Reply To: Keto Diet or Febuxostat for Uric Acid Control?

Stopping Gout Together Forums Help My Gout! The Gout Forum Keto Diet or Febuxostat for Uric Acid Control? Reply To: Keto Diet or Febuxostat for Uric Acid Control?

Keith Taylor

Hi Phillip,

You need to take febuxostat according to your prescription. Because a good doctor will prescribe febuxostat to match your target uric acid in 3 phases:
1) Starting phase – start with lowest practical dose and test kidney function and liver function after 2 weeks. If all OK, increase dose until uric acid is at best target for debulking (dissolving old uric acid crystals).

2) Debulking phase – maintain highest practical dose until you’ve gone 6 months without a gout flare and without uric acid rising above 6 mg/dL (5 is better and even lower uric acid will speed gout recovery).

3) Maintenance phase – usually for life, maintain the dose that gives uric acid below 6mg/dL (below 5 is better). Get liver function and kidney function tests with each uric acid test. Test uric acid at least once per year. Liver function test is especially important with febuxostat.

Febuxostat and diet
Febuxostat makes all foods low-purine. So no need to worry about that. Except too much animal protein is bad for general health. So I recommend Mediterranean style eating. However, if that diet does not provide enough meat for your personal taste, the DASH diet is also relatively healthy. I recommend these diets for the sake of your general health. Because febuxostat will control your uric acid effectively. But, it seems pointless to stop your gout only to fall ill to heart disease or another metabolic syndrome disease.

Normally, I would advise gout sufferers to avoid ketogenic diets because they raise uric acid. However, febuxostat removes that risk. However, I’m not convinced that keto diets are particularly healthy. But, I’m prepared to be convinced if evidence is available.

Coincidentally, I’m preparing a report comparing Mediterranean Diet with a ketogenic diet[*]. So, I’ll be sure to consider the health benefits of both diets beyond uric acid control.

* Castaldo, Giuseppe, Luigi Monaco, Laura Castaldo, Giovanna Galdo, and Emanuele Cereda. “An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity.” International journal of food sciences and nutrition 67, no. 6 (2016): 696-706.
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