Gout and the Atkins Diet: Revisiting the Question

Some rheumatologists are finding Twitter a useful forum. Recently, a question from an Irish nutritionist brought responses from rheumatologists literally around the world, including one from Baylor rheumatologist John Cush MD. It revives an old issue about gout.

The question, from dietitian Paula Mee: Any evidence for increase in gout attacks with more people following a high protein purine diet?

It's not a new issue, but could be "trending" now, given increased attention to gout. Irish rheumatologist Ronan T. Kavanaugh quickly suggested posing it again to Dr. Cush, and on the Twitter stream called "rheumedu."

"Big issue, unproven by literature," responded Dr. Cush, who is director of clinical rheumatology at Baylor University Medical Center, the next morning. [Twitter abbreviations are expanded here for clarity.] "But I've seen 2 patients with gout flare on the Atkins diet. Hence, IMHO, yes."

"Good epidemiological evidence of increased gout in those who eat more red meat," added rheumatologist Philip C. Robinson of the University of Queensland in Australia, who has just written a review on gout epidemiology for Maturitas.

On Twitter, Robinson cited a large prospective study of purines and gout published in the New England Journal of Medicine in 2004. It showed significant increases in gout risk among men with high intake of red meat or seafood (the latter only among slender or normal-weight men). Cogent, but not about the Atkins diet specifically.

Rheumatology Network recycled the dialogue on Twitter and LinkedIn, where it generated some more interest. We're repeating it here, to our audience of rheumatologists.

Have you noticed an increase in gout flares among patients after startomg the high-protein Atkins diet? (Scroll down to find the Comments box.)

Thanks for continuing the conversation.