What Foods Should You Eat
Although a gout-friendly diet eliminates many foods, there are still plenty of low-purine foods you can enjoy.
Foods are considered low-purine when they have less than 100 mg of purines per 3.5 ounces .
Here are some low-purine foods that are generally safe for people with gout (20,
- Fruits: All fruits are generally fine for gout. Cherries may even help prevent attacks by lowering uric acid levels and reducing inflammation (
- Vegetables: All vegetables are fine, including potatoes, peas, mushrooms, eggplants and dark green leafy vegetables.
- Legumes: All legumes are fine, including lentils, beans, soybeans and tofu.
- Nuts: All nuts and seeds.
- Whole grains: These include oats, brown rice and barley.
- Dairy products: All dairy is safe, but low-fat dairy appears to be especially beneficial (
- Beverages:Coffee, tea and green tea.
- Herbs and spices: All herbs and spices.
- Plant-based oils: Including canola, coconut, olive and flax oils.
Best Diet For Gout: What To Eat What To Avoid
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Gout is a type of arthritis, an inflammatory condition of the joints. It affects an estimated 8.3 million people in the US alone (
Fortunately, gout can be controlled with medications, a gout-friendly diet and lifestyle changes.
This article reviews the best diet for gout and what foods to avoid, backed by research.
Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
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Foods You Can Eat In Moderation
Aside from organ meats, game meats and certain fish, most meats can be consumed in moderation. You should limit yourself to 46 ounces of these a few times per week .
They contain a moderate amount of purines, which is considered to be 100200 mg per 100 grams. Thus, eating too much of them may trigger a gout attack.
- Meats: These include chicken, beef, pork and lamb.
- Other fish: Fresh or canned salmon generally contains lower levels of purines than most other fish.
Summary: Foods you should eat with gout include all fruits and vegetables, whole grains, low-fat dairy products, eggs and most beverages. Limit your consumption of non-organ meats and fish like salmon to servings of 46 ounces a few times weekly.
Myth: Only Wealthy And Obese People Get Gout
Truth: People of all sizes get gout although extra pounds increase the risk, says John Reveille, M.D., director of rheumatology at the University of Texas Health Science Center in Houston. Gout is also more common in people who have other, often weight-related health problems, including diabetes and high blood pressure or cholesterol. And while income has nothing to do with the condition, genes do play a part: If your parents had gout, you’re more likely to have it as well.
Gout is not a gender-specific disease.
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Treatment Of High And Low Levels
Certain foods contain purines, which create uric acid when the body breaks them down. Eating a diet that is too rich in purines can cause uric acid to build up in the blood.
It is not possible to avoid purines completely because small amounts are present in many foods. However, a person can follow a low purine diet and take other steps to help lower purine levels.
Foods that include moderate or high levels of purines include:
- alcohol
The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
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Lowering Blood Levels Of Uric Acid
A high level of uric acid in the blood causes problems for people with gout and may increase the risk of kidney disease in people without gout. Lowering the level of uric acid in the blood helps dissolve deposits of uric acid in the tissues and prevent flare-ups.
People with gout who especially need their blood level of uric acid lowered include those who have the following:
-
Frequent, severe flare-ups despite taking colchicine, an NSAID, or both
-
Tophi that are found on examination
-
Uric acid kidney stones
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Conditions that make NSAIDs or corticosteroids more complicated to take
People taking drugs to lower the blood level of uric acid should know their level, just as people with high blood pressure should know their blood pressure. The goal of drug therapy is to decrease the level to less than 6 milligrams per deciliter . If the blood level is maintained below 6 , uric acid will stop being deposited in the joints and in soft tissues, and the existing deposits will eventually dissolve, although this may take several years. Most tophi on the ears, hands, or feet shrink slowly when the uric acid level decreases to less than 6 milligrams per deciliter .
is another drug that lowers blood levels of uric acid. It is especially useful in patients who cannot take or have not been helped by allopurinol. As with allopurinol, flare-ups can occur as the uric acid level in the blood first decreases.
Most Common Gout Attack Sites
The most common site for a gout attack is what is known as the bunion joint on the big toe. It is typically the first joint affected by gout. As gout worsens, the ankle, mid-foot, knee, and elbow can become common sites of gout attacks. Uric acid crystals can also collect in soft tissues and form lumps called tophi, most typically on the hands, fingers, elbows, and ears.
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Lets Talk More About Tophi
Sometimes, after repeated severe gout attacks, uric acid crystals collect beneath the skin and form small white or yellow lumps called tophi. They are typically found in soft tissue around the affected joints on the elbow or on the exterior part of the ear. Fortunately, tophi can be dissolved with treatment. When left untreated, they can gradually destruct bones and cartilage, leading to discomfort and immobility.
What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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Analysing The Bones: What Can A Skeleton Tell You
Imagine you are an archaeologist excavating at a new building site in East London, the location of an ancient cemetery. Deep down you uncover bones that look old. You recover a full skull with teeth, and most of the bones of the body, missing a few smaller vertebrae and toes.
What can you find out about the person youâve found? You can actually learn a lot just by having a closer look at their bones and teeth – such as who they were, what their life was like, and sometimes even how they died.
Associations With Diagnosis Of Covid
Results from the association analyses of 16 diseases with COVID-19 diagnosis using Model 1 are presented in Table 2. Both gout and RA associated with an increased risk of COVID-19 diagnosis of 1.5-fold and 2.0-fold , respectively. In comparison, data for cerebrovascular diseases were , heart failure , chronic kidney disease , pulmonary heart disease , immunodeficiencies and chronic obstructive pulmonary disorders . Two to three-fold increases in risk were estimated for hypertensive diseases , diabetes mellitus , and lipoprotein disorders . One to two-fold increases in risk were estimated for ischemic heart diseases , cancer , asthma , osteoarthritis and dementia strongly associated with COVID-19 . After adjustment by Model 1 variates and the additional 15 co-morbidities evaluated , gout no longer associated with COVID-19 diagnosis, nor did RA, ischemic heart disease, asthma and osteoarthritis . Age was associated with decreased risk of SARS-CoV-2 infection and / or COVID-19 diagnosis . This decreased risk may reflect a number of factors that influence exposure to SARS-CoV-2 in this age group, including public health messaging around limiting exposure for older people.
Analyses A-C adjusted by all other exposures listed in the table .
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Associations With Death Upon Diagnosis Of Covid
When testing for association with death from COVID-19 within the cohort with COVID-19 diagnosis , there was no evidence for association with any disease in either of Models 1 or 2 with the exception of immunodeficiencies OR=3.4 and OR=3.7 . Established risk factors for death from COVID-19, namely male sex and older age, were strongly associated with death .
We then tested for association with death from COVID-19 comparing to the entire population-based cohort . Gout was associated with a 1.7-fold increase in COVID-19-related death under Model 1 but not in Model 2 . In contrast, RA associated with increased risk of death from COVID-19 in both models â OR=2.9 in Model 1 and OR=1.8 in Model 2. Sex-specific analyses for death from COVID-19 related death in RA were OR=2.5 for males and OR=3.1 for females in Model 1, and OR=1.6 and OR=1.9 , respectively, in Model 2. None of the sex-specific analyses in gout associated with risk of death in Analysis C.
When Gout Becomes A Long
When uric acid levels in your blood stay too high, more and more crystals form around your joints. It can turn into a long-term condition, leading to painful and damaged joints.
Gout will happen differently for everyone. But signs that it may be getting worse include:
- Flares happen more often and last longer. Over time, the inflammation causes lasting damage to bone and cartilage.
- Flare-ups in other parts of your body. About half of people with gout have their first attack in the joint at the base of the big toe. When gout gets worse, it can affect other joints, including the ankle and knee.
- Bumps form under the skin. Uric acid crystals may start to collect in soft tissue, forming lumps called tophi. They often appear on the hands, fingers, elbows, and ears, but they can show up almost anywhere on the body.
- Kidney problems. Your kidneys normally get rid of uric acid in your body. But too much of it can also damage the organs. Kidney problems linked with gout — and signs that gout is getting worse — include gouty kidney, kidney stones, and kidney failure.
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What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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Get Involved With Patient
If you are diagnosed with gout or another musculoskeletal health condition, we encourage you to participate in future studies by joining CreakyJoints patient research registry, ArthritisPower. ArthritisPower is the first ever patient-led, patient-centered research registry for joint, bone and inflammatory skin conditions. You can use ArthritisPower to track your disease symptoms, share patterns with your doctor, and participate in voluntary research studies. Learn more here.
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Obesity And The Metabolic Syndrome
Gout is very commonly associated with comorbidity, including the metabolic syndrome. In a large cross-sectional study undertaken in NHANES-III, the prevalence of the metabolic syndrome in people with gout was 62.8% compared with 25.4% amongst people without gout 3.05 95%CI 2.01, 4.61 adjusted for age and gender) .
Several individual components of the metabolic syndrome have been shown to be independent risk factors for the development of gout . A dose-dependent effect between increasing BMI and risk of incident gout has been demonstrated in several large prospective epidemiological studies. In the THIN database case-control study, individuals with a BMI between 2529kg/m2 had an multivariate OR of 1.62 for incident gout and those with BMI of 30kg/m2 an OR of 2.34 compared to those with a BMI 2024kg/m2 . In the HPFS, compared to those with a BMI 2122.9kg/m2, the multivariate RR of incident gout in men was 0.85 in those with a BMI < 21kg/m2, increasing to 1.40 with BMI 2324.9kg/m2, 1.95 with BMI 2529.9kg/m2, 2.33 with BMI 3034.9kg/m2 and 2.97 with BMI 35 kg/m2 . Furthermore, risk of incident gout was increased in men who had gained 2029lbs and 30lbs in weight since the age of 21 years compared with those whose weight was stable. In contrast, weight loss of 10lbs or more since baseline reduced the risk of incident gout by 39% .
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How Food Affects Gout
Gout occurs when excess uric acid crystals form in the body. An estimated 4 percent of American adults have gout, according to the Arthritis Foundation.
Diet can increase a persons risk for gout because some foods contain purines. These are compounds the body breaks down into uric acid, and excess uric acid can lead to gout.
What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
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Myth: Gout Pain Always Attacks The Big Toe
Truth: Gout occurs when uric acid builds up in the blood, forming crystals that lodge in and inflame joints. It’s true that gout often first attacks the joints of the big toe, but it can also occur in the knees, ankles, feet and hands. In women with osteoarthritis, for example, gout pain commonly starts in the small joints of the hands. Although the first attacks often involve only one or two joints, over time multiple joints become affected. If the disease isn’t treated, it can cause permanent damage.
Avoiding alcohol may reduce your chance of getting gout attacks.