Jan. 23, 2004 -- Once known as the scourge of the rich and gluttonous, gout may be staging a comeback. But is the popularity of high-protein, low-carbohydrate diets like the Atkins diet to blame? Yes and no, say experts.
Recent British news reports linking rising gout rates and the Atkins diet have stirred interest in a possible link between gout and diets. But experts say there is no real proof that any particular weight-loss plan can cause the painful condition.
"We have only anecdotal evidence from individual patients who have had gout in the past that going on an Atkins diet has exacerbated the problem and precipitated attacks," says George Nuki, MD, emeritus professor of rheumatology at the University of Edinburgh in Scotland.
Researchers say there are logical reasons to believe that a high-protein, high-fat diet might increase the risk of gout in people already prone to the disease. But the real reason why gout appears to be on the rise may be old-fashioned overindulgence.
What's Gout All About?
Gout is a form of arthritis that occurs when abnormally high levels of uric acid build up in the body, causing crystals to form in joints. The crystals cause sudden, severe attacks of joint pain and swelling.
Uric acid is a substance that is normally released by the kidneys when the body breaks down waste products called purines. When the kidneys are no longer able to flush uric acid out of the body properly, it crystallizes and accumulates around the joints.
Some people are born with a genetic condition that makes them prone to uric acid overproduction and buildup, but other factors are known to increase the risk of developing gout, including:
- Drinking too much alcohol
- Eating too much of foods high in purine
- Sudden weight loss or crash diets
- Sudden, severe illness
- High blood pressure and use of diuretics
Little is known about the current prevalence of gout in the U.S., but a recent study showed that the condition affects about 1.5% of men and 0.4% of women in the U.K., which is about twice the rate found 50 years ago. -->
The Truth About Gout and Diets
Researchers say gout rates typically fall in times of hardship, such as during World War II, and rise in times of prosperity and indulgence. This means it would come as no surprise to many that gout rates are very likely increasing in the U.S. as the nation faces an epidemic of obesity.
"Gout tends to be associated with obesity and high blood pressure," says John Klippel, MD, president and CEO of the Arthritis Foundation. "Those are two common health problems in this country, and obesity certainly seems to be increasing.
"If someone were to study it, that might mean that there might actually be more gout [in the U.S.], but one would speculate that's because we're dealing with a society that is by and large overweight," Klippel tells WebMD.
But losing weight too quickly might also increase the risk of gout.
"As you lose weight, you start to metabolize body tissues, and there is an increased flux of purines that the body has to deal with, which leads to increases in uric acid," says Klippel. "Crash diets where people are losing weight very rapidly are going to increase the risk of gout."
Nuki says that's where the link to high-protein diets like Atkins comes in. Any diet that produces rapid changes in weight raises the risk of gout, but he says low-carbohydrate diets may carry an additional risk for two reasons.
First, many of the foods promoted by these diets, such as bacon, organ meats, and some types of seafood, are high in purines and cause uric acid levels to rise. Second, low-carbohydrate diets put stress on the kidneys, which might make them more sensitive to changes in uric acid levels.
Even so, Nuki says diet is only part of the picture.
"Gout in almost all cases is a combination of having an underlining genetic predisposition and then being faced by a challenge, either something like an Atkins diet or generally the challenge of over-nutrition and alcohol," says Nuki, who is also a trustee of the UK Gout Society.
"What is important is that if you have an attack of gout, that should be a red flag and a warning that you need to look at other aspects of your health because most people who have a first attack of gout are a bit overweight, eat unsuitably, and drink a bit too much."