Clinical research first recognized gouty arthritis, a worsening form of arthritis, among the earliest diseases in which the Egyptians identified podogra (acute gout occurring in the first metatarsophalangeal jointy). Hippocrates referred to it as the unwalkable disease.
Gout is clearly associated with diet and human lifestyles. Consuming excess dietary purines derived from meat, seafood, and alcohols contribute to an increase in the incidence and prevalence of gout worldwide.
Should gout sufferers restrict their food intake? What’s the connection between fasting and gout? These are the questions that we’ll discuss in this article.
Etiology of Gout
Uric acid was found to be the key agent for gout. The breaking down of purine releases uric acid as by-product. What happen when there’s too much uric acid in the body?
Uric acid will crystallizes, leaving solid crystals precipitate in and around the joints, fluids, and tissues within the body.
This explain the swelling of joints among gout patients. Once uric acid enters the bloodstream, it will be excreted in urine.
However, in the case that uric acid still presence in the body, there will be an increase in blood uric acid levels.
This condition is known as hyperuricemia, that is, when the plasma urate level is greater than 420 μmol/l (7.0 mg/dl) in males or 360 μmol/l (6.0 mg/dl) in females.
Can Gout Be Overcome By Losing Weight?
Blood uric acid levels and therefore the extent of acute attacks could be reduce by losing weight. Losing weight also minimize the stress on weight-bearing joints such as hips, knees, ankles, and feet.
Gout sufferers need to avoid any sort of prolong dieting, as this may lead to an increase in uric acid levels and trigger gout attacks.
Should a Gout Sufferer Try to Fast?
Fasting has been practice for thousands of years. Yet, there are no scientific guidelines on how to fast.
However, due to the decrease in vitamins, minerals, and macro-nutrients while fasting, Fung and Moore suggested that not everyone should fast especially without medical supervision.
Here’s lies the connection between fasting and gout. In their book entitled The Complete Guide To Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting, Fung and Moore warned gout sufferers to be cautious with fasting as uric acid elimination decreases during fasting.
For anyone who haven’t fasted before, 3-4 days are needed to prepare the body for being without food.
The Different Type of Fasting
As mentioned, losing weight do help to reduce the level of blood uric acid. Fasting and gout do have relationship in managing health.
A popular diet that has been around for many years is the fasting diet where you basically restrict the intake of certain food to detox your body.
Some people fasts for religious reasons like Muslims that are obliged to fast during the Ramadhan. There are different type of fasting.
Some allow only intake of liquids like water, tea, coffee or juice. Others control the intake of certain food like meat and seafood.
Fung and Moore categorized fasting according to:
- What is allowed on the fast; and
- The length or frequency of fasting.
Based on both categories mentioned, they then came up with a few types of fasting, which are:
1. Water only fasting
There are three variations of water only fasting:
– No salt, tea, or coffee allowed
– Salt, tea, or coffee allowed
– Only salt is allowed
2. Juice fasting
This isn’t true fasting, but is a type of abstention. For juice fasting, juice and other liquids are allowed but fruit juicing should be avoided.
3. Fat fasting
Same with juice fasting, fat fasting also isn’t true fasting, but is a type of abstention. Fat fasting allow consumption of only pure fats from oils, creams, and butters.
4. Dry Fasting
Dry fasting do not allow any fluids intake. This type of fasting however, is not recommended due to a high risk factor for dehydration.
5. Fast-mimicking Diet
This fast-mimicking diet attempts to recreate the benefits of fasting without needing to fast. A gradual reduction in calories over five days every month is expected from this type of fasting.
Can Fasting Lead To Gout Attack?
The mentioned types of fasting helps in considering the kind of fasting that one will proceed to. For gout sufferers, it is important that they seek advice from their consultant before decided to fast.
Increasing uric acid levels during fasting could lead to hyperuricemia.
According to Centers for Disease Control and Prevention (CDC), though hyperuricemia is the key factor for gout, most people with raised uric acid levels never develop gout.
Hyperuricemia that does not progress to gout is known as asymptomatic hypeuricemia.
In a study conducted by Runcie and Thomson, they proved the occurrence of hypeuricemia in 42 of their obese patients who went through total fasting.
Interestingly, none of the patients suffered from acute gout, including one male patient whom was a gout sufferer.
Throughout the study, the gout sufferer had exceeded his level of serum uric acid (SUA) concentration to more than 15 mg/100 ml for 28 days of total fasting, reaching a maximum value of 30 mg/100 ml.
It is still a mystery for both researchers on how this patient didn’t suffer from acute gout.
According to Runcie and Thompson, the acute joint disturbance of gout may be precipitated by rapid fluctuations in the levels of serum urate.
Their study suggested that changes in fluctuating hypeuricemia among their subjects may have occurred too slowly to precipitate an attack. This implies that there are factors other than hypeuricemia which lead to gout attack.
Citing a study conducted by Lennox (1924), Llyod-Mostyn et al. supported the finding of both Runcie and Thomson. Other factors could temporarily interfere with the uric acid excretory power of the kidney.
Lloyd-Mostyn et al. cited that in some cases there was a decreased uric acid excretion in the urine, but was unable to show evidence of disturbance of renal function.
The reasons for no acute gout occurrence though there’s a rise in SUA concentration still remain obscure.
Further research is required into those factors, other than hypeuricemia, which lead to the deposition of urate crystals in joints.
Dangers and Risks of Fasting
Fasting and gout can sometimes have opposite impact. Going three days without drinking (dry fasting and water fasting) would probably make the gout worse, not better, not to mention risking kidney damage.
Gout is a build-up of uric acid crystals in joints, most often in the feet. Becoming dehydrated will increase the uric acid build-up.
Fasting may have some benefits but it also comes with health risks. Here are a few dangers and risks of fasting:
Lose the wrong type of weight: Fasting usually restricts calories intake, a reason why you lose a lot of weight faster. However, those weight loss may come from water, carbohydrates, and even muscle mass. In other words, you actually lose the wrong type of weight.
Become dehydrated: Around 20-30% of your daily water intake comes from the foods you eat. Restriction of food intake means your body might not getting enough water, leaving you dehydrated.
Experiencing orthostatic hypotension: Orthostatic hypotension is a sudden reduce in blood pressure. It happens when all of a sudden you feel dizzy, light-headed, and at risk of fainting.
If you ever experience these symptoms during fasting, fasting may not suit you. Fasting may worsen several medical conditions like gout.
You may need to consult your healthcare consultant before decided to fast. Bear in mind, gout is what you eat. If you are not careful with how you consume your food, your condition will get even worse.
Recommendations for Gout Sufferer
It is recommended that gout sufferers avoid excessive protein consumption, drink more water, and take allopurinol daily.
Consuming more water daily will help to decrease the level of uric acid in the body. Water also helps lubricate the joints. In order to get this benefit, you must consume at least 8 glasses of water per day.
If you don’t, then there is a higher risk of developing a gout attack, dehydration or even kidney failure.
Fasting is actually not recommended for gouty patients. Healthy diet and healthy lifestyle are more important. All gout sufferers must know that a healthy diet is the key to minimizing the impact of gout.
It is important to add that a healthy diet will keep all the nutrients inside the body and it will provide more than enough of them, which all means that gout sufferers will benefit from it.
Though researchers proved the occurrence of hyperuricemia during fasting didn’t result in gout attack, it doesn’t mean that fasting is safe for gout patients.
Still, a lot of research need to be conducted in search of other factors or mechanism that could lead to acute gout attack especially during fasting.
Relationship between fasting and gout has to be emphasized more realizing the trends of fasting which has becoming more popular nowadays.
Fasting is not recommended for gout patients. But a healthy diet is. Indeed, even fasting have to be carried out, gout sufferers need to consult their healthcare consultant first.