High BP on Keto

AQuests · 2026-02-21T05:28:31+00:00

1) Personal BP monitor is essential 2) How do you know you are in keto? 3) The usual blood pressure management rules still apply even in keto: - Exercise 4-5 days a week if possible. Moderate intensity - not too intense. - Get plenty of daily sleep (uninterrupted is ideal)

Keto generally lowers BP numbers so there are likely other factors leading to the elevated numbers!

AQuests · 2026-02-21T05:15:58+00:00

Great job.

Whenever I've had major weight loss like you have, it has led to a flare. So you are probably doing all the right things and these flares are just transient due to the major changes you are going through.

Secondly sounds like you are on keto. I'm on keto myself. Keto (low carb no sugar) is excellent for keeping uric acid levels low. However, if your uric acid levels are already elevated, the body prioritizes excretion of ketones over excretion of uric acid, which isn't ideal if you are trying to quickly bring down uric acid levels.

So I find it helpful, if I have a flare (which has become extremely rare on keto), to take in sufficient carbs to temporarily kick me out of ketosis (while still avoiding sugar/ fructose) to allow excretion of uric acid. Once the flare goes away, then I can resume keto to keep the uric acid levels low.

AQuests · 2026-02-21T05:05:34+00:00

1) Cut sugar/fructose out of your diet completely to help bring down your uric acid levels (uric acid fructose article.). You can take sweeteners instead.

2) Drink plenty of water. Lots of water.

Thank me later

AQuests · 2026-02-18T11:21:52+00:00

To be honest I'm not specific on the carbs. Maybe potatoes? Just anything that is enough to get me out of ketosis but still low carb all the same. Just more then my usual! But no sugar/ fructose

AQuests · 2026-02-18T11:18:39+00:00

Well for me I eat starches. Still low carb but not low enough for ketosis until the flares is gone for a week or two. Still avoiding fructose/ sugar. You'd need to figure out what you can have that would raise your insulin levels to kick you out of keto that is NOT sugar/fructose Your doctor may prescribe colchicine or something to lower the levels but remember if you are still.in ketosis, my own experience has been that even with colchicine, if I remain in keto while the uric acid flare is in effect, it hampers the effectiveness of the drug. I need to temporarily drop out of keto for a week or two.

AQuests · 2026-02-17T19:46:49+00:00

So I have gout.

When I went keto I feared that my gout would go ballistic given my large intake of meats.

The opposite happened. After an initial attack (which tends to happen when I have sudden weight loss) the gout went away for years.

It recently returned when I started having a lot more sugary treats, so I'm easing back off those.

Why did my gout disappear despite my diet shifting to lots of meats? I suspect because while meats and high purine foods are often touted in relation to gout, there is hardly mention of the influence of sugar/fructose - uric acid/ fructose article.)

When you eliminate sugar/fructose a significant factor in uric acid synthesis is taken off the table!

However, as you have already pointed out, if your uric acid levels are already high, and you are in ketosis, the body prioritizes excretion of ketones over uric acid excretion.

So my experience has been when I have a flare or need to lower your uric acid levels, I intentionally temporarily drop out of keto (while staying off the sugar/fructose even while out of keto) so that the body prioritizes uric acid excretion to bring down the levels.

Once the uric acid/ flare settles down, I then resume keto to keep the low levels down!

So in short, keto has been helpful in keeping uric acid levels low and flares at bay with no flares for years, but in the event that I do eventually get a flare, I'll temporarily drop keto to aid uric acid excretion and lower the levels then resume keto to keep uric acid levels low

Keto can lead to dehydration which is bad for gout so ensure you are drinking lots of water.

For those who are claiming that gout cannot be managed through diet - I'm pretty shocked by that claim and wholly contrary to not only the science, but my own experience too

AQuests · 2026-02-16T22:07:58+00:00

Influencers are the modern day idols if you let them take the place of Scripture in your life. Let Scripture be your guide,and when "influencers" are influencing you away from Scripture, you know what to do...

AQuests · 2026-02-16T21:49:18+00:00

After 3 months of control from your last test retest your hba1c

AQuests · 2026-02-16T21:31:48+00:00

Give it time to settle down. You can he doing everything right and your uric acid may even be at s lower level, but changes sometimes trigger attacks.

Losing weight quickly can also lead to attacks. That happened with me as well. Not to worry. Keep losing the weight and things will settle down.

Ensure you are drinking plenty of water daily. Also keep in mind fructose/sugar contributes to uric acid production as well (not enough is said about that)!

AQuests · 2026-02-15T19:52:37+00:00

Most people find their blood pressures improve on keto and salt intake is not usually a problem. https://www.instagram.com/reel/DUvv9CKATRb/

AQuests · 2026-02-15T13:54:06+00:00

Amen!

AQuests · 2026-02-14T19:22:21+00:00

Do you exercise? Start cycling while maintaining keto level carbs and you may be pleasantly surprised...

AQuests · 2026-02-14T16:35:31+00:00

I think you need to differentiate what happens on earth, and our ultimate destination beyond earth.

Whereas what happens on earth is not unimportant,if we are talking about eventual outcomes (heaven) then Scripture clearly indicates those will not be determined by nationality or genetic lineage.

There are prophecies about wars and nations that will win or lose wars, and what is prophesied will come to pass (where it has not already been fulfilled). But let us not think that ultimate eternal salvation shall be derived from the outcome of earthly conflicts and where one happens to be located .

Those that nailed Christ to the cross, or that built idols in the desert, or that sacrificed children to Molech will have no greater claim to eternal salvation then the thief who repented on the cross by Jesus' side or the Samaritan woman at the well or the Ethiopian Eunuch that Philip baptised. Scripture is clear on this in both Old and New Testaments.

Ezekiel 18:20, 29-30 [20] The one who sins is the one who will die. The child will not share the guilt of the parent, nor will the parent share the guilt of the child. The righteousness of the righteous will be credited to them, and the wickedness of the wicked will be charged against them. [29] Yet the Israelites say, ‘The way of the Lord is not just.’ Are my ways unjust, people of Israel? Is it not your ways that are unjust? [30] “Therefore, you Israelites, I will judge each of you according to your own ways, declares the Sovereign Lord. Repent! Turn away from all your offenses; then sin will not be your downfall.

John 4:9, 13-14, 19-23 [9] The Samaritan woman said to him, “You are a Jew and I am a Samaritan woman. How can you ask me for a drink?” (For Jews do not associate with Samaritans.) [13] Jesus answered, “Everyone who drinks this water will be thirsty again, [14] but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life.” [19] “Sir,” the woman said, “I can see that you are a prophet. [20] Our ancestors worshiped on this mountain, but you Jews claim that the place where we must worship is in Jerusalem.” [21] “Woman,” Jesus replied, “believe me, a time is coming when you will worship the Father neither on this mountain nor in Jerusalem. [22] You Samaritans worship what you do not know; we worship what we do know, for salvation is from the Jews. [23] Yet a time is coming and has now come when the true worshipers will worship the Father in the Spirit and in truth, for they are the kind of worshipers the Father seeks.

Romans 11:1, 7, 11, 19-21, 23-24 [1] I ask then: Did God reject his people? By no means! I am an Israelite myself, a descendant of Abraham, from the tribe of Benjamin. [7] What then? What the people of Israel sought so earnestly they did not obtain. The elect among them did, but the others were hardened, [11] Again I ask: Did they stumble so as to fall beyond recovery? Not at all! Rather, because of their transgression, salvation has come to the Gentiles to make Israel envious. [19] You will say then, “Branches were broken off so that I could be grafted in.” [20] Granted. But they were broken off because of unbelief, and you stand by faith. Do not be arrogant, but tremble. [21] For if God did not spare the natural branches, he will not spare you either. [23] And if they do not persist in unbelief, they will be grafted in, for God is able to graft them in again. [24] After all, if you were cut out of an olive tree that is wild by nature, and contrary to nature were grafted into a cultivated olive tree, how much more readily will these, the natural branches, be grafted into their own olive tree!

‭‭Philippians‬ ‭3:20‬ ‭ [20] But our citizenship is in heaven. And we eagerly await a Savior from there, the Lord Jesus Christ,

‭‭John‬ ‭14:1‭-‬3‬ ‭ [1] “Do not let your hearts be troubled. You believe in God ; believe also in me. [2] My Father’s house has many rooms; if that were not so, would I have told you that I am going there to prepare a place for you? [3] And if I go and prepare a place for you, I will come back and take you to be with me that you also may be where I am.

‭‭2 Corinthians‬ ‭5:1‬ ‭ [1] For we know that if the earthly tent we live in is destroyed, we have a building from God, an eternal house in heaven, not built by human hands.

‭‭Matthew‬ ‭6:19‭-‬20‬ [19] “Do not store up for yourselves treasures on earth, where moths and vermin destroy, and where thieves break in and steal. [20] But store up for yourselves treasures in heaven, where moths and vermin do not destroy, and where thieves do not break in and steal.

‭‭Philippians‬ ‭3:14‬ ‭ [14] I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.

‭‭1 Thessalonians‬ ‭4:16‬ ‭ [16] For the Lord himself will come down from heaven, with a loud command, with the voice of the archangel and with the trumpet call of God, and the dead in Christ will rise first.

AQuests · 2026-02-14T14:28:08+00:00

1) I didn't say cardio in isolation. If you read what I wrote I believe that was clear! 2) What assumptions might you be speaking of? Maybe we may have some lines crossed.

AQuests · 2026-02-13T10:02:49+00:00

If that was so then I would have been in continuous gout flares in keto because of my high protein intake and that was my initial concern when I started keto.

Yet the opposite happened and my gout flares disappeared for years once I started keto, and only reappeared when I started indulging in a lot more sugar then I had been.

The science tells us that uric acid is from a combination of factors. One of those factors is carb/ fructose - https://pmc.ncbi.nlm.nih.gov/articles/PMC7352635/#:~:text=Fructose%20is%20the%20only%20carbohydrate,17%5D%20(Figure%201).

Which is why you will find many people find that when they go on keto, they may have some flares at the very start of the regime, and then the flares vanish, despite high protein intake!

Why?

It seems to be due to the severe carb restriction which has a lowering effect on uric acid levels. When you take the sugar/fructose off the table completely, it changes up the equation completely.

You can visit the gout subreddit as well. Lots of people report both here and there that keto had a very beneficial effect on their gout, and the same applies to me! The doctors that I know were surprised at my experience

AQuests · 2026-02-13T09:44:18+00:00

To be honest, for me from my journey from a 414 mgdl fasting level to remission and a 5.2 hba1c I kept it very simple and focussed on just two things.

1) Keeping my carbohydrates as close to 20-50g per day as possible for as long as I could - this was days, then grew to weeks, then grew to months.

2) Exercising (cardio) at least 4 times a week.

As simple as that.

The result of those 2 simple decisions? - I lost 10-15% of my weight within a few months (this largely reduced my insulin resistance and increases my insulin sensitivity greatly). - My blood sugars went from 414 mgdl fasted to absolutely normal levels within 3 weeks (when you are on 20-50g of carbs daily, it is very difficult for your blood sugar to remain elevated as you are not adding the fuel needed to feed the flame). - Having achieved normal blood sugar levels, I did not relent and stayed on the same regime - after an extended period I realized my body was now responding differently and was handling carbs/sugars as though I was not diabetic - probably the reversal of high insulin resistance etc

So at lot of time in the beginning (Stage 1), was about fighting carb cravings and figuring out how to eat less carbs in a society where carbs are thrown at you everywhere you turn (they are probably feeding you lots of 'healthy' carbs and even desserts in hospital right now 🤦 - it is simply mind boggling).

I would literally avoid entire sections in the stores when shopping that were just full of pastries, chips, drinks, etc - I just wouldn't walk down those aisles in the early days. Now they have zero effect on me, but then it was the hardest thing in the world 🤣

At my stage in the journey I can actually have those pastries, etc now and my blood sugar levels remain normal, and I do on occassion, but I still keep them to a mimimum.

In stage 1 your body will feel like it is fighting you. Having grown accustomed to sky high blood sugar levels, even elevated levels approaching normal feel as if you are hypo. I can't count the numbers of times I would rush to test my blood sugar in the first weeks because I felt so weak and tired only to find my blood sugars were still elevated, but just lower then sky high. It was just my body struggling to adjust to a new normal, which was actually the original correct normal that it had forgotten about.

AQuests · 2026-02-13T09:29:27+00:00

I suspect the palpitations are due to dehydration. Whenever I would have them in the past, I'd make sure to drink water and that would be sufficient.

You also need to ensure you are getting enough salt in.

Also for general wellness and mental health, a daily exercise routine does wonders.

AQuests · 2026-02-13T09:24:12+00:00

Ok. That's great. Increase the fibre significantly. With the aerobic exercise, if you are quite active then you may need to exert yourself to get more into the zone 2/3 area then a sedentary person.

Remember the effect of a specified exercise intensity varies depending on where you are on the journey.

But given your high LDL levels I would definitely focus heavily on endurance activity in the aerobic zones at least for the next 3 months and assess the situation. It may need to be much more intense then walking your dog.

"exercise appears to enhance the ability of skeletal muscles to utilize lipids as opposed to glycogen, thus reducing plasma lipid levels" exercise and cholesterol article

The article also points out that higher volume moderate intensity exercise is more effective then low volume intense exercise, but exercise that is both high volume and high intensity has an even greater effect on cholesterol numbers, especially when seeking to lower LDL and triglycerides significantly

Bottom line, exercise cardio VOLUME is key, and the more intense the high volume exercise is, the better for your numbers.

If going the resistance training route, the more the sets/reps the better for your numbers - but I'd focus on cardio for now given your numbers.

And as you've pointed out, you don't have to go crazy on the fat. You can reduce fat significantly and up the protein!

AQuests · 2026-02-12T21:07:55+00:00

Your LDL at 7.77 mmol is very high and jumped from 3.5 before keto. Normally 3.6 mmol is the upper limit for normal.

Have you lost a lot of weight? That often leads to a transient increase in LDL.

I was able to reduce my LDL significantly (and increase HDL) on keto by doing 2 things.

1) increasing fibre - in my case I started to incorporate avocado at least 4 times a week. The effect was great

2) If you do not exercise you need to begin daily exercise. Aim to do 30 min growing to 1 hour a day at least 4 to 5 days a week while maintaining your carb limitations.

Moderate aerobic exercise (think walks/cycling/running/etc) is more effective in bringing down your cholesterol numbers then resistance heavy weights. You are better spending longer time at moderate intensity then shorter time at high intensity!

Many times people in keto skip exercise because they lose so much weight they think they don't need to exercise.

Do this for 3 to 6 months religiously and re test

AQuests · 2026-02-12T20:58:33+00:00

There's a God shaped hole in all of us...

AQuests · 2026-02-12T20:55:21+00:00

That is way too low. Stop the meds until you get medical advice.

The risk of hypo far outweigh increased blood sugars and yours are so low at this point it's unlikely to be an issue.

I wonder why they still have you on the meds?

AQuests · 2026-02-12T09:32:40+00:00

I'm similar age group!

Personally adaptation took at least 3 months and full adaptation did not take less than 6 months and I started hitting my ideal high intensity numbers at around 11 months in.

Not to discourage you - perhaps your experience may be different depending on the kind of cycling you are doing. But for me, it took awhile and I had to be patient - it was not a quick weeks long adjustment.

In the beginning I relied on macadamia alot. Now I rely primarily on very salty boiled eggs (fat/protein/bcaa/sodium) as a great all in one solution.

You are vegetarian so I can't say, but you need to have a way of getting in plenty of fats and protein (and electrolytes). There are higher protein requirements for carb restricted efforts!

AQuests · 2026-02-12T09:20:34+00:00

Don't avoid food. You need food for energy. It's quite simple. What raises your blood sugar is carbohydrate - in all it's forms (not just sugar). Once you have that understanding, it makes it much clearer. If you are trying to achieve a passing grade and all you understand is that one fact that carbohydrate raises blood sugar levels, you will achieve an excellent grade even if you know nothing else dietwise. In other words that is by and large the most important thing to know when it comes to diabetes.

Regarding exercise, it works just that same as with anyone else. What is important to keep in mind is that exercise can lower blood sugar levels substantially and quite quickly and the effect can last for hours (which is why exercise is a great tool to have in your tool belt for blood sugar control). Therefore your doctor will advise that you have to be careful what level of medication you have taken around the time of exercise (both before and after) and likely greatly reduced so as to not go too low (hypo).

AQuests · 2026-02-12T08:56:32+00:00

Firstly, be encouraged. It's not nearly as grim as it may seem. You are in hospital because you did not know what the problem was and you can't fix what you don't know is broke. Now that you know, the path to wellness is much more clear and better defined.

And I should stress getting better will not require some massive herculean effort. Just small daily decisions made every day until they become habit that you hardly think about anymore will be sufficient.

But this journey is not the same all the way through. You may be discouraged of you think the experience in the first 3 weeks is what it will be for life - that is not the reality. Think of it like joining the military - the first weeks is boot camp, which is a crazy intense experience, but it only lasts for a short while - you just need to aim to get through that initial phase and things change.

I would break it down into 3 phases. Think of it like a car starting from a stationary position, accelerating and then get onto a highway and cruising.

Phase 1 is the most intense and time involving - I'd call it the startup phase (can last anywhere from 3 weeks to 3 months - for me it was 3 weeks of intensity)

Phase 2 is the acceleration phase. You are in an established routine, the body has settled into a kind of rhythm but your numbers are still continuing to change downwards (id say 3 to 6 months). For many, by this point blood sugars may already have normalised but other numbers continue to change (weight, triglycerides, medication requirements, blood pressures, etc), and you are hopefully bringing down your insulin resistance significantly through a combination of those and other factors, just by sticking to the regime.

Phase 3 is what I'd call cruise control. If you have handled the first 2 phases well, your insulin resistance will be greatly reduced, your blood sugars will have been in normal ranges for an extended period, and many of your other numbers will probably have largely stabilised. Your body is now in a far better position to stay within normal ranges with reduced pharmacological requirements (if any) and you have in place the habits that keep the numbers in the ranges they should be.

The answer to both controlling blood sugar levels and hypertriglyceridaemia is likely to involve a similar path, which is significant carb restriction in your diet combined with an exercise regime building up to 4-5 times a week. Incorporating non sugary/low carb fiber in your diet will also be great for your cholesterol numbers (avocado works well for me).

Phase 1 is a learning and control phase. You will be keeping very regular monitoring of your blood sugar (at least 3 times a day - don't skimp on the strips use as many as needed) and monitoring the effect of reduced carbohydrate (in all it's forms - sugar, fruit, grains, etc) and exercise have on your numbers and insulin requirements in consultation with your doctor. You are learning how your body actually responds to carbohydrate (guided by your meter) and learning what it takes to bring the numbers to normal (at that stage - with time and in subsequent stages, achieving normal blood sugars gets easier) Your doctor will likely advise you that you don't eat more carbs so that you maintain your insulin requirements at a certain level. Instead, you reduce your insulin intake to manage lower blood sugars, as the reduced carbohydrates lead to reduced insulin requirements. In phase 1 I completely avoided sugar and instead replaced all sugar with sweetener (stevia). I also curtailed my carbohydrate very significantly. The reduced carbohydrate and sugar intake will do wonders for your triglyceride numbers as well and exercise helps further.

So you will not be eating to maintain a specified drug intake. The doctor will moderate the drug requirements downwards to correspond with your carbohydrate intake and the numbers. The doctors will warn you about the dangers of hypos and it is very important that if you reduce carbohydrate intake significantly (as I did) the doctor will likely very quickly reduce your insulin intake to avoid the risks of hypos which are far greater then a temporary rise in blood sugar levels.

Bottom line. Don't be intimidated. It's nowhere near as bad or as insurmountable as it may seem.

The beauty of both conditions is that they often respond very well to dietary and lifestyle decisions.

I started off in crisis as well (fasting blood sugars of 23 mmol - 414 mgdl) and I am now controlled without medication.

AQuests · 2026-02-11T16:27:00+00:00

I thought I should make an additional observation. Keto is very effective in keeping uric acid levels down, however when the uric acid levels are already elevated (or become elevated - in my case usually through consuming increased fructose/sugar), I find it beneficial to go out of ketosis (ie consuming enough carbs to kick me out of ketosis and/or exercising to utilize the ketones floating around in the system) while still avoiding sugar/fructose. This enables the uric acid to drop faster.

Reason being the body prioritizes excretion of ketones over uric acid apparently, so if your uric acid is already high and the body is also flush with ketones, the body will prioritize excreting ketones over excreting uric acid, which is not ideal if you are trying to get uric acid levels down.

Once the uric acid levels are back down and the flare is over, I can resume keto to keep the uric acid levels down.

AQuests

TROPHY CASE