Gout: Relief Through Metabolic Change

A topic that we occasionally need to discuss with clients who are embarking on their weight loss journey with PHD Advanced Nutrition and PHD Weight Loss is gout. This debilitating metabolic issue is a burden for all who suffer from it.  A small minority of people going through their life change with PHD notice an increase in gout related symptoms. This can result after beginning the metabolic shift recommended by Dr. Ashley Lucas and her Certified PHD Consultants. While this effect may be painful, it is temporary and a sign of the body changing its metabolism from carbohydrate addiction to fat burn.

Nutrition can play a tremendous role in the management and prevention of gout. Unfortunately, many people do not find the relief they are seeking from the traditional dietary recommendations.  A closer look at the science of gout demonstrates that a metabolic shift toward fat burn may improve or eliminate your gout symptoms all together.

First, let’s look at what gout is all about.

Gout is classically described as a condition characterized by the accumulation of uric acid in the body to such a high level that it will crystallize into the joints. The result of a gout attack is pain, swelling and redness of the effected joint. The body produces uric acid from the digestion of foods rich in purines as well as the turnover of cellular material. Purines are literally in our DNA as a backbone of the genetic material it carries. The body must balance rising levels from every source and pair it with elimination in the kidneys through urine.  An imbalance of this system will result in elevated blood levels of uric acid and possibly gout attacks.

Medical treatment of gout involves multiple medication options. While these medications can be effective, if the underlying reason why the body has elevated levels of uric acid isn’t corrected, the medication requirement may be permanent and occasionally inadequate. Nutrition can be the key to bringing the uric acid levels down and preventing future attacks. The traditionally recommended diet is one with limited foods containing purines. These foods include numerous nutritionally dense items such as seafood, red meats and organ meats.  Often certain vegetables are avoided and limiting alcohol intake is also recommended.

Despite the efforts of many people following these recommendations, some continue to struggle with recurrent and chronic symptoms. While medical therapy can be effective, I have found evidence to suggest that the traditional nutrition approach may be flawed.

The current literature suggests that a diet high in purine rich foods will increase serum uric acid by 1-2 mg/dl.  However, because uric acid levels are tightly controlled by the body, there is a natural kidney response to this increase.  Urinary excretion of uric acid increases in response to purine consumption.  In addition, if the purine rich food is high in protein the kidneys respond with additional uric acid excretion.  Both adjustments by the body, will counter the mild rise in blood levels. So, while traditional dogma simply links dietary consumption of purine rich food to elevated levels of uric acid, the truth may be much more complex.

Why does the risk of gout attack increase when the body shifts fat burn into high gear? It’s all about the fuel.

The human body can run on two fuel sources.  We can either burn glucose (carbohydrates/sugar) or fat. After years of eating the recommended American diet the human body becomes inefficient at burning fat. When we ask it to change fuel sources, there is a transition period of two to three weeks under the best circumstances. During this transition several physiologic effects can be felt. They can all be explained by the process required to wake up the fat burning potential of the human body.

Once the body starts to burn fat it produces “ketones.” This will be a topic of another blog post, but in basic terms these ketones are what the body uses as fuel while burning mostly fat. Initially, when these naturally occurring fuel sources are circulated to the kidneys, some of them are excreted in urine instead of used for fuel as your cells have not yet learned how to burn them efficiently. During this transition, the ketones “compete” with uric acid for excretion causing a temporary increase in blood levels of uric acid. This may result in a gout attack in susceptible individuals. While this is not ideal, the transition is well worth the effort because of the additional metabolic effects seen after the transition occurs. Once the body becomes efficient at using ketones for fuel, as nature designed it to be, the kidneys stop excreting the ketones in the urine, blood levels return to normal, and the risk of gouty flare-ups begin to dramatically diminish from this point forward.

Let’s look at the benefits of lower carbohydrate eating and how it relates to gout.

A profoundly beneficial effect of eating a lower carbohydrate diet is the reduction of insulin levels in your blood. Insulin is a hormone that tells your body’s cells to allow glucose in through their cell walls; it puts your body into “storage mode.” Insulin levels also influence numerous other systems including the kidneys. High levels of insulin, most commonly stimulated by a high carbohydrate diet, will cause kidneys to fail to excrete uric acid as demonstrated in this study.   Importantly, uric acid levels will rise in tandem with insulin levels leading to gout attacks in susceptible individuals.

It’s important to note that while sugar from any source may be culpable. Fructose may play a particularly important role. Fructose is a monosaccharide that makes up 50% of typical “table sugar.” Fructose has recently received increasing recognition due to the omnipresent sweetener “high fructose corn syrup.” It is also found in higher concentrations in fruits such as apples and pears. Fructose is a unique “sugar” because it is metabolized very differently than glucose, the other 50% of “table sugar.” While glucose is metabolized in the stomach and intestines, fructose is transported directly to the liver. This different pathway, when over utilized, can lead to several pathologic entities including fatty liver disease, lipid abnormalities, glucose intolerance and high levels of insulin, and most related to this post, high levels of uric acid.  One study in particular, demonstrated that when fructose is consumed at high levels (normal for many people following traditional dietary recommendations) uric acid levels increased almost 20% and excretion in the urine decreased by nearly 10%.

In conclusion, as our clients become fat adapted through the PHD Weight Loss Approach, I can reassure you that gout symptoms should improve. The initial increase in risk can be offset by medical therapy and anyone concerned about this should discuss it with their personal physician. While on the program and in maintenance, when the body is in the blissful state of fat burn, the lower insulin levels and reduction of fructose in the diet will lead to a consistently lower level of uric acid regardless of purine consumption. So, enjoy the rich foods that are now a part of your new life and congratulate yourself on your journey to the achieving better health!

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Dr. Doug Lucas Discusses Gout