Last update and review: December 2, 2020.
A short summary.
Several notes on “healthy fat”, ketosis and blood uric acid levels.
The study of high fat diet, ketosis and other factors in relation to the metabolism of uric acid by Lecocq and McPhaul, 1965 (1).
“Healthy fat” consumed on a “high-fat low-carb diet”, carnivore diet, as MCT-oil or in other forms, can produce ketosis and an elevation of serum uric acid.
Lecocq and McPhaul, 1965 (1):
High fat diets were fed to 6 individuals in an attempt to produce ketosis without caloric deprivation. The results of these studies are shown in figure 9. Scrum uric acid averaged 4.9 rag. per cer~t for the group during the control period directly preceding the high fat diet. After 6 days of high fat feedings mean serum urate concentration was 7.0 mg. per cent. Uric acid clearance dropped from an average of 13 ml./min, to 7 mt/min, during the same time period. Serum ketones rose from a mean control of 1.5 mg. to 8.0 rag. per cent by the sixth day of high fat feeding (fig. 9). One patient did not respond to the diet with the characteristic ketosis and he demonstrated the least changes in serum and urine uric acid levels.
High fat diets also have been shown to cause an increase in blood and a decrease in urine uric acid levels. Harding and co-workers 11 reported that the diets must be sufficiently high in fat content to produce ketosis before an increase in blood urate concentration resulted. However, Adlersberg and Ellenberg 12 studied patients on high fat diets using supplemental carbohydrate calculated to prevent ketosis and acidosis, and found similar changes in uric acid balance. They attributed the hyperuricemia and decreased uric acid excretion to the high fat content itself.
Uric acid levels do not always fall during prolonged starvation. What about ketosis?
Stephen Phinney and Jeff Volek theorized that uric acid falls after a period of “keto-adaptation”. But is this always true?
Phinney and Volek on the website of Virta Health (2):
In short, the figure below depicts the serum uric acid levels typical for a healthy person fed a moderate protein ketogenic diet for 12 weeks. The acute rise in the first week occurs simultaneously with the increase in blood ketones, but then the slow progressive decline occurs despite stable levels of dietary protein and blood ketones. In other words, the initial rise in blood uric acid appears linked to the onset of nutritional ketosis, but then the body slowly adapts back to normal uric acid clearance despite sustained ketones in the blood.
In some experiments, levels of uric acid in blood dropped. But in some, they didn’t.
Lecocq and McPhaul, 1965 (1):
Figure 2 demonstrates uric acid balance during 3 consecutive weeks of starvation in one patient. Maximal changes occurred during the first week of the fast and were maintained for the subsequent 2 weeks.
In the study by Irving et al., 1976 (3), levels of uric acid in the blood dropped, but they remained at the levels associated with gout, tendon damage, hypertension.
This still holds since 1965: “ketosis can cause a decrease in uric acid excretion”.
Lecocq and McPhaul, 1965 (1):
The data from these studies show that ketosis can cause a decrease in uric acid excretion and suggest that this is the factor responsible for the altered uric acid balance of starvation. Ketosis depressed uric acid clearance without lowering glomerular filtration rate, indicating that the fall in urine uric acid excretion was the result of an alteration in renal tubular urate disposition. Since it has been postulated that normally filtered urate is almost completely reabsorbed by the tubules, ~3 it is possible that ketones affect uric balance by blocking renal tubular uric acid secretion. The uric acid data obtained in these starvation studies are in agreement with other published data. 1-9 It is apparent that the fall in urine uric acid.
Consumption of probiotic-fermented products and uric acid: lactate should not be a problem.
The levels of lactate and pyruvate in the present report are not of the magnitude to suggest that they are responsible for the change in uric acid balance found during fasting.
Selected references:
1. Lecocq and McPhaul, METABOLISM, VOL. 14, NO. 2 (February), 1965.
2. Phinney and Volek. Article on the website of Virta Health.
https://www.virtahealth.com/blog/keto-adapted
Accessed on December 2, 2020.
3. Irving et al. Metabolism, Vol. 25, No. 5 (May), 1976 551
2 Comments