A diet for gout and high uric acid is necessary to treat and prevent flare-ups. The expert told us which products should be included in the daily menu and which should be completely excluded.
Gout: symptoms and treatment
Gout is the most common form of arthritis and has been known for several thousand years. Gout is caused by the deposition of uric acid crystals in joints and various tissues and occurs in association with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is usually broken down and eliminated from the body through the kidneys. However, if the body produces too much of it or the kidneys cannot adequately remove it from the body, uric acid builds up in the joints.
Gout is more common in men than women because estrogen increases the excretion of uric acid through the kidneys.
The main causative factors for gout appear to be diet and genetic predisposition.
Throughout history, gout has been commonly associated with rich people's diets (a sign of affluence! ) and excessive alcohol consumption, and dietary guidelines for gout have been around for a long time.
In 1876, A. B. Gerrod was one of the first to recommend reducing the consumption of purine-rich foods such as meat and seafood. Shortly thereafter, Professor Ebstein recommended moderate food intake with plenty of water, fruits such as cherries and strawberries, and avoidance of alcohol.
Causes of gout
To understand how purines can affect a person with gout, you must first understand how gout occurs.
Gout develops when uric acid builds up in the body. Normally, uric acid is dissolved in the blood, filtered by the kidneys, and then excreted from the body in the urine. When this process is disrupted, excess uric acid can build up in the joints to form sharp crystals, which can cause severe joint discomfort and also trigger the formation of kidney stones.
The role of purines in the development of gout
Purines are chemical compounds found in certain foods that break down into uric acid when metabolized.
Uric acid, which comes from high-purine foods, however, makes up only about 15% of the uric acid in the body. The rest is found naturally in the body's tissues, and genes play a large role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those on a high-purine diet had five times the risk of developing gout compared to those on a low-purine diet. Purine base intake was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medication.
Diet and lifestyle modifications are the main aspects of non-drug treatment for gout.
Nutritional principles in treatment should vary depending on the severity of the process, the frequency of exacerbations, the level of uric acid in the blood plasma and body weight.
The basic principles of diet therapy for gout are the full coverage of the body's physiological needs in energy, macro- and microelements, dietary fiber, vitamins and minerals. We usually talk about the "Table number 6" diet.
The diet should include an optimal amount of protein with a balanced composition of amino acids, a reduction in the total amount of fat from animals (the ratio of animal and vegetable fat is 1. 2: 1) with a sufficient content of polyunsaturated fatty acids of ω-6 and ω-3families, as well as reducing the carbohydrate part of the diet by reducing the amount of digestible and refined sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid foods (jelly, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drinking up to 2 litersof liquid per day.
It is recommended to limit the consumption of table salt, as well as to ensure that the body receives a sufficient amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of a diet for gout in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Limiting foods rich in purine bases (meat, fish).
- Including foods in your diet that can control uric acid levels (cereals, milk).
- Drinking adequate fluids.
- Weight loss, achieving a healthy body weight and good eating habits.
A good rule of thumb is to eat moderate portions of healthy foods, this will be the best cure.
Antipurine diet
It is recommended to exclude from the diet foods containing large amounts of purines (over 150 mg per 100 g of product).
These products include: beef offal (brains, kidneys, liver), meat extracts, sardines, anchovies, small shrimps, mackerel, fried legumes.
Limit the consumption of foods containing 50-150 mg of purines per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Since meat from young animals is higher in purines than meat from adults, it should also be avoided.
If you want to include animal protein in your diet, it is recommended that you consume it only in moderation. It is recommended to avoid large portions of purine-rich meat. A typical portion of meat is 85 grams and fish 110-115 grams.
When cooking meat, up to half the amount of purines goes into the broth, so it is recommended to eat boiled meat. In any case, meat and fish dishes, if it is impossible to completely refuse them, are included in the diet no more than 2-3 times a week.
It is also recommended to significantly reduce the consumption of saturated fat, since with increased levels of cholesterol in the blood, the excretion of uric acid by the kidneys worsens. It is believed that the daily diet should not contain more than 200 mg of purine bases.
Foods high in purines to avoid if you have gout:
- Byproducts
It is recommended to avoid dishes such as chopped liver, as well as other offal such as kidneys, heart, as they contain a lot of purines.
Alternative solution: You can eat other types of meat, such as poultry and beef, which contain fewer purines. For example, you can try a vegetarian recipe for mushroom and walnut pate, which mimics the taste of liver but contains ingredients that won't worsen gout symptoms. - Cold drinks
Although fructose and sugar-based soft drinks do not contain high levels of purines, they have been shown to increase the risk of gout. This is because uric acid is one of the byproducts of fructose metabolism.
Evidence has shown that consuming large amounts of fructose can increase blood uric acid levels.
Drinking soda with high fructose corn syrup has been linked to an increased risk of gout. According to a study published in the journal BMJ, men who drank two or more servings of carbonated water per day had an 85% higher risk of gout than those who drank less than one serving per month.
Alternative solution: You can drink diet sodas, which do not cause gout and can help you give up sweets. For example, you can try water with lemon and lime slices. - Seafood
Some types of seafood—anchovies, clams, crab, shrimp, sardines, herring, trout, mackerel, and others—contain moderate to high levels of purines. Men who ate the most seafood were more than 50 percent more likely to have high uric acid levels than those who ate the least in a study conducted at Vanderbilt University Medical Center in Nashville.
Alternative solution: Since fish is good for the heart and blood vessels, it makes sense to keep it in the diet. One option is low-purine cod. You can also eat small, palm-sized portions of high-purine fish balanced with large portions of vegetables, such as roasted zucchini or broccoli in lemon juice, as lemon juice helps neutralize uric acid. - Alcohol
According to a 2014 study from Boston University School of Medicine, drinking wine, beer, or liquor was associated with an increased risk of developing gout. The more alcohol a person drank, the greater their risk, the researchers found.
Alternative solution: The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity really matters, the less alcohol the better—no more than one (women) or two (men) drinks a day.
Foods to avoid:
- smoked meats, canned goods, frozen meats, fish.
- meat extracts, broths;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables.
- alcoholic beverage;
- dried cereals, excluding husked rice, husked wheat and milled wheat.
- dried fruit, excluding prunes;
- cookies, confectionery products made with salt and powdered sugar.
- salt, hot sauces, dips, mustard, marinades, seasonings, olives, ketchup and pickles.
Patients are advised to use foods and dishes with low or no purine content. The diet for gout during an exacerbation should be especially strict.
The general principles of the gout diet correspond to standard recommendations for a healthy diet.
Weight loss
Being overweight increases the risk of gout and losing weight reduces the risk of gout. Research shows that cutting calories and losing weight—even without a purine-restricted diet—lowers uric acid levels and reduces the number of gout attacks. Losing weight also reduces the overall stress on your joints and also reduces the risk of diabetes.
Consumption of complex carbohydrates
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and drinks with high fructose corn syrup and limit your intake of naturally sweetened fruit juices.
Consumption regime
Maintain an adequate water regime. To accelerate the elimination of purine bases from the body with food, the total amount of fluids is increased to 2. 5 l/day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruits, berries, vegetable juices, milk, alkaline mineral water. It is recommended to avoid strong tea and strong coffee: frequent use can lead to aggravation.
Fat reduction
Reduce your intake of saturated fat from red meat, fatty poultry and whole milk products.
Choose lean meats and poultry, low-fat dairy products and lentils as sources of protein.
Special product recommendations
Offal. Avoid meats such as liver, kidneys, which have high levels of purines and contribute to increased levels of uric acid in the blood.Red meat. Medium portions for beef, lamb and pork.Seafood. Some types of seafood, such as anchovies, mussels, sardines and tuna, contain more purines than other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish are an integral part of the gout diet.Vegetables with a high purine content. Research has shown that vegetables high in purines, such as asparagus and spinach, do not increase the risk of gout or recurrent gout attacks.Alcohol. Beer and alcoholic beverages are associated with an increased risk of gout and recurrent attacks. Moderate wine consumption does not increase the risk of gout. Avoid alcohol during gout attacks and limit alcohol consumption, especially beer, between attacks.Sweet foods and drinks. Limit or avoid foods that contain sugar, such as sugary cereals, pastries and sweets. Limit your consumption of naturally sweetened fruit juices.Vitamin C. Vitamin C can help lower uric acid levels.Coffee. Some studies show that drinking coffee in moderation may be associated with a reduced risk of gout. However, it is necessary to take into account the presence of accompanying diseases.Cherry. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Recommended foods and drinks for daily consumption
- Beans and lentils;
- legumes;
- low-fat dairy products.
- whole grains such as oats, brown rice and barley.
- fruit and vegetables.
Beans and legumes are excellent sources of protein. Eating these plant sources can help meet your daily protein needs while reducing the amount of saturated fat found in high-purine animal proteins.
So, for gout, a vegetarian diet is recommended. In countries where the traditional lifestyle includes eating mainly plant foods, gout is rare.
It is important to understand that gout diet is not the only treatment. Instead, it's a lifestyle change that can help reduce or eliminate gout symptoms.
Following a diet, along with calorie restriction and regular exercise, can also improve your overall health and quality of life.