Can eating a high-fat, low-carb diet make gout worse? The keto diet has become a popular choice for weight loss and better blood sugar control, but it may raise concerns for people dealing with gout.

Gout is a type of inflammatory arthritis that happens when too much uric acid builds up in the blood and forms sharp crystals in the joints. This buildup can lead to sudden and painful inflammation, often in the feet or other joints.

Some parts of the keto diet—like eating large amounts of red meat, losing weight too quickly, or not drinking enough water—may increase uric acid levels and trigger gout flares.

This article looks at how the keto diet could affect gout symptoms and offers practical ways to manage both.

Before deciding if the keto diet is right for someone with gout, it’s important to understand how both conditions work in the body. Gout and keto may seem unrelated, but they share key connections that affect uric acid levels, excess weight, and inflammation.

Gout is a form of inflammatory arthritis caused by a buildup of uric acid in the blood. When blood uric acid levels get too high, sharp crystals can form in the joints. These crystals lead to sudden and painful inflammation, often in the big toe but also in the ankles, knees, and other joints. Common gout symptoms include swelling, redness, heat, and intense joint pain that may come on without warning.

Higher uric acid levels are more likely in people who carry excess weight or have elevated blood insulin levels, both of which are also linked to other health problems like metabolic syndrome. Following a low-purine diet may help lower uric acid levels and reduce the likelihood of flare-ups in some people.

The keto diet is a high-fat, low-carb, and moderate-protein eating plan. It shifts the body into a state called ketosis, where fat is burned for energy instead of carbs. This strict low-carb diet reduces sugar intake and refined carbohydrates, which may support weight loss and help lower elevated blood insulin levels.

However, some parts of the diet—like higher meat consumption or not staying hydrated—can raise concerns for gout patients, especially those already prone to higher uric acid levels.

The keto diet may change how the body handles uric acid, especially during the early stages. People new to keto may experience a shift in how their kidneys and metabolism work, which can affect gout risk. Some also combine keto with intermittent fasting, which may further influence how the body processes uric acid and other components tied to inflammation.

During ketosis, the body produces ketones as it burns fat for energy. In the keto-adaptation phase, this process may lead to a temporary rise in uric acid levels. One study showed uric acid levels increased early on in people starting a ketogenic diet, especially when combined with rapid weight loss. For some, this can trigger gout attacks or make existing symptoms worse.

While the increase isn’t always long-lasting, those with a history of gout or higher uric acid levels should be cautious. Jumping on the keto bandwagon without understanding how it affects your body may raise the risk of developing gout, especially if combined with unhealthy behaviors or poor hydration.

Certain parts of the keto diet can raise the risk of gout attacks, especially during the early stages. Paying attention to these common triggers can help prevent sudden and painful inflammation, especially in those following a strict low-carb or diet high in purines.

Possible gout triggers on the keto diet include:

• Rapid weight loss, which can increase uric acid production during fat breakdown

• High-purine foods, such as organ meats, red meat, and shellfish, which may raise uric acid levels

• Dehydration, which reduces the kidneys’ ability to flush out uric acid efficiently

• Not drinking enough water  increases the chance of uric acid crystals forming in the joints

• Excessive meat consumption, often seen in meat eaters following poorly balanced keto plans or diets high in saturated fats and protein

Some studies and expert reviews may suggest the keto diet may raise uric acid levels early on, especially in people with elevated levels or a history of gout. While a well-formulated ketogenic diet can support weight loss and improve metabolic health, its direct impact on gout risk requires further research.

However, these benefits often depend on healthy lifestyle changes and proper lifestyle modifications. Weak observational studies and the presence of other components in people’s diets—like processed foods, sugar, or high meat intake—can influence results. Nutrition research is still evolving, and more studies are needed to fully understand how low-carb eating patterns affect those at risk of developing gout.

Individuals with gout considering a ketogenic diet should consult with their healthcare provider to determine the best dietary approach for their condition.

Choose keto foods that are low in purines to help manage gout risk. Leafy greens, fresh vegetables, nuts, seeds, eggs, and avocados are good options. Stick to lean proteins like chicken or tofu, and limit meat consumption, especially red meat and organ meats. Avoid foods with high fructose corn syrup, which can raise uric acid levels and increase gout risk.

Drinking plenty of water can support kidney function and may help the body eliminate uric acid more effectively. Staying hydrated helps the kidneys flush out uric acid and lowers the chance of kidney stones. People on keto need even more fluids since low-carb diets often cause the body to lose water quickly.

Track any signs of gout, such as joint inflammation, pain, or swelling. Gout flare-ups can happen suddenly, especially during the keto adaptation phase. If symptoms increase, adjust the diet or speak with a healthcare provider for support. Regular check-ins may help manage symptoms early and reduce the risk of complications.

Balancing gout care with keto dieting takes careful planning. Paying close attention to food choices, nutrient balance, and lifestyle habits can make a big difference in how the body breaks down purines and manages uric acid.

Avoid going to extremes with protein or fat. A well-formulated ketogenic diet should include healthy fats, moderate protein, and plenty of low-carb vegetables. In some cases, a slightly lower protein intake may help reduce gout flare-ups, especially in people sensitive to purine-rich foods.

Reducing alcohol and sugar consumption may help lower gout flare risk in some individuals. Limiting fructose consumption and avoiding refined carbohydrates can reduce the chance of elevated uric acid levels. Including other foods such as nuts, seeds, and fresh produce provides essential building blocks for a balanced and anti-inflammatory eating pattern.

If you notice gout attacks happening more often, it may be time to adjust your keto diet. Swap out high-purine meats for plant-based or low-protein sources, add more low-purine vegetables, and reduce saturated fats. While protein intake on keto isn’t necessarily high, some people may benefit from lowering it slightly during flare-ups.

Staying hydrated and choosing foods with fewer purines may help lower uric acid levels and support joint health. It's also important to understand that geographic differences in diet, food quality, and lifestyle can affect how people respond to the keto diet while managing gout.

Managing gout while on the keto diet can be challenging, and medical support is important when symptoms change or worsen. A doctor can help adjust your diet, monitor uric acid levels, and recommend safer strategies for long-term health.

Reach out to your healthcare provider if you:

• Notice more frequent or severe gout flare-ups after starting a low-carb or keto diet

• Have a history of kidney problems, as these can affect how your body handles uric acid

• Experience new joint pain, swelling, or redness that doesn’t go away with home care

• Plan to start a strict low-carb or ketogenic diet and have a known history of gout

• Need help balancing weight loss goals with gout management to avoid triggering symptoms

Keto isn’t the only way to manage weight and improve health. For some people, a different low-carb plan may work better with fewer gout risks.

Not all low-carb diets affect gout in the same way. Some plans, like the Mediterranean diet, offer a more balanced approach that may be easier on the joints and better for long-term health. These diets may support weight loss and better blood sugar control, which could help reduce the risk of gout flare-ups in some people.

Gout-friendly low-carb options may include:

• The Mediterranean diet, which includes fruits, vegetables, whole grains, and healthy fats like olive oil

• Low-carb, plant-forward diets that focus on nuts, seeds, legumes, and fresh produce

• DASH (Dietary Approaches to Stop Hypertension), which limits sugar and red meat while supporting heart health

• Flexible low-carb diets that reduce refined carbs without going extremely high in fat or protein

• Anti-inflammatory eating patterns that avoid processed foods and support joint health

Eating a well-rounded diet can make a big difference in managing gout. It helps reduce uric acid levels, supports steady weight loss, and lowers the risk of painful flare-ups. A balanced approach also improves overall health and may help prevent issues tied to metabolic syndrome.

Key benefits of a balanced diet for gout include:

• Lowering uric acid levels by limiting high-purine foods and choosing more plant-based options

• Reducing gout flare-ups through steady hydration and nutrient-rich meals

• Supporting healthy weight loss, which can ease pressure on joints and lower inflammation

• Improving blood sugar and insulin levels, which may play a role in reducing gout-related risk factors

• Promoting a healthier lifestyle overall with fewer refined carbs and more fresh, whole foods

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Following the keto diet with gout takes careful planning, but it can be done with the right strategy. Key steps include choosing low-purine foods, staying well-hydrated, and watching closely for signs of gout flare-ups.

Ketosis may cause a temporary rise in uric acid levels, especially in the early weeks of the diet. However, long-term benefits like weight loss and lower blood sugar may help reduce gout risk over time.

Since not everyone with gout reacts the same way to a low-carb diet, it’s important to adjust based on symptoms and work with a healthcare provider for safe guidance. Some individuals may find that a balanced ketogenic diet aligns with their gout management plan, but it's essential to consult with a healthcare professional.

The information provided in this article is for educational and informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider before starting any new dietary supplement, especially if you are pregnant, nursing, have a medical condition, or are taking other medications. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

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