Fasting and Gout: Here's What You Need to Know
Fasting is good for us, we know that. But there are a few situations where people might need to be careful with fasting. If you’re fasting, or thinking about fasting, gout deserves special attention.
Let’s talk about that.
What is gout?
If you’ve ever had a gout flare-up, you know that gout is no joke. Gout presents as super intense, sudden pain, swelling, and inflammation, usually in the big toe, foot, or ankle, and can even settle into spots where you’ve had a previous injury.
Gout used to be thought of as an “old person” condition, or as something caused by eating too much meat or drinking too much alcohol. But like most things, that’s not really factual, with the exception of alcohol. This painful condition is actually caused by high levels of uric acid in the blood. When uric acid builds up it can form sharp crystals that settle into your joints. That’s what causes the intense pain.
So what causes the uric acid? The uric acid comes from the breakdown of purines, which are found in food, but are also made naturally by your body. Most of the time, it’s not a problem. Your kidneys filter the uric acid and you get rid of it when you pee. The problem starts when you make too much uric acid, or your kidneys don’t filter it out, or both.
Gout often shows up alongside obesity and metabolic disease because of our good friend insulin. High insulin levels tell the kidneys to hold onto uric acid instead of letting it go. And remember, eating around the clock is what keeps insulin levels high.
So why is fasting bad for gout?
Fasting lowers insulin. So that should be good for gout, right? And for the most part, it is. But Extended Fasting can be problematic, especially if you are already prone to gout.
Here’s the thing: when insulin lowers, your body switches over to burning ketones for fuel, which are made from the breakdown of fat. That’s how we lose fat. But ketones and uric acid can’t both get out of the kidneys at the same time, at least not efficiently. So when you switch over to ketones, uric acid clearance temporarily goes down. And that can lead to higher uric acid levels, even when you’re doing everything right. For someone who is prone to gout attacks, this can be enough to trigger a flare.
So the issue isn’t fasting itself, it’s how long you fast, and how aggressive you are with the fasting. This is why leading Fasting Expert and nephrologist, Dr. Jason Fung, advises that you should not do Extended Fasting if you have experienced gout in the past or you know that you are prone to gout.
Why Intermittent Fasting works better
Intermittent Fasting is much more gout-friendly. Shorter fasts, like 18/6, 19/5, or even OMAD (One Meal a Day), improve insulin sensitivity without causing prolonged ketone build up. That means:
-
Insulin levels decrease
-
Kidneys can still get rid of uric acid
-
Ketones rise more gently
-
Your risk of gout flares is way less
Because Intermittent Fasting lowers blood glucose and improves insulin sensitivity, a consistent IF routine can actually reduce gout attacks, versus Extended Fasting, which can trigger them. In other words, Intermittent Fasting heals the root of the problem that causes gout in the first place.
Tips from Dr. Fung
Dr. Fung also suggests adding lime juice in your water, and taking a cherry root extract, during your fasting.
Lime juice helps alkalise urine, which can improve uric acid excretion. It also provides vitamin C, which has been shown to lower uric acid levels.
Cherry extract has anti-inflammatory properties and may reduce both uric acid levels and your flare severity. It’s not a cure, but it is a helpful and potentially preventative tool.
Hydration and Electrolytes
Proper hydration and electrolytes are always important, but they become especially vital if you are prone to gout.
Remember to drink at least 1.8 Litres/64 ounces of water a day, and more when you’re thirsty, and get your electrolytes in, even when you’re doing Intermittent Fasting.
Bottom line
If you have gout, or you’ve experienced it in the past, it doesn’t mean fasting is off the table for you. In fact, fasting is a tool that can help reduce your risk for gout. But Intermittent Fasting is a smarter and safer option for you.
And that’s not a fail! Intermittent Fasting is just as powerful a tool for healing and fat loss as Extended Fasting is.
