Common Myths About Eating For Gout
While a gout diet can be restrictive, some foods are just fine for gout sufferers despite myths that surround them. Many people misconstrue acidic foods as contributing to uric acid buildup in the blood, but the two are unrelated. Acidic foods, including tomatoes, oranges, and lemons, dont affect gout at all, so enjoy them as much as you like.
Dairy products are also healthy foods you can include in a gout eating plan. You can even add in beans occasionally, as long as you arent having them every day. If youre already a healthy weight and not currently in the midst of a gout attack, you can have an occasional dessert or a rich main dish without worrying about having a follow-up attack.
Drink Intake Is Also A Factor
Beyond monitoring protein consumption, being careful about what you drink might help gout symptoms. Because alcohol consumption is a cause of uric acid buildup, eliminate alcohol from your diet. Drink water instead of alcohol. Water can help reduce your body’s uric acid levels, which can lessen the severity of your gout symptoms.
Food Loaded With Omega 3 Fatty Acids
When you hear omega 3 fatty acids, you think of fish instantly. This is particularly true. Almost every fish contains plenty of this compound. But, you can get the same from walnuts for example. Add the fact some fish can be consumed despite the fact you have gout and you get a more versatile diet.
You can consume salmon, herring, sardines, and mackerel. Start with small amounts and gradually increase portions. Omega 3 fatty acids dont affect uric acid directly. It will decrease inflammation and swelling which is beneficial during the gout attack.
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Things To Cut Down On
Meat and seafood
High intakes of red meat and seafood are associated with a greater risk of gout because of their high purine content and impact on uric acid production.
Foods that contain yeast, such as Vegemite and Marmite, are also high in purine.
Fructose is a simple sugar found in honey, fruit, some vegetables and sweeteners. Fructose increases purine metabolism, raising blood uric acid levels.
Avoid sweeteners high in fructose such as honey, brown sugar, high-fructose corn syrup, golden syrup and palm sugar. Check your tolerance for fruits, vegetables and other foods high in fructose.
Uric acid levels tend to be higher in people who regularly consume sugar-sweetened drinks. Those drinking one to two sugar-sweetened soft drinks a day are almost twice as likely to have gout as those who drink only one a month.
When it comes to whole fruit, results are not clear. While one study found a higher risk of gout with higher fruit intakes, another found a lower risk. The opposing results are partly confounded by the variation in fructose content of different fruits.
The effect of specific alcoholic beverages on blood uric acid levels varies. Beer is high in purine and increases uric acid more than spirits, while moderate wine intake appears neutral.
Using Tart Cherry Juice For Gout
Tart cherry juice may help decrease uric acid levels and inflammation in gout. Research is limited, with often small numbers of study participants and short-term follow-up.
Nevertheless, a 2019 review of six studies that looked at the effect of cherry juice or cherry extract intake on gout concluded that cherry intake was associated with a reduced risk of gout attacks. Researchers did note that larger, more long-term studies are needed to clarify this association.
When choosing tart cherry juice, be sure to look for unsweetened varieties to help reduce the amount of added sugar in your diet.
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Which Other Lifestyle Factors Can Affect Gout
While there are no controlled studies or evidence on the effect of lifestyle changes on the incidence of gout, expert opinion is that positive changes in lifestyle can be beneficial to the management of gout. Being overweight is not recommended for gout suffers and the available evidence indicates that losing weight may helpful. Dietary modifications to achieve a healthy body weight are recommended, however the use of crash, high-protein and low-carbohydrate diets should be avoided. Slow and steady weight loss is ideal and support from a dietitian should be sought to help develop a sustainable and balanced weight loss plan. Rapid weight loss is not recommended as it can increase the amount of uric acid in the body leading to an increased chance of a gout attack.
Regular exercise such as swimming or walking is also recommended as it may help reduce the frequency of gout attacks. In addition, it may have a beneficial effect on associated co-morbidities such as type 2 diabetes, hypertension and insulin resistance.
High Risk Does Not Always Mean High In Purines
High content, moderate content, high risk, and low risk are some of the ambiguous terms experts use to describe gout-causing foods and their purine content. It causes confusion because classifications based on content amounts can vary from each source. It is not uncommon to see the same type of food, like lobster, listed as high in purine by one source, but then listed as a moderate-risk by another.
Not to mention, different purine studies or tables have different data and results. A more simplified approach will taken instead of sounding like a technical report on determining purine content.
Several major health authorities consistently state the following food groups as high risk or high in purine content.
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Can I Drink Alcohol
Drinking alcohol can increase your risk of a gout attack as it can raise the level of uric acid in your blood. While it is possible to control gout attacks without completely cutting out alcohol, try to reduce the amount of alcohol you drink and avoid binge drinking . Talk to your doctor or read the Australian government guidelines on recommended alcohol intake.
What Is Gout And What Causes It
Before we can look at foods to avoid with gout, it is necessary to briefly understand what it is.
Gout is a form of joint inflammation, caused by excessive uric acid in circulation .
When the bodys natural uric acid threshold is exceeded, painful crystals can form in and around the joints. These crystals trigger the characteristic symptoms and pain.
Not everybody with high uric acid levels will get gout, but those who do always have high uric acid levels. This indicates there are other factors at play, but from a dietary perspective uric acid is the focus.
Excessive uric acid in the blood stream is typically driven by two factors: genetic predisposition and the ingestion of high-purine foods. Obviously, the dietary factor we can control.
When purines we eat are broken down and metabolised by the body, uric acid is formed as a by-product of this process. Its normal and healthy for uric acid to be formed, but excessive amounts are problematic.
Therefore, consuming less purine-rich foods should lower uric acid levels in your blood, lowering gout risk.
At least, in theory.
Its actually not that clear-cut because other nutrients appear to aggravate gout symptoms too
Heres a list of foods to avoid if you have gout, based on real scientific evidence.
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The Dash Dietary Approaches To Stop Hypertension Diet
The DASH diet is designed for lowering high blood pressure and can also help with maintaining overall health. On top of managing blood pressure, weight and the risk of some diseases, the DASH diet is also great for those with gout.
The DASH diet prioritises whole grains, vegetables and fruit as the main part of a healthy diet, with importance also placed on low-fat dairy, lean meats, fish, and plant-based proteins like nuts, seeds, and legumes in smaller portions. Those on a DASH diet are recommended to stick to small amounts of plant oils and minimise animal-based fats.
Following a healthy diet is just about the best thing you can do for your health, but it is also true that highly restrictive diets can be hard to stick to. Unhealthy foods like sweets, puddings, alcohol and sugary drinks are discouraged, but having small amounts of them purely for pleasure rather than health is usually okay.
Some people with gout find it helpful to keep a food diary to work out if there are particular triggers for flare-ups and help manage their condition naturally.
The Cause Of Gout Is More Than Just Diet
While diet is critical, dont overlook other important factors that affect gout. These include family history, sleep apnoea, and lack of physical exercise to name a few.
Further discussion of best treatment for gout is outside the scope of this article. But there are foods thought to be protective namely dairy, cherries, and coffee, in decreasing order of evidence.
And as much as I prefer focusing on what you should eat to prevent health scares, there are just so many clear trigger foods for gout.
Its important to deal with these factors first and foremost.
About Joe Leech, Dietitian
Joe Leech is a university-qualified dietitian from Australia.
He graduated with a Bachelor’s degree in exercise science, followed by a Master’s degree in Nutrition and Dietetics in 2011.
Learn more about him on the About page.
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Most Soy Should Be Fine
Soy foods like tofu, soy milk, and edamame have moderate amounts of purines. Traditionally doctors have cautioned against eating too much soy for people with gout. One study found that soybeans, soymilk, and soy powder increased uric acid in the blood significantly. However, larger population studies have recently told a different story. Several have reported that not only are soy products harmless for gout patients, but also people who eat more soy tend to have a reduced gout risk.
Dont Be Scared Of Beans Legumes Vegetables
The most inconsistent recommendations are for beans, legumes and certain vegetables. No source indicated to avoid these food groups. However, many state they are high risk like some seafood.
From this particular purine table, beans, lentils and peanuts have far less purines than the other food groups mentioned previously. Therefore, they are not as high-risk for gout. Keep in mind, cured or dried food, such as beans, will have a higher purine concentration per weight because of shrinkage.
Some sources caution eating asparagus, cauliflower, peas, chickpeas, spinach and broccoli because it contains more purines than most vegetables. However, the purine amounts for asparagus, spinach and broccoli are less than half of pork or beef. Lastly, a recent study concluded purine-rich vegetables are less of a risk than animal based purines.
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So There You Have It: 42 Well
You can change things up by substituting other nutritious options, such as:
- Turkey breast instead of chicken breast.
- Baked potato with 1 cup max. of sauteed mushrooms .
- Smoked haddock, grilled tomatoes and poached egg / scrambled eggs.
- Roasted red pepper risotto with brown risotto rice, vegetable stock, no wine.
- Baked or grilled hake with salsa verde and steamed vegetables.
- Wholegrain penne pasta with onion, garlic, red and yellow bell peppers, zucchini, dried Italian herbs, and fresh basil.
Remember the meat, poultry and fish in these listings have to be restricted to a 4 oz serving since they generally have a moderately-high purine content.
But what about pork?
Except in certain religious communities, pork is the most widely consumed meat, so is it safe to eat in a gout diet?
It is, but only in moderation. However, there are several important health and moral issues being hotly debated which I cover in another article Pork and Gout: Safe For Gout Sufferers?
Characteristics Of The Mediterranean Diet
The Mediterranean diet focuses on cereals , fruits, vegetables, nuts and legumes, whose consumption should be on a daily basis. These foods are rich in fiber and antioxidants . Consumption of olive oil replaces other forms of saturated fat, such as animal butter and margarines. In moderate consumption, dairy products, especially yoghurt and cheese, are found even on a daily basis, while consumption of fish and poultry is recommended up to twice a week. Eggs can be eaten up to 47/week. Climbing up the food pyramid, there are foods which should be consumed on a monthly basis in small quantities, such as red meat. Alcohol accompanies each meal and if there is no other problem associated with its consumption then the safe recommended units are 2 glasses/day for men and 1 glass/day for women. There is a preference for red wine because of its flavonoids and antioxidants content. In addition to dietary characteristics, emphasis is also put on moderate daily physical activity to maintain a normal weight, to achieve well-being and to help eliminate diseases that are caused by excess body weight.
The Mediterranean diet is rich in antioxidants and vitamins and has anti-inflammatory properties. Thus, it reduces pro-inflammatory cytokines, increases anti-inflammatory cytokines and reduces oxidative stress . Diet per se seems to have little effect on serum uric acid levels, and a diet low in purines can reduce SUA by 1015%.
Dietary factors studied in PREDIMED.
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How Does Food Affect Gout
If you have gout, certain foods may trigger an attack by raising your uric acid levels.
Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product .
This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.
However, people with gout cant efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack (
Foods that commonly trigger gout attacks include organ meats, red meats, seafood, alcohol and beer. They contain a moderate-to-high amount of purines .
However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks .
And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though theyre not purine-rich (
For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout .
On the other hand, research shows that low-fat dairy products, soy products and vitamin C supplements may help prevent gout attacks by reducing blood uric acid levels (
Summary: Foods can either raise or lower your uric acid levels, depending on their purine content. However, fructose can raise your uric acid levels even though it is not purine-rich.
What Are The Symptoms Of Gout
Gout is a very painful condition and a typical gout attack usually develops over a two to three hour period and often resolves within two weeks. The NHS advises that you always see a doctor if you experience the symptoms of gout, which include sudden, severe pain in any joint or red, hot, swollen skin over any joint.
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Be Careful About Protein Consumption
In addition to prescribing medication, your doctor will also recommend dietary changes when you’re diagnosed with gout. Most notably, you’ll have to reduce your intake of foods high in purines, as these foods cause an increase in uric acid. Protein sources of purines include beef, pork, shellfish, anchovies, mackerel and organ meats such as liver and kidneys. Other foods to remove from your diet include asparagus and mushrooms.
Frequent Consumption Of Certain Fruits May Trigger Recurrent Gout Attacks
High sugar drinks may not be the only stimulant of gout flare ups.
Certain fruits which are a natural source of fructose have also been linked with gout.
This is a highly contentious area, because several studies have linked higher fruit intake with less incidence of gout. This is probably due to their high fibre content .
And unlike fruit juice and other sugar-sweetened drinks, whole fruits are nutritious and generally good for health. There is no disputing this.
However, if you continually have gout attacks despite cutting out alcohol and sugar-sweetened drinks then Im not convinced a large amount of fruits are safe for you. Especially if you are overweight and eat a Western diet.
So cutting back on certain very high-fructose fruits is like a Plan D, if you will.
The link comes back to fructose, which stimulates uric acid production in a similar manner to alcohol. Fructose is naturally found in fruit and honey.
One study found that the consumption of apples or oranges the most popular fruits in this study was linked with an increased risk of gout compared to those who consume less than one serving of fruit per month. No link was found with other fruits however .
While most fruits are very low in fructose, a few are very high. Frequent consumption of these could theoretically causes problems for gout sufferers.
Foods Highest in Fructose per 200 Calories :
Note this list is ranked on a per calorie basis, not per serving.
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The Ingredients And How They Work With Gout:
|Cherries:||If you google foods that can help prevent gout attacks, cherries are pretty much number one. Tart cherries, to be specific. Cherries have antioxidant and anti-inflammatory properties, hypouricemic effects, and the ability to downregulate NFkB-mediated osteoclastogenesis .|
|Sunflower Seeds||Sunflower seeds are low in purines and high in fiber, making them a wonderful seed for people with gout! They are also a great plant based protein source.|
|Flaxseed Meal||Two tablespoons of flaxseed meal contains more than 140% daily value of the inflammation-reducing omega-3 fatty acids. They are also high in fiber and lignans. Lignans have antioxidant properties, and have been considered to potentially lower the risk of some cancers.|
|Bananas||Bananas are high in vitamin C, and low in purines. Vitamin C may help to lower uric acid levels.|
|Egg Whites||Eggs are naturally low in purines, and are a great gout-friendly protein source!|
Collins, M. W., Saag, K. G., & Singh, J. A. . Is there a role for cherries in the management of gout?. Therapeutic advances in musculoskeletal disease, 11, 1759720X19847018. https://doi.org/10.1177/1759720X19847018
Lowcock EC, Cotterchio M, Boucher BA. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. Cancer Causes Control. 2013 Apr 24:813-6. doi: 10.1007/s10552-013-0155-7. Epub 2013 Jan 25. PMID: 23354422.