ALL ABOUT GOUT
MENTION THE WORD ‘GOUT’ AROUND A BRAAI FIRE, AND YOU’LL SEE MOST PEOPLE FLINCH IN RESPONSE – MIDDLE-AGED MEN IN PARTICULAR. IT’S A COMMON CONDITION – BUT DOES LCHF HELP OR HINDER IT?
How living LCHF can affect gout
every person afflicted by gout will behave in much the same way when you raise the subject: they’ll tell you their own (often gruelling) experiences in graphic detail, dispense free advice, and share remedies they swear by – some of which are rather strange. Everyone has their own, very strong, opinion. That’s because gout is one of the most painful, unpleasant conditions imaginable.
An acute gout attack happens when uric acid (urate) crystals precipitate into the tissue in or around a joint, most often in one particular joint (the base of the big toe is the most common). This causes a sudden pain so sharp that it would certainly wake you up at night – and no matter how you try to position your foot, the pain will not only stay, it will get worse. Even if you’ve never had a gout attack before, you’ll know it the instant you experience it: a constant, nagging, throbbing, burning pain that demands all your attention. The affected joint swells up and becomes red and hot. To walk is nearly impossible – if you do, you look like you’re 145 and people laugh. In other words, nothing about gout is fun.
WHERE DOES URIC ACID COME FROM?
Purines are natural substances found in the cells of all animals and plants. They provide part of the chemical structure of genes in the cells. Most of the purines in our bodies are manufactured by our own bodies, and a small percentage are added by the foods we eat. Foods high in purines are organ meats, anchovies, mackerel, mussels, yeast and beer. When cells die and get recycled, the purines in their genetic material are also broken down, and it’s the breakdown of those purines that forms uric acid. It is completely normal and healthy for uric acid to be formed in the body from breakdown of purines. In our blood, for example, uric acid serves as an antioxidant and helps prevent damage to the linings of our blood vessels. The problem occurs when the uric acid is raised to unnaturally high levels.
WHY DO PEOPLE GET GOUT?
The real answer is, we don’t really know. Although gout is linked to increased levels of uric acid in the majority of cases, up to 30% of patients with an acute gout attack have normal, or low, uric acid levels. And not all people with high uric acid levels get gout. But let’s look at the majority of cases, where uric acid does play a role. In these cases, there could be several reasons why that happens:
1. You’re producing too much uric acid
This could be hereditary – sometimes the lack of certain enzymes can cause raised uric acid levels, and this is usually the case when the sufferer is younger. It can be extensive and debilitating because it can cause permanent damage to the joint. Sometimes overproduction of uric acid is caused by repeated trauma to the joint, and sometimes by diseases involving damage to or the breakdown of body cells (like cancer or chemotherapy), or by other medical conditions, like infections.
2. You’re consuming too many purine-containing foods
Beer, meat, liver, kidneys, anchovies and sweetbreads are all culprits because of their high purine content. New studies have also shown that a high fructose intake stimulates the synthesis of purines, and high fructose corn syrup is a major problem here.
High fructose foods include • soda drinks, sauces, fast foods,
pastry, with corn syrup • honey • apples, pears, cherries, figs, mango, grapes, watermelon, black berries • dried fruits and fruit juices. Low fructose fruits are avocado, lime and lemon.
3. You’re not getting rid of enough uric acid in your system
This can be because of kidney damage from hypertension or diabetes, or because you’re taking medication like diuretics, which cause under-excretion. It might be that you’re drinking too much alcohol: alcohol increases the production of lactic acid, which blocks uric acid excretion from your kidneys – or it could be that your insulin levels are too high, because insulin also suppresses the excretion of uric acid.
WHO GETS IT?
Mainly middle-aged men and menopausal women – it’s rare for younger women in their productive years to suffer. Some younger people with genetic flaws in their purine metabolism also get it, and that can lead to chronic gout. And then, of course, people who suffer from our old friend, metabolic syndrome (overweight, hypertension and diabetes are all signs), which causes decreased excretion of uric acid.
RIGHT. WHAT ABOUT THE ROLE OF DIET?
In the past, all the blame was placed on overindulgence in wine and meat, but new research shows that high intake of fructose might also be a major cause of acute gout. But, contrary to previous popular belief, purine-low diets have little effect on the lowering of uric acid levels in the blood. So – again – this is a matter of personal experimentation, to see what works for you. There are some people whose gout worsens when eating LCHF, in which case you’ll need to modify your diet (see below), or even stop completely.
But the good news is that for most people, eating LCHF means your kidney function will improve, and with that the excretion of uric acid. Plus, it will lower your insulin levels, which means you‘ll be more effective at excreting uric acid – both should help.
If you have gout and are just starting to eat LCHF, you need to: stay on your medication (like Allopurinol) until you have lost most of your excess weight check your uric acid levels after 6 weeks on the diet to determine whether they’ve risen. Previous studies have shown that your levels will come down to below the pre-diet levels within 6-12 weeks. limit or, even better, avoid food with a high purine content like red meat, organ meats, mussels and mackerel. Instead, eat more mono-unsaturated fats like olive oil, avos, egg yolks, almonds, macadamia nuts and nut butters, and saturated fat-rich foods like lard, butter, cream, coconut oil and cheese. drink enough water for proper kidney function.
of water! Drink lots