September 5, 2018

Gout: Is it Meat, or Metabolic Syndrome?

I’ve never experienced a gout attack, but if common graphical representations are to be believed, it feels like there are shards of broken glass embedded in your joints, or like someone’s holding a flamethrower on full blast and aiming it right at your big toe. For whatever reason, the big toe seems to be the joint that suffers the worst in gout, but the condition can manifest in other joints as well.

Conventional medicine holds that animal proteins and alcohol are major triggers for gout, so typical advice for those who suffer from gout is to reduce consumption of alcohol and animal protein—red meat and seafood, in particular.

Part of the rationale for these recommendations is that gout results from an abnormal accumulation in the blood of a compound called uric acid. At high blood concentrations, uric acid can crystallize and be deposited in the joints, and these uric acid crystals are responsible for the pain, swelling, and other fun stuff that comes along with gout. And a major source of uric acid is the metabolism of purines, which are nitrogen-containing compounds found in proteins (and other substances). Some foods are higher in purines than others, hence the recommendations to eliminate or reduce red meat and seafood in the diet. Beer is also high in purines, and other plant foods are sources of purines as well.

But uric acid is a normal compound in the body. It’s not solely a metabolic waste product; it performs important functions as well. So we don’t want to get rid of uric acid entirely, and we certainly don’t want to eliminate protein from our diets.

So if the body normally produces uric acid, what’s really the problem in gout? Does the body produce too much uric acid, or is the uric acid not cleared away properly?

If it’s the latter, and the problem isn’t with overproduction, but rather, with impaired clearance, how is uric acid cleared from the body, and what impairs this?

Well, to cut right to the chase, the kidneys filter excess uric acid out of the blood so it can be excreted in the urine. And what impairs the kidneys’ ability to do this? Insulin. Yes, dear readers, our old friend insulin strikes again. (I mentioned this insulin and gout connection way back in the insulin series.) Alcohol also reduces the kidneys’ ability to excrete uric acid, so there might be some truth to cutting back on alcohol if you have gout.  

Mankind has been consuming animal proteins for a long time now, and gout is a relatively new disease. Well, “new” since about 300 years ago, which is when more accounts of it started being recorded. At that time, it occurred mainly among wealthy people—the people who could afford to eat rich meats and drink alcohol. But something else these “refined” individuals could afford that most common folk couldn’t, was sugar. Refined sugar.  ;-) 

Interesting, huh? 

Typical old-school representation of gout: a demon shooting fire at the toes.
Notice what appears to be a wealthy looking man eating what might be a meatball, and there’s alcohol on the table.

So what’s the real deal with gout? Is it caused by meat, or metabolic syndrome--that is, chronically elevated insulin?

Read all about it in my latest post for the KetoDiet Blog: Is Gout Caused by Red Meat or Metabolic Syndrome?  I think you’ll find the details interesting, and what’s really fascinating is that a few studies have shown that diets that are higher in protein can actually reduce uric acid levels and frequency of gout attacks—provided that the diets are also lower in carbs. Nice, huh?

If you or someone you know suffers from gout, and you think you’ve been relegated to a life without steaks and red wine (perish the thought!), check out the post to learn why it’s not meat, but rather, chronically high insulin, that causes gout.

As a personal aside, I have a friend who suffers from gout, and he’s a vegetarian. No red meat, but lots of fruit, fruit juice, and grains. And fructose, via its effects on the liver, can be a huge contributor to hyperinsulinemia and gout.

If you’d like to learn more, Georgia Ede, MD, has a fabulous post that covers all of this as well—gout, meat, insulin, alcohol, and fructose, and it’s a highly recommended read: Got Gout but Love Meat?

Also, the must-read book, Good Calories, Bad Calories, by Gary Taubes, originally included a chapter on gout, but it didn’t make it into the version that got published. Fortunately, this “lost chapter” is available online and its another educational read on the connections between insulin, fructose, and gout: Gout: The Missing Chapter from Good Calories, Bad Calories

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

August 14, 2018

Does Protein Harm the Kidneys?

Hey kids! My previous blog post laid waste to the myth that a high protein intake is harmful for bone health. This time, it’s my great pleasure to decimate another “high protein is bad for you” thing. Today, it’s kidney function. Many of you have been eagerly awaiting this post. Here’s hoping I don’t disappoint.

Even if you’ve accepted that everything we thought we knew about saturated fat and cholesterol in our diets was almost completely wrong, and you’ve been following a low-carb or ketogenic diet confidently for fat loss, migraines, GERD/acid reflux,  reversing type 2 diabetes, reducing insulin needs and evening out blood sugar for type 1 diabetes, or for some other health issue, maybe there’s still some lingering fear in the back of your mind that the protein you’re eating—especially animal protein—is bad for your kidneys.

We’ve heard this over and over from just about everyone with an agenda to discredit the efficacy of low carb diets. Now, mind you, low carb diets are not, by definition, high in protein, but in walking away from sugars, grains, beans, and starchy vegetables, many of us find that, compared to our former high-carb life, our protein consumption does increase, whether in absolute grams, as a percentage of total calories, or both. Not to mention the growing carnivore movement, where people are eating only animal foods. For these folks, protein consumption almost certainly increases compared to a standard Western diet, and likely even compared to if/when they were following a ketogenic diet.

So with all this in mind, it’s important that we set the record straight about the influence of dietary protein on kidney function.

July 17, 2018

Is a High Protein Intake Bad for Bones?

Tl;dr Read the very short version of this here.  For the juicy details, stay here!

Let’s start with an enticing tidbit from a paper in no less than the Journal of the American College of Nutrition, with the wonderful title, “Dietary protein: an essential nutrient for bone health.”

“In agreement with both experimental and clinical intervention studies, large prospective epidemiologic observations indicate that relatively high protein intakes, including those from animal sources are associated with increased bone mineral mass and reduced incidence of osteoporotic fractures.”

Let’s not be guilty of the same sloppy epidemiological science we accuse other nutrition camps of, though. Epidemiology can generate hypotheses, and give us ideas to think about that then need to actually be tested.  Epidemiology can’t prove cause and effect, but it can generally disprove it.  For example, in the case of dietary protein, if epidemiological findings suggest that higher protein intakes—including animal protein—are “associated with” better bone health, we can’t conclude that the protein itself is directly responsible for the stronger bones, but we can safely assume that protein isn’t harmful for bones.  And in the case of protein and bone mass, we do have pretty good clinical and experimental evidence showing that indeed, higher protein intakes do induce positive changes in bone tissue.  Not in cultured bone cells. Not in mice. In actual living, breathing humans.

It’s hard to believe that in certain circles, protein has gotten a reputation as being harmful for bone health.  After all, Paleolithic hunter-gatherer diets typically contained a large amount of meat, yet anthropologists can sometimes distinguish the remains of hunter-gatherers from those of agriculturalists solely by examining the bones: the high-protein eating hunter-gatherers typically had bones that were larger, stronger and denser, and showed fewer signs of chronic disease. 

Scientists believe the differences in physical activity between the two civilizations played a bigger role than any dietary changes, and sure, hunting and gathering no doubt required a lot of time on one’s feet, but ask any farmer: farming isn’t exactly sedentary work!  Even if a heavy physical workload was responsible for Paleolithic peoples’ stronger bones, we can still conclude that a high intake of animal protein didn’t work against building bone mass.    

So how did some people come to think that protein—animal protein, in particular—is harmful for bones?

June 13, 2018

Has Your Cholesterol Skyrocketed on a Ketogenic Diet? Read This!

Has your cholesterol skyrocketed on a low carb or ketogenic diet?

Or did it start out already high, and hasn’t come down like you thought it would after cutting carbs for a while?

Is your doctor on your case to “do something” about it?  Are they pushing you to take cholesterol-lowering medication and stop that crazy high-fat diet you’ve been following?  

Or maybe your doctor’s actually pretty easygoing about it, but you are alarmed by the big jump in your cholesterol since you started low carb.  Maybe you’re wondering if all that butter, cheese, bacon, and red meat isn’t quite such a good idea after all...

People who adopt carbohydrate-restricted diets have widely varying effects on their lipid profile.  Generally speaking, triglycerides go down and HDL goes up.  This is practically a given.  Happens like clockwork.  Totally predictable.  If you were the betting kind, you could put money on it and have a virtually guaranteed return.  And this is a good thing.  More and more evidence is emerging that regardless of your total cholesterol or LDL, the triglyceride-to-HDL ratio is a strong predictor of cardiovascular risk.  

According to Drs. Phinney and Volek in their book, The Art and Science of Low Carbohydrate Living:

“The triglyceride/HDL ratio provides a broader assessment of risk, and its relationship with insulin resistance makes it far superior to LDL-C.  And how best to improve your triglyceride/HDL ratio?  The striking reductions in plasma triglycerides and consistent increases in HDL-C in response to low carbohydrate diets are unparalleled by any other lifestyle intervention, or even drug treatment, and therefore represents the most powerful method to improve this ratio.”

LDL is a different story.  In some people, LDL goes down, but in others, it goes up.  Something that happens on a low carb diet often, but not always, is a shift from LDL particles that are “small and dense” to LDL particles that are “large and fluffy.”  Even when the total LDL goes up, the pattern of the particle makeup shifts.  It’s believed—but has not been proven conclusively—that the latter pattern, called “pattern A,” is less atherogenic.  That is, when your LDL particles are predominantly the large, fluffy type, they’re less likely to “clog your arteries” (*groan*) and cause a heart attack, stroke, or other cardio/cerebrovascular disease than when your particles are predominantly small & dense, called “pattern B.”  So, on balance, even if LDL goes up on a low carb diet, it’s believed that the shift from pattern B to pattern A is a beneficial change and represents an improvement in your cardiovascular health.

But what if your total cholesterol or LDL absolutely skyrockets?  Does your particle pattern even matter then?  If your total cholesterol is 300, 400, 500, or higher, and your LDL is 200 or higher, surely—surely—all that cholesterol has to be clogging your arteries, right?  Surely your very next slice of bacon could have you staring down the barrel of cardiac arrest, right?  I mean, even if your triglycerides are low and your HDL is high, and your glucose and insulin are low, all your inflammatory markers are low, you’ve lost 60 pounds, your energy levels are through the roof, and your doctor has stopped your GERD medication, your beta-blocker, and your insulin injections, there’s no way your cholesterol could be that high and not cause trouble.


Not so fast.

May 31, 2018

Ketogenic Diets for Migraines

Do you or someone you know suffer from migraines?

If so, then you know these debilitating attacks are far more than mere headaches. In addition to severe, throbbing pain, migraines often also involve visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.

As many as 25% of migraine sufferers experience a visual phenomenon called an aura. Attacks typically last between 4 and 72 hours and in 15-20% of cases, the head pain is preceded by the other neurological symptoms.

Because migraines are increasingly recognized as neurological in origin, it’s possible ketogenic diets may have a therapeutic effect for people afflicted with these attacks. Ketogenic diets exert their effects via several mechanisms that induce multiple biochemical changes in the body and brain that improve neurological function. Some of the mechanisms that are beneficial for various neurological disorders may also make them effective for migraines.

Clinical trial data studying the efficacy of keto for migraines is limited, but anecdotes and personal accounts abound on the low carb and keto interwebs. Some people who start LCHF or ketogenic diets for fat loss or other reasons are pleasantly surprised to find an unexpected “side effect” of keto is reduction in severity and frequency of migraines, or in some cases, total remission. Nice!

As I mentioned in a post not long ago, I’ve joined the writing team at Martina Slajerova’s KetoDiet site. I wrote a post there on keto for migraines, so if you’d like to get the details on why and how keto might be beneficial for migraine sufferers, head on over and check it out: Can the Ketogenic Diet Help with Migraines? It’s fully referenced in case you’d like to look at any of the relevant studies and dig into the mechanisms at work.

Please feel free to send the link to friends and family who suffer from migraines and have not experienced relief with conventional medications, or who have not been able to identify dietary or environmental triggers for their migraines. They might consider giving keto a try. If it doesn’t work, it doesn’t work, but it’s definitely worth trialing for a few months. They have nothing to lose except their morning bagel or muffin—and possibly their migraines.

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

May 8, 2018

Keto Retreat in CANADA - Sept 2018!

Calling all Canadian readers!

Are you tired of all the low carb and keto events happening south of the border?  Have you been wishing someone would start a keto-oriented social event in your country?  Would you like to listen to some low carb lectures and connect with like-minded people?

If so, come see me at the Keto Retreat in beautiful Perth, Ontario.  Loyal blog reader Wendy Moore (no relation to Jimmy) has put together a fabulous event September 14-16, 2018.

I’ll be speaking about ketogenic diets for Alzheimer’s disease, as well as on keeping keto simple.  And guess who else will be there?  Megan Ramos!! That’s right—Program Director and Co-Founder of the Intensive Dietary Management Program (with Dr. Jason Fung).  She’ll be talking about…yes, fasting!  Also presenting will be Dr. Doug Bishop, a keto-friendly MD in Canada, and his daughter Tiia Bishop, who’ll be talking about gut health, keto and exercise, and common barriers/challenges to adhering to a ketogenic diet.

The registration fee is extremely reasonable for this kind of event.  It does not include meals and lodging, but there are several wonderful places to stay in the area, and of course, you can always do Air B&B for convenience.  There’ll be complimentary keto snacks and a cash wine bar during a casual “meet & greet” the evening of Friday, Sept 14, as well as after the speaker presentations on Saturday and Sunday.  Saturday evening, Sept 15, a 3-course keto dinner will be available at the Perth Manor Boutique Hotel.  (See here for details on food and lodging.)

I think this is going to be a great mix of keto science and casual fun – a great way to learn a lot in a relaxed atmosphere, where everyone is welcome.  Not obsessed with biohacking every second of your life away?  Come to the retreat!  Feel jumpy at the mere thought of weighing and measuring your food, and tracking every last molecule and “macro?”  Come to the retreat!  Just want to share a meal with other humans who won’t look at you funny when you ask for your burger without a bun?  Come!  Not at your goal weight?  Heavier than you’d like to be?  Still working on some health issues?  COME AS YOU ARE!  You are absolutely, totally, 100% welcome with us!  (News flash: I ain’t at my goal weight either!  It’s all good!  Don’t you dare let any of that stop you!) 

Even if you’re just kinda sorta “into” low carb, but don’t devote your entire existence to it, you’re also welcome!  Just come, learn, meet people, take a breather, and have some fun.    

Check out the retreat website for all the details on the speakers, pricing, reserving a spot, getting to Perth, and more.  Wendy’s contact information is on the site.  If you have any questions, please contact her directly, as she will be able to help you far better than I will!

Really looking forward to this, folks.  I’m a huge fan of both hockey and maple syrup … I’m practically Canadian already!  Now that my severe depression has finally (mostly) lifted and I want to rejoin the world of the living, I’m attending several low carb and keto events this year.  It’s going to be so nice to come out from behind the screen and meet some of you in person.  Come join us in Perth in September!

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.