A recent survey reported 28.69% of Americans gained over 5lbs during the 2020 pandemic. So like many who wanted to shed some pounds, I decided to tighten up the diet and jump into better shape. Everything was going as planned until the second week. Oh, sh-t! Gout struck on the side of my left big toe! From this latest gout episode, I learned fasting causes gout.

This shocking gout strike was fast and intense. I used all my available counter measures and popped a colchicine. A few hours later, I was unable to stand. It was a full-blown gout.

After reevaluating (lots of WTFs), I concluded it was not my diet triggering this. So what could it be? I investigated and found enlightening facts and theories on why gout can develop from dieting or fasting.

What research confirms fasting causes gout?

Yes. Fasting can cause gout. Hyperuricemia, or excess of uric acid in the blood, is a well-known outcome of starvation or fasting. When the body cannot remove uric acid, gout will strike. Here are some supporting studies.

Since 1924, several research studies conclude fasting will cause uric acid levels to rise. Several studies under different test parameters, from total fasts to intermittent fasts, indicate uric acid levels rise in 2 to 14 days.

An Australian university weight loss study in 2019 collected patient data for fasting two days and continued with regular eating for five days, and repeated the cycle three times. The outcome confirmed a drastic increase of uric acid levels, blood pressure, and body temperature after the first cycle (7 days).

An extensive Japanese study published in 2019 involved a 58 hour fast analyzing several metabolic factors. Results per gout indicated a drastic increase in purines and uric acid, especially during the first 34 hours.

Why does fasting cause gout?

When you go on a weight-loss diet, your body needs time to adjust to the new low calorie or reduced food intake. Several metabolic processes or biological reactions from fasting causes gout.

Blood Sugar Decreases

The first source of energy the body will use is the available glucose (sugar) from food. Hunger signifies your body has used up the glucose from recent food and needs to find more glucose elsewhere.

Since carbohydrates from food are stored as glucose, eating fewer carbohydrates will also lower the glucose level in the body. When the blood runs out of the current glucose supply, the body will use the second energy source which is stored fat.

This is why weight loss diets always require eating less sweets and carbohydrates. In addition, low blood glucose is a critical element in why gout occurs from fasting.

Ketosis Restricts Uric Acid Excretion

The second metabolic process while fasting is called ketosis- when the body starts to use fat for energy. Depending on the individual’s health, lifestyle and diet program, it can take 2-14 days to reach ketosis.

Burning fat makes acids called ketones. During this process, ketones can build up in your blood. The excess ketones can alter the chemical balance of your blood and disrupt your entire system.

Research studies indicate ketones cause many enzymic activities throughout the body. Per gout, ketones change the biochemistry in the kidneys where uric acid becomes less soluble and harder to pass into urine. Instead of removing the normal amount, more uric acid stays in the blood.

Whenever your body reaches ketosis, the accumulation of ketones in the blood restricts the ability of the kidneys to filter out uric acid. The excess uric acid in the blood eventually accumulates at a joint to cause gout.

Picture goutproof - Fasting causes gout at toe

Other Ways Fasting Increases Uric Acid

All the cellular processes associated with fasting and uric acid are still not completely understood. However, there are research studies that suggest other ways fasting increases the risk of gout.

Endogenous purines produced by the human body

As mentioned, fasting provokes several metabolic activities involving purines and uric acid production. Extreme weight-loss diets disrupt normal metabolism. When this happens, the body will use or produce what it needs to maintain homeostasis.

During this transition period, the body may metabolize more endogenous purines from damaged, dying, or dead cells. Consequently, more uric acid will be produced.

Fatty tissue produce and secrete uric acid through XOR

Another scenario where the body adjusts while fasting is the release of uric acid stored in fatty tissues. Research using mouse models concluded fatty tissue, especially visceral fat, produces and secretes uric acid.

One of several biochemical activities activates xanthine oxidoreductase (XOR); a major enzyme in purine metabolism. Additionally, obese people have a higher rate of XOR activities where more pro-inflammatory chemicals are released from stored fat.  

Not Enough Alkaline-forming Foods

Alkaline-forming fruits include kiwi, cherries, blueberries, pineapples, papaya, lemon and apples. There are several, but the ones listed are also great for a goutproof diet. Also, some alkaline-forming vegetables are cucumbers, asparagus, bell peppers, celery and leafy greens.

Why are alkaline-forming foods important to gout sufferers? After being digested and metabolized, alkaline-forming foods keep the urine from getting highly acidic. When urine is less acidic or more alkaline, uric acid will be easier to filter out by the kidneys. This is coincides with the negative effects of ketones on kidneys and the urinary tract.


Dehydration occurs when the amount of fluids leaving the body is much greater than the amount being taken in. The depletion of water in your system makes it more difficult for the kidneys to flush out toxins and uric acid.

Dehydration can develop without realizing it. Remember about 20% of fluid consumption comes from food. When fasting or eating less to lose weight, water from food is also reduced. The sensible move here is to always include hydrating foods like fruits and vegetables in your new diet.

Another possibility of dehydration is working out for long periods and/or in humid conditions. No one exactly knows how much they sweat and the fluid amount for proper replenishment. It is essential to drink the recommended amount of 64 oz. of fluids per day. However, you don’t have to stop there. You may to need drink even more than usual because of intense workouts.

Final Thoughts

The major lesson I learned fasting causes gout. Whatever the weight-loss program, any type of food deprivation is still considered fasting. Many metabolic reactions take place when starting a new diet. A drastic change from a poor diet and pre-existing health conditions are a large part in how and when the body reacts to maintain homeostasis.

Gout sufferers need to realize when the body is in ketosis, ketones are created from burning stored fat. The excess ketones prevents the removal of uric acid. If precautions are not taken, your risk of gout increases.

There are consequences in reaching the threshold for ketosis. The good- you’re starting to burn fat and lose weight. The bad- gout is waiting to strike!

I have to admit, this latest gout attack ends my streak of over four years without a vicious and crippling outcome. Previous times, I stopped it from getting worse because I knew when I overindulged. This time, I was caught off guard like a sucker punch! Oh well, now I know for the better.

So, in the first week of your new diet and workout program, load up on more gout-fighting foods and products to prepare for a gout attack. If gout strikes, then you will likely soften the blow. If it doesn’t strike, then you are golden. In the long run, when you lose extra pounds, you become more GOUTPROOF!

  1. From purines to purinergic signaling: molecular functions and human diseases – https://www.nature.com/articles/s41392-021-00553-z
  2. Uric Acid Secretion from Adipose Tissue and Its Increase in Obesity – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779712/
  3. β-hydroxybutyrate deactivates neutrophil NLRP3 inflammasome to relieve gout flares – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527297/
  4. Quarantine Weight Gain – https://runrepeat.com/quarantine-15-weight-gain-study
  5. Effects of food, fast and alcohol on serum uric acid and acute attacks of gout – https://www.amjmed.com/article/0002-9343(67)90005-8/pdf
  6. Hyperuricemia, Acute Gout, Renal Insufficiency and Urate Nephrolithiasis Due to Starvation – https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780080509
  7. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125106/
  8. How Long Can I Fast Before I Start Losing Muscle? – https://www.livestrong.com/article/437499-how-long-can-i-fast-before-i-start-losing-muscle/
  9. Mechanism of fasting hyperuricemia – https://pubmed.ncbi.nlm.nih.gov/7444305/
  10. Uric acid induces oxidative stress and growth inhibition by activating adenosine monophosphate – https://pubmed.ncbi.nlm.nih.gov/23707617/
  11. Purine Accumulation in Human Fat Cell Suspensions – https://www.jbc.org/article/S0021-9258(18)68377-2/pdf
  12. The Evolution of Very-Low-Calorie Diets: An Update and Meta-analysis – https://onlinelibrary.wiley.com/doi/10.1038/oby.2006.146
  13. Alteration in plasma free amino acid levels and its association with gout – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664792/
  14. Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684327/

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