Keto Knees and Joint Pain on Keto while Adapting to Keto

Disclaimer: I’m not a doctor or medical professional of any kind, I just wanted to share an issue I had and how I fixed it for myself. 

The Problem

So this isn’t an issue that will affect everyone, but some folks will get sore joints during keto flu. It’s more likely if you’re already prone to sore joints like I am with my RSI in my hands + people with a history of gout, but there’s probably no knowing ahead of time if it will affect you specifically.

Early on in my keto journey, I could tell it was already making an impact on my energy levels and I was losing weight. Which was great. But then it wasn’t long before I started having horrible knee pain. I had a very long flight of stairs to get up to my room each day and it was extremely painful.

Recently I had gone off keto for a really long time and the issue came back. I’ve gone off and on keto quite a bit so it’s not something that happens every time with keto flu, this is actually the only time this has happened since I first started keto years ago. But I had gotten quite lazy with my diet in the past year or so with all the travel and wanting to try new foods. But this time my knees and my ankles were sore and my RSI in my hands which is normally very well managed by keto came back with a vengeance. It actually hurt worse than it did when I was OFF keto a few weeks prior. So this can cause some joint pain in general. I also feel some tightness/muscle soreness in my lower back and soreness around my kidneys. This is what tipped me off to this being potentially a uric acid issue.

Why It’s Happening 

When you’re adapting to keto your body has to shift from burning primarily carbohydrates to primarily fat. While this is what the human body generally is made for– if you’ve not been doing it already sometimes things get worse before they get better. One of the things that can happen early on is it your body can have issues with uric acid. You aren’t producing more, but when your body raises keto production ketones and uric acid may fight for excretion a bit til your body adjusts. (Or at least this is my understanding of it)

Thankfully it’s a temporary issue and the fix is fairly easy. It’s not a very common issue and likely people are just writing it off as part of the keto flu. But I was definitely getting enough electrolytes and apple cider vinegar wasn’t helping.

P.S. This isn’t the same as gout but there are some similarities. More in relevant links.

How to Fix It

Now you can definitely just wait it out and the pain will go away once your body is fully adapted. Unfortunately, this can take anywhere from 1-3 months from my reading into anecdotes of people with similar pain. It was about 2 months for me. Since I didn’t want to just struggle to walk for several months I decided to take a supplement. Again, it’s not this severe for most folks so I don’t want to scare anyone away from keto. Once I adapt keto is a vital part of how I manage the RSI joint pain in my hands.

The supplement that helped me with this increase in uric acid is Tart Cherry Extract capsules . I don’t recommend drinking the actual juice itself because it’s pretty carby– the unsweetened one I checked out was 14g of carbs in just 2 tablespoons. Which is a lot when you’re only supposed to have 20g in a day! I just bought 1 bottle and that was enough for me, once that ran out I stopped taking it and the pain didn’t come back. It made a difference very quickly for me, within a day or two. I was still sore but it was much better. I gave it to a friend of mine who was also doing keto and she said it helped her a lot too.

There are lists of foods that help lower uric acid too if you just Google it, but the capsules were more convenient. Dr. Eric Berg mentions having some lemon to help so that might be worth trying too. He also mentioned getting some electrolytes. In the book “The Salt Fix” Dr. James DiNicolantonio also mentions that salt can help with the kidneys. For me I had some Lemon Spindrift Sparkling Water with a Raw Unflavored LMNT Electrolyte Powder mixed in. 

Temporary Kidney Pain Relief: Dr. Eric Berg mentions in his video to press on the front of your stomach on the opposite side of where you feel the pain on your back. This can provide temporary pain relief until you fix the root issue.

Back Massage with Heat: I have a Zyllion Back and neck Massager with Heat that helped provide some pain relief. If you don’t have one you can also get some washcloths and warm them with hot water and lay them on your back. If you get someone to massage you be careful, too much pressure when your kidneys are already having problems can hurt–so start gentle and up the pressure.

Relevant Links – Study shows uric acid goes up temporarily but goes down after about 6 weeks.  – Diet Doctor has a good article on Uric Acid & Gout  – Dr. Ken Berry talks about how meat doesn’t cause gout – Dr. Eric Berg on Kidney Pain with keto. He also mentions some other things it could be if uric acid isn’t the problem. Oxalates is a common one. – another common reason is oxalates, this video by Loving it on keto talks about it

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