uric acid - need advice

I detailed how when I went into ketosis on a fast 2 months ago I developed low back pain. This seems to be a relatively common, yet underappreciated, thing, as there are numerous threads on reddit about the topic. No one seems to know what causes it, although it does go seem to go away from peoples experiences (it's not electrolytes).

https://www.reddit.com/r/keto/comments/7am5yx/has_anyone_had_experience_with_lower_back_pain/

about a week after the lower back pain started, I started to get some tendonitis in all 4 limbs and some upper back/neck pain. This whole complex lasted for 4 weeks. Thinking it might be serum sickness again from the IVIG we stopped that.

Since going back ketogenic my nerve pain has been doing great. Really optimistic for the first time ever.

But 2 weeks ago I had what I thought was a UTI, which it appears was more likely a bout of interstitial cystisis. So far it seems have been contained and is now doing better, knock on wood.

But 4 days ago the muscle/joint pain came back in force. It's quite bad. I'm baffled. My rheumatologist didnt think it sounded like lupus or any of the connective tissue diseases. It's eveywhere. It feels metabolic in nature.

I've been hydrating and taking electrolytes.

My creatinine did rise to 1.45 when I had the IC event, but I just retested it and its back to normal. May have just been dehydrated from urinating so much. My BUN didnt move. Urologist wasnt concerned about this.

The urologist mentioned that high levels of acidity could trigger IC. So i started reading about ketosis/high animal protein diets and acidity. Both can cause uric acid to rise if you dont take proper precautions. Uric acid can also cause gout.

My joint pain is not "gouty" in that it is not in any one small joint, its kind of everywhere. But I had my uric acid measured anyway, and it came back at 7.5, which is high. Can this cause full body inflammation/pain? Somehow I think these things are linked, the IC and the pain. My urine Ph is always on the low-side, even when not in ketosis, like a 5.5.

I spoke w/ Mary R, and she felt that I was likely oxalate dumping. Most likely my body started oxalate dumping in the fast, and now it's doing it again. She recommended taking any citrate based electrolyte for the citric acid, as that would bind the oxalates. I took mag citrate last night and I did wake up feeling better. Citrate alkalizes the body as well (ironically when the acid is processed it has an alkalizing effect), so not sure what pathway that is working on, oxalates or the acid theory.

Just curious if anyone has any ideas?

My neuropathy/immune system/stomach feels so much better on this diet that I'm loathe to break it, but would like to know what's going on.

Edit: I just tested my urine Ph this am, and it does seem to have risen (6.25) after pounding the citrate yesterday. Maybe it was just a Ph problem, hard to know. Pain a bit better this am, we will see if it continues to improve or not.

Post Edited (dcd2103) : 8/19/2021 6:12:53 AM (GMT-6)

I have a positive ANA. Been positive for about 10 years.

Gout tends to be in the small joints and often in only one joint, like the big toe. But maybe the high uric acid/low blood Ph is just contributing to an inflammatory process. It's hard to say

I had been eating a lot of red meat. The diet is mostly supposed to be fat, and mary r recommends no more than 6oz protein a meal, but I really like my meat and tend to overdo it. I'm going to try cutting that back and really increasing fat intake like I'm supposed to, in addition to more hydration combined w/ the citrate electrolytes and see what happens.

Feeling a bit better this Am which is a good sign

hi dcd - cant really offer any great explanations

i would bear in mind though that the "normal ranges" for uric acid in urine will have been taken from 1000 random people eating mostly a standard western diet - so mainly energy from carbs.

if you are eating keto style - and even overdoing the meat a bit as many do - then you can expect uric acid to be somewhat higher than the baseline of carb eating majority - but not necessarily higher than say a native Inuit population. so i would say its likely normal for the lifestyle and not necessarily linked to the new symptoms you are feeling.

glad you are feeling a little better - it could just be some adjustment process your body is going through
the mag citrate wont hurt

gout is defo focussed in localised locations - not all over - so doubt its that

anything else you are taking or trying that could be causing some kind of reaction or delayed reaction ??

First, great you are getting married, and she knows your whole health situation. Wish you the very best on that.

The Spero Clinic is close, isn’t it? September? Answers are coming. And too many times a proliferation of symptoms is credited to the mind. This doesn’t appear to be the cause here, as you have pointed out.

You’re getting married today?

Congratulations dcd!!

Congratulations on getting married : ) I hope you have an as good day as possible!

Was Probenecid discussed?

When I was taking amoxy - my LLND had me take Probenecid with it because high doses of amoxy could cause gout. (High Uric acid levels )
Probenecid can stave it off