Stuff I've Said on Facebook About Gout

Georgia Ede has written a good chapter on gout. I've got a link to it and other stuff I've found out about it on a page I put together for quick reference. (This page in fact.)

​In my case I've found that high uric acid isn't the problem so much as changing levels of ketones. Ketones compete with uric acid for excretion and when you are changing your diet it can bring on gout attacks with both a rise OR a fall in uric acid levels. 
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Modern medical mythology persists with the idea that gout is linked with purines and meat eating. They have found that they can prescribe drugs (like alopurinol) and bring about some relief while dispensing advice like "lower your red meat intake" etc. 

I have found that while my uric acid was on the rise during my health decline on a standard diet, it had a bit of a spike (as did my lipids) when I started LCHF and ZC, but then started to go down as I settled more into my ZC lifestyle. My gout 'attacks' seemed to come when I was losing weight (particularly when I fasted for a period like 5 days).

The last doctor I saw regarding it noted that I'd changed my level down to within 'normal' range and said that the best idea would be to take a diclofenac (slow release) whenever I felt a bit of gout pain starting up. This advice seems to have worked and has headed off the gout pain at the pass about 3 times in the last 12 months. 

Another possible factor in my lowered numbers on the graph is that I've been supplementing vitamin D3 at a daily rate of 5000IU for the last year and a half. It has such a central role in 500 odd metabolic reactions in our body that I cannot discount it as a player in some of my outcomes. ​

Various Articles and Research on Gout

The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner By Lyle McDonald
(Extract)

See also page on Uric Acid
From Malaena Medford
You did not develop kidney stones on Keto. It takes years for most to develop and the circumstances require specific biological mechanisms such as vitamin K2 deficiency, excessive sugar consumption, oxalates consumption, and other factors.

What you experienced was the crystals you had from a previous WOE that dislodged as they broke down because Ketogenic breaks down crystalline formations.

Now, I will state this, lemons are not essential, but are medicinal and do help to break apart formations in both gout and kidney stone sufferers.

Meat does not cause uric acid to hike, sugar, alcohol, and plant proteins do. The plant proteins are coupled with massive amounts of carbohydrate, which blocks uric acid excretion. The results on purines are so inconsistent that they can't even be considered, but the results with those other factors are pretty solid. What meat does is cause a flare with temporary purine hike.

There is natural medicine for this and it's supported by science:

1/2 cup tart cherry juice
2 tbs raw apple cider vinegar
2 tbs lemon or lime juice
1/8th tsp magnesium sulfate
1/2 tsp pink or sea salt
Enough water so it doesn't kick your face in.

Tart cherries have been shown through study to break apart crystalline formations of many types, and has been medicinally recommended for a few years now. Vinegar is a healing substance that has a similar function, but other properties, one of which is diuretic, making you pee and clearing the urinary tract out. Sour citrus has polyphenols or plant nutrients which break apart crystals as well and stimulate the kidneys, which helps them recover from a high carb diet. The magnesium relaxes smooth muscles in the urinary tract and helps you pass the stones easier. The salt is if needed and balances electrolytes as the diuretics can deplete them. Water is water. You don't dilute this, it will be like drinking pure vinegar in intensity.

Once you have cleared out, you will not form stones again. The symptoms of the stones leaving is not you developing them. Meat does not and never has caused any diseases involving stones.

Edit: Retract the vitamin C on breaking stones, it helps get rid of UTI's. I need to find the studies I misplaced showing the polyphenol reaction to stone breakdown.
GOUT 
(posted by Lynette DeBeer on FB
While many people (including doctors) still believe that gout is a result of eating too much protein, the science is pretty clear that fructose is the major culprit here.

With that in mind, if you're predisposed to gout, here's some information you should know: A very predictable change in serum chemistry is a sharp rise in uric acid concentrations in the first week or two of carbohydrate restriction. This is due to competition between circulating ketones and uric acid for renal tubular excretion. 

Put another way, uric acid rises in the blood not because the body is making more of it, but because the kidneys temporarily clear less of it. Thus the blood level needs to rise in order for the same amount of it to be cleared by the kidneys (because ketones are getting in the way). Subsequent to this abrupt early rise in uric acid, within 4-6 weeks the level then falls back to or below its pre-diet level even if the dietary carbohydrate restriction and ketonemia continue. This is part of the body's ongoing adaptation to nutritional ketosis. 

In the vast majority of patients, this rise in serum uric acid is completely benign and requires no intervention. In the minority of individuals predisposed to gout, however, wide swings in uric acid can trigger an attack. And this goes both ways—either the abrupt rise with diet initiation or the analogous abrupt fall if the ketonemia is reversed by breaking the carbohydrate restriction in the first few weeks, can act as a trigger. 

Most people with the genetic predisposition to gout know it long before they consider a low carbohydrate diet, so either preventative medication or prompt intervention at the first symptoms can usually pre-empt an attack. 
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Also, because it is the rapid change in uric acid that is the primary trigger, once on a carbohydrate restricted diet, the patient with a history of gout should be counselled to avoid frequent cycling in and out of carbohydrate restriction (i.e., avoid 'going on and off the diet')