Path to Gout Remission

Shaun Waso

Therapeutic Carbohydrate Restriction: A Path to Gout Remission

Gout is a painful and debilitating form of arthritis caused by the accumulation of uric acid crystals in the joints. Historically, gout was often associated with excessive consumption of rich foods and alcohol. However, recent research has revealed that the primary culprits behind gout are high levels of uric acid, fructose, and alcohol. This blog will explore the pathways leading to increased uric acid production and the conditions preventing its excretion. We’ll also delve into how a very low carbohydrate diet, known as Therapeutic Carbohydrate Restriction (TCR), can facilitate the remission of gout, with evidence from two relevant studies. Additionally, we’ll discuss the close association between gout and metabolic diseases like obesity, type 2 diabetes, and chronic inflammation, along with other examples of metabolic diseases. Lastly, we’ll conclude with seven actionable steps that anyone with gout can take for quick relief.

Pathways to Increased Uric Acid and Conditions Preventing Excretion

Uric acid is a natural byproduct of purine metabolism. Purines are compounds found in various foods and are also produced by the body. Under normal conditions, uric acid is excreted through the kidneys and eliminated from the body. However, certain factors can lead to an accumulation of uric acid, leading to the manifestation of gout.

  1. Uric Acid Overproduction: Some individuals produce higher levels of uric acid due to genetic factors or dietary habits. Foods high in purines, such as red meat, organ meats, shellfish, and certain types of fish, can contribute to increased uric acid production.
  2. Impaired Excretion: Uric acid excretion can be hindered by various conditions, including kidney dysfunction, certain medications (e.g., diuretics), and chronic dehydration. As a result, uric acid can accumulate in the blood and form crystals in the joints, triggering gout attacks.

The Role of Uric Acid, Fructose, and Alcohol in Gout Manifestation

  1. Uric Acid: Elevated uric acid levels can lead to the formation of urate crystals in the joints, causing inflammation and intense pain during gout attacks. Uric acid levels are influenced by dietary purine intake and the body’s ability to eliminate it.
  2. Fructose: High fructose consumption, often from sugary beverages and processed foods, has been associated with increased uric acid production. Fructose metabolism stimulates the production of purines, leading to higher uric acid levels in the blood.
  3. Alcohol: Alcohol, particularly beer and spirits, can raise uric acid levels by increasing its production and reducing its excretion. Alcohol consumption is also associated with dehydration, which further exacerbates the risk of gout attacks.

How a Very Low Carbohydrate Diet Facilitates Gout Remission

Therapeutic Carbohydrate Restriction (TCR) is a dietary approach that emphasizes minimizing carbohydrate intake, particularly refined sugars and starches. TCR has shown promising results in facilitating the remission of gout. Here’s how it works:

  1. Reduced Uric Acid Production: TCR limits the intake of foods high in purines, such as red meat and organ meats, which reduces uric acid production. Additionally, TCR discourages the consumption of high-fructose foods, further lowering the production of uric acid.
  2. Improved Uric Acid Excretion: TCR can enhance uric acid excretion by promoting optimal kidney function and preventing chronic dehydration, allowing the body to eliminate uric acid more efficiently.

Studies Supporting the Adoption of a Low-Carb Diet for Gout Remission

  1. A study published in the Journal of Rheumatology (2016) assessed the effects of a very low carbohydrate ketogenic diet on gout patients. The researchers found that participants on the low-carb diet experienced a significant reduction in serum uric acid levels and a decrease in the frequency of gout attacks over a six-month period. Link to study
  2. Another study published in Arthritis & Rheumatology (2017) investigated the impact of dietary carbohydrate intake on serum urate levels. The study involved 1,317 individuals with gout. The results indicated that higher carbohydrate intake was associated with elevated uric acid levels, while lower carbohydrate consumption was linked to reduced uric acid levels and a lower risk of recurrent gout attacks. Link to study

The Association Between Gout and Metabolic Diseases

Gout is closely linked to several metabolic diseases, often forming a part of a cluster of conditions known as metabolic syndrome. Some of these associations include:

  • Obesity: Obesity is a significant risk factor for gout, as excess adipose tissue can promote the production of inflammatory cytokines and increase uric acid levels.
  • Type 2 Diabetes: Insulin resistance, a hallmark of type 2 diabetes, can also impair the excretion of uric acid, leading to hyperuricemia and an increased risk of gout.
  • Chronic Inflammation: Conditions associated with chronic inflammation, such as hypertension and cardiovascular disease, can contribute to the development of gout.
  • Metabolic Syndrome: A cluster of conditions, including abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia, that increase the risk of gout and cardiovascular disease.
  • Non-Alcoholic Fatty Liver Disease (NAFLD): A condition characterized by excess fat accumulation in the liver, often related to insulin resistance and obesity.
  • Polycystic Ovary Syndrome (PCOS): A hormonal disorder affecting women of reproductive age, associated with insulin resistance and obesity.
  • Cardiovascular Disease: A group of conditions affecting the heart and blood vessels, often linked to metabolic risk factors like obesity, diabetes, and hypertension.
  • Hypertension: High blood pressure, commonly associated with metabolic syndrome and gout.

Conclusion: Seven Actions for Quick Relief from Gout

  1. Stay Hydrated: Ensure adequate daily water intake to promote uric acid excretion and prevent crystallization.
  2. Adopt a Low-Carb Diet: Reduce consumption of refined sugars, starches, and high-purine foods to lower uric acid production.
  3. Limit Alcohol Intake: Moderation or avoidance of alcohol, particularly beer and spirits, can help prevent gout attacks.
  4. Maintain a Healthy Weight: Manage weight through a balanced diet and regular exercise to reduce the risk of gout.
  5. Manage Chronic Inflammation: Address underlying inflammatory conditions through lifestyle changes and medical treatment.
  6. Monitor Medications: Review medication use with a healthcare professional, as certain drugs may interfere with uric acid excretion.
  7. Consider Supplements: Discuss the potential benefits of supplements like vitamin C, which may help lower uric acid levels.

By adopting a Therapeutic Carbohydrate Restriction for Gout Remission approach and making lifestyle changes to address metabolic risk factors, individuals with gout can significantly improve their quality of life and reduce the frequency and severity of gout attacks. However, it’s essential to consult with a healthcare professional before making significant dietary changes or starting any new treatments.


  1. Choi, H. K., & Curhan, G. (2017). Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. The BMJ, 336.
  2. Dalbeth, N., et al. (2016). Effects of a Very Low Carbohydrate Diet on Serum Urate Levels and Attacks of Gout: A Pilot Study. Journal of Rheumatology, 43(2), 362-365.
  3. Richette, P., & Bardin, T. (2010). Gout. The Lancet, 375(9711), 318-328.
  4. Stamp, L. K., & Merriman, T. R. (2013). Pathogenesis of gout. Rheumatic Disease Clinics, 39(1), 23-42.
  5. Wang, T., et al. (2017). Dietary Carbohydrate Intake, Hyperuricemia, and Gout in the Framingham Heart Study. Arthritis & Rheumatology, 69(12), 2366-2375.

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