce plasma uric acid in women[*]
- Mineral water — inhibits uric acid crystal formation[*]
- Coffee — moderate coffee consumption lowers uric acid levels[*]
Exercise And Gout
In addition to the above dietary tweaks, a regular exercise program may also help with gout.
- Increases insulin sensitivity, and can improve metabolic syndrome[*]
- Clears liver glycogen, which contains uric-acid-promoting fructose
- Prevents hyperinsulinemia, which may help with uric acid clearance[*]
What about a ketogenic diet for gout?
During the first couple weeks of the keto diet, you may see a short-term increase in gout risk. That’s because high levels of ketones stop your kidneys from properly clearing uric acid[*].
But here’s the good news: after two to three weeks, you become keto-adapted, and your uric acid levels return to normal. In fact, on a ketogenic diet, the long-term risk of gout (measured by uric acid levels) actually decreases[*].
For one thing, keto keeps your insulin levels in check. When you carb restrict on a high-fat keto diet, your blood sugar stays low — and when your blood sugar stays low, your insulin stays low, too. Low insulin, if you recall, helps your kidneys clear uric acid.
There are other mechanisms at play, too. On a ketogenic diet, your liver produces ketones, with beta-hydroxybutyrate (BHB) being the most important.
Recently, a group of researchers at Yale found that BHB reduced the risk of gout flares in rats[*]. BHB, reduces inflammation by inhibiting a part of the immune system called the NLRP3 inflammasome, which could decrease risk of gout attacks.
Keto And Gout: The Bottom Line
Many things increase your risk of developing gout. Dehydration, fructose, insulin resistance, and alcohol all increase uric acid, which drives crystal formation and eventually gout.
To prevent gout, avoid these risk factors and try dietary tweaks like drinking coffee and taking vitamin C. Also consider a regular exercise program to boost your insulin sensitivity.
Finally, when it comes to gout risk, don’t worry about eating fat and protein. Sugar (especially fructose) is the macro to avoid.
A low-carb ketogenic diet appears to be a good long-term strategy for reducing gout risk. To learn more about going keto, check out our easy-to-follow Keto Kickstart Guide.