Volek & Phinney, The Art and Science of Low Carbohydrate Living, p 166-7
"A very predictable change in serum chemistry is a sharp rise in Uric acid concentration in the first week or two of carbohydrate restriction. As noted above, this is due to the competition between circulating ketones and Uric acid for renal tubular excretion. Put another way, Uric acid rises in the blood not because the body is making more of it but because they kidneys temporarily clear less of it. Thus the blood level needs to rise in order for the same amount of it to be cleared by the kidney (because ketones are 'getting in the way'). Subsequent to this abrupt early rise in Uric acid, within 4-6 weeks the level then falls back to or below its pre-diet level even if the dietary carbohydrate restriction and ketonemia continue. This is a part of the body's ongoing adaptation to nutritional ketosis.
In the vast majority of patients, this rise in serum Uric acid is completely benign and requires no intervention. In the minority of individuals predisposed to gout, however, wide swings in Uric acid can trigger an attack. And this goes both ways - either the abrupt rise with the diet initiation or the analogous abrupt fall if the ketonemia is reversed by breaking the carbohydrate restriction in the first few weeks, can act as a trigger. Most people with the genetic predisposition to gout know it long before they consider a low carbohydrate diet, so either preventative medication or prompt intervention at the first symptoms can usually pre-empt an attack. Also, because it is the rapid change in Uric acid that is the primary trigger, once on a carbohydrate restricted diet, the patient with a history of gout should be counseled to avoid frequent cycling in and out of carbohydrate restriction (i.e. Avoid 'going on and off the diet')."
늦어서 번역은 없고 3줄요약만있음
1. 초창기엔 탄수 제한만으로 요산수치가 올라갈 수 있으나(케톤체와 요산이 배출경쟁을 한 결과임) 그 자체만으로는 통풍으로 이어지지 않음.
2. 예외적으로 유전적으로 통풍이 있는 경우만 문제될 수 있으나 이 경우엔 탄수제한을 했다 말았다 해서 요산수치에 큰 폭의 변동을 주지만 않으면 괜찮음.
3. 즉 요산수치가 높아진 것보다 요산수치의 변동폭이 큰것이 통풍의 원인이 됨. 고로 치팅하지 말라는 것.
