Gout is a type of arthritis, usually caused by the accumulation of uric acid in the blood. When the level of uric acid rises, uric acid crystals form, which deposit in the joints and cause irritation, inflammation, and swelling. This is called a gout attack and can be very painful. There are many reasons why the blood may contain high levels of uric acid. This may be the result of the reduced ability of the kidneys to remove uric acid. This may be an overproduction of a compound called purine. It may be a combination of the two.
Although medication is a key factor in the management and treatment of gout, dietary factors can also play an important role. Following dietary advice may or may not be accompanied by medication, but it helps stabilize blood uric acid levels, thereby reducing the risk of gout attacks.
Dietary advice for managing gout
Gout is a painful arthritis that occurs when high levels of uric acid in the blood cause crystals to accumulate in and around the joints.
Uric acid is produced when the body breaks down a chemical substance called purine. Purines are naturally found in your body, but they are also found in certain foods. Uric acid is excreted through urine.
A gout diet may help reduce the level of uric acid in the blood. The gout diet cannot be cured. But it may reduce the risk of recurrence of gout and slow the progression of joint damage.
Gout patients who follow a gout diet usually still need medication to control pain and lower uric acid levels.
Gout diet goals
A gout diet is designed to help you:
- Achieve a healthy weight and good eating habits
- Avoid some, but not all, foods with purines
- Include some foods that can control uric acid levels
A good rule of thumb is to eat moderate portions of healthy foods.
The general principles of a gout diet follow typical healthy-diet recommendations:
- Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
- Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
- Water. Stay well-hydrated by drinking water.
- Fats. Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
- Proteins. Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.
Recommendations for specific foods or supplements include:
- Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
- Red meat. Limit serving sizes of beef, lamb and pork.
- Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
- High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don't increase the risk of gout or recurring gout attacks.
- Alcohol. Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn't appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
- Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
- Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
- Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
- Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Here's what you might eat during a typical day on a gout diet.
- Whole-grain, unsweetened cereal with skim or low-fat milk
- 1 cup fresh strawberries
- Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
- Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
- Skim or low-fat milk or water
- 1 cup fresh cherries
- Roasted salmon (3 to 4 ounces)
- Roasted or steamed green beans
- 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
- Low-fat yogurt
- 1 cup fresh melon
- Caffeine-free beverage, such as herbal tea
Following a gout diet can help limit the production of uric acid and increase its elimination. The gout diet is unlikely to reduce the concentration of uric acid in the blood enough to treat gout without the need for medication. But it may help reduce the number of attacks and limit their severity.
Following a gout diet, while limiting calories and exercising regularly, can also improve your overall health by helping you achieve and maintain a healthy weight.
What can you do to prevent gout attacks?
Reach a healthy weight
Obesity may be the main consideration for lowering the level of uric acid in the blood. Insulin resistance is common in obese people, and it may be related to the development of gout. Insulin resistance has been shown to reduce the amount of uric acid cleared in the urine. A condition called "metabolic syndrome" is a series of symptoms, including insulin resistance, abdominal (abdominal) obesity, high blood pressure, and abnormal blood lipids (lipids)-such as high cholesterol. This condition is closely related to high uric acid levels and can be improved by slow, gradual weight loss.
Weight loss has been shown to improve insulin resistance, thereby reducing uric acid levels in the blood. However, it is important to avoid strict diets such as low carbohydrate and high protein diets. These may increase the consumption of purine, which is a compound that breaks down into uric acid. In addition, rapid weight loss through strict diets can lead to tissue breakdown. This can temporarily cause uric acid levels to rise. A gradual, safe weight loss of 1-2 pounds per week helps to achieve optimal weight.
For many years, excessive drinking has been associated with gout. However, not sure how it is related. Certain types of alcohol, especially beer, contain high levels of purines, which may be an indirect cause of gout. Alternatively, the association between alcohol and gout may be due to excessive alcohol consumption leading to obesity. Alcohol contains 7 calories per gram, so excessive drinking can lead to weight gain.
Compared with spirits, drinking beer is more likely to cause gout, and drinking wine in moderation has no associated risks. If you choose to drink, it is recommended to drink in moderation. Men and women should not drink more than 14 units per week. These units should be dispersed within a week, and there should be at least two days a week without drinking.
A unit of alcohol is:
- One 25 ml shot of spirits.
- Half a pint of standard-strength lager/beer (3-4% alcohol by volume).
- One small 125 ml glass of wine (11% alcohol by volume).
Higher strength alcoholic beverages will contain more units. For example, a pint of high-strength beer (alcohol concentration of 5.2%) is 3 units, and a small glass of 125 ml of wine (alcohol concentration of 12%) is 1.5 units.
Ensuring adequate fluid intake helps reduce the risk of crystals forming in the joints. Staying hydrated and avoiding lack of fluid (dehydration) in the body can reduce this risk and help prevent gout attacks. The goal is to drink at least 2 liters a day. However, depending on your weight, whether it is hot, or whether you are exercising, you may need up to 3-3.5 liters of water per day.
Reduce purine intake
Purines are natural compounds found in many foods. When purines are metabolized, they are broken down and the final product is uric acid. Therefore, reducing purine-rich foods, especially foods that are often consumed, may help prevent gout attacks.
Reduce red meat (especially beef, pork and lamb), poultry and seafood, because these are the main sources of purines. The goal is not to exceed one serving of any meat (including poultry) or fish a day, and skipping meat 1-2 days a week may help. To ensure that you get enough protein, add meat-free protein sources such as eggs, low-fat dairy products, tofu, cheese, nuts, or beans with low purine content, such as lentils. There is evidence that plant foods do not increase the risk of gout, even if they have a higher purine content.
Certain foods are very high in purine content and should be quite limited if it cannot be avoided completely. These include:
|Meat Sources||Liver, heart, kidney, sweetbreads, ox, game (eg, venison, rabbit), meat extracts (eg, stock cubes/gravies).|
|Fish Sources||Anchovies, crab, fish roes, herring, mackerel, trout, sardines, shrimps, sprats, whitebait.|
|Other Sources||Yeast and extracts, beer, high fructose corn syrup.|
Limit sugary foods/sweets
Excessive addiction to these foods can lead to weight gain and obesity. In addition, sugary foods, beverages and snacks often contain fructose or substances that may be labeled as high fructose corn syrup/glucose-fructose syrup. A large intake of fructose will increase the level of uric acid in the blood and may increase insulin resistance. These are risk factors for the development of gout, so these foods should be restricted.
In addition to biscuits, cakes, candies, fruit juices and sugary drinks, high fructose corn syrup can also be found in unexpected foods. These include:
- Frozen pizzas.
- Cereals and cereal bars.
- Jarred sauces.
- Some condiments such as jams, ketchup, mayonnaise or salad dressings.
Check labels to compare products and choose fresh ingredients instead of processed foods whenever possible.
Although fruit contains fructose, it should not be restricted. This is because fruit is not a concentrated form of fructose. When consumed whole, it contains fiber, protective vitamins and minerals such as potassium, vitamin C and other antioxidants, which would otherwise be lost during processing.
Which foods are the best?
A healthy and balanced diet helps to achieve and maintain a healthy weight. It can also provide enough energy and nutrition to maintain optimal health and reduce the risk of gout attacks.
Lots of fruits and vegetables
The recommendation is five servings a day, but try to eat as much as possible. Eat more meals, such as meat sauces, casseroles and vegetable stews, to help reduce meat content. Fruits and vegetables contain vitamin C. Although the evidence is unclear, a large intake of vitamin C (500 mg or more) may help reduce uric acid levels in the blood. Adding cherries to the diet may be particularly useful, as they have also been found to reduce uric acid levels in the blood.
Lots of starchy carbohydrates
These may include rice, potatoes, pasta, bread, couscous, quinoa, barley or oats, and should be added at every meal. These foods contain only a small amount of purines, so these foods and fruits and vegetables should be the basis of your diet. Whole wheat varieties are a better choice because they contain more fiber and nutrients.
Some meat, fish, eggs, beans and legumes
Eat these foods in moderation. Taking vitamin C with meals can help increase iron absorption, so you can drink a small glass of orange juice, eat a piece of fruit as a dessert, or eat with a lot of vegetables. Use your hands as a guide to control the amount of meat. One serving is about the size and thickness of the palm of your hand.
Some milk and dairy products
Including low-fat dairy products (such as skimmed milk, low-fat yogurt, and low-fat cheese) may help prevent blood uric acid levels from rising. These foods are good sources of protein and have low purine content, so if you want to reduce the intake of meat (including poultry) and fish, these foods are useful additives.
Lowering the level of uric acid in the blood helps prevent gout attacks. This can be done in the following ways:
- Limiting alcohol.
- Drinking plenty of fluid.
- Achieving a healthy weight.
- Avoiding/reducing foods high in purines.
- Limiting foods sweetened with fructose.
- Consuming low-fat dairy products.
- Eating plenty of fruit and vegetables, There is some evidence that eating cherries is associated with a reduced risk of gout attacks.