Tuesday Q & A: Paying Attention To Diet May Help Prevent Gout Flare
DEAR MAYO CLINIC: What causes gout? I have had one attack and am not on treatment but am watching my diet. Is it possible that I wont have additional attacks or need treatment for it, or is it likely to come back again?
ANSWER: Gout is a form of arthritis that happens when sharp particles, called urate crystals, build up in a joint, causing severe pain, tenderness and swelling. As in your situation, treatment usually is not recommended after just one attack. But gout can come back. Being careful about what you eat may help prevent another gout flare-up. If it does come back, medication is available that can effectively control gout.
The urate crystals that lead to gout form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines substances found naturally in your body, as well as in certain foods. Uric acid usually dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either makes too much uric acid or your kidneys flush out too little uric acid. When this happens, gout is often the result.
Certain foods and beverages have been shown to increase the risk of gout attacks, including those that are rich in fructose, such as fruit-flavored drinks, non-diet soda and many processed foods. Seafood, fatty fish and red meat also are associated with increased risk of gout.
Are Tomatoes Recommended For Gout
Many sources, such as the Centers for Disease Control and Harvard Health recommend a diet high in colored vegetables and fruits, including nightshades like tomatoes. These foods contain nutrients like carotenoids called beta-cryptoxanthin and zeaxanthin, lycopene, and Vitamin C, all of which could help reduce inflammation and improve joint function.
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Cherry Juice For Gout Management
Cherries and cherry juice are a popular folk remedy for gout, but the scientific evidence to support their supposed benefits is still coming in.
Nonetheless, theres reason to believe that cherries may help fight gout. They contain chemical compounds called anthocyanins, which have been shown to help reduce inflammation.
Cherries may also have a beneficial effect on uric acid levels.
One large study of people with recurrent gout found that eating cherries was associated with a lower risk of gout attacks, especially when cherry consumption was combined with taking a common uric acidlowering drug.
Despite these findings, experts say that more research is needed before any definitive recommendations can be made about cherries or cherry juice for gout.
Foods To Avoid For Gout By Mayo Clinic
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
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 (
10 ).
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 (
16 ).
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.
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Citrus Fruits Cause Inflammation
Some people believe that they should avoid citrus fruits because the acidity is inflammatory. However, this is not the case. In fact, citrus fruits have anti-inflammatory benefits, as well as being rich in vitamin C and antioxidants.
Grapefruit juice can, however, interact with some medicines that doctors use to treat arthritis. People who are undergoing treatment should check with a doctor before incorporating it into their diet.
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Conventional Treatment of gout Allopurinol is the pharmaceutical drug of choice used in long-term prevention of gout and decreases the bodys production of uric acid. People experiencing gout attacks should, however, avoid medications containing aspirin as these can make gout worse. Pain relievers such as paracetamol or other more powerful analgesics, are often used to manage the pain. Anti-inflammatories, such as non-steroidal anti-inflammatory drugs , are used to decrease joint inflammation and reduce the pain. If NSAIDs cannot be given because of an ulcer, your doctor may use colchicine may be used to settle an attack. I have found the homeopathic colchicines can be very useful for the gout patient instead of this drug. Do you take a water tablet or a diuretic? Pharmaceutical diuretics may cause gout in people who are genetically predisposed to gout by increasing the accumulation of uric acid within the body.
Resting the joint, possibly in a splint, and applying ice packs may help. Ice is a great acute gout treatment which I highly recommend.
Preventing further gout attacks
Prevention is the thing which you need to focus your attention to, and in my opinion is equally as important as treating the gout.
· Reduction or elimination of alcohol consumption, this is the BIG one in my opinion. Alcohol causes uric acid levels to rise and has a diuretic effect that can add to dehydration and bring on gout attacks
Erics gout recommendations
Final thoughts
Gout Diet: What’s Allowed What’s Not
Medically reviewed by Drugs.com. Last updated on Jul 2, 2020.
Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint.
Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.
A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.
People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.
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Understand What Purine Is
Purine by itself isnt the problem. Purine is produced naturally in your body and is also found in certain foods.
The problem is that purines break down into uric acid, which can form into crystals that deposit in your joints and cause pain and inflammation. This joint pain is referred to as gout, or a gout attack.
One third of the uric acid your body makes is due to the breakdown of purines you get from food and drink. If you eat a lot of purine-heavy foods, your body has a higher level of uric acid. Too much uric acid can result in disorders like gout or kidney stones.
Some Meat Fish Eggs Beans And Pulses
Eat these foods in moderation. Having vitamin C with meals can help to improve the absorption of iron, so drink a small glass of orange juice, have a piece of fruit for dessert, or serve up meals with plenty of vegetables. Keep your portions of meat controlled by using your hands as a serving size guide. A serving is about the size and thickness of the palm of your hand.
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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
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Medications To Prevent Gout Complications
If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s level of uric acid may be recommended.
- Medications that block uric acid production. Drugs such as allopurinol and febuxostat help limit the amount of uric acid your body makes. Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. Febuxostat also may increase the risk of heart-related death.
- Medications that improve uric acid removal. Drugs such as probenecid help improve your kidneys’ ability to remove uric acid from your body. Side effects include a rash, stomach pain and kidney stones.
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Fact: People Of All Sizes Can Develop Gout
Uric acid levels tend to be higher in people who are overweight, according to research published on The Rheumatologist, which can increase your risk of gout. But weight is not the only risk factor for gout, which means that people of all sizes could develop gout. The Cleveland Clinic notes that high blood pressure, diabetes, heart disease, and kidney disease can all increase your risk for gout. Genes play a big role as well. In fact, genetic factors might matter more than weight when it comes to risk of gout.
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.
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Consider The Source Of Uric Acid Build
Now lets turn back to the body. Uric acid is produced from birth, yet normally the body does a good job of getting rid of it as quickly as it is produced.
Gout happens when for some reason, your body stops managing to removal uric acid effectively. Doesnt it make sense then, that rather than masking the symptoms you fix what has gone wrong?
After all, were not asking your body to do anything magical. Were simply getting it back to its natural state. Is it really that complicated?
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Vegetables Cooked In Animal Products
Similar to how you might think okra is good for gout simply because it is a vegetable, you might assume animal products are good for gout because they are sources of protein. However, there is a reason why many animal products fall into the list of foods to avoid with gout: they are high in purines and animal fat. While some animal products are allowed such as low-fat dairy products, poultry and some seafood many high-fat animal products are to be avoided on a diet to reduce gout.
Vegetables cooked in animal products may have higher purine content, which can lead to more uric acid in the body. According to Cleveland Clinic, high uric acid levels can also be attributed to genetics. If the increased risk of gout is hereditary, they still recommend adopting a healthy diet.
Avoid cooking vegetables in the following animal products:
- High-fat butter
- Gravy
- Fish sauce
For example, mashed potatoes and gravy are a popular combination. While potatoes themselves are compliant on a gout-reducing diet, potatoes doused in gravy are not. Many people also consume vegetables cooked in butter or grease, which are both discouraged. If you have gout, season your vegetables with herbs, spices and other low-fat sources of flavor.
According to Mayo Clinic, high-fat animal products are limited because of their saturated fat content. While fats are important for overall health, people with gout should stick to sources of healthy dietary fats and avoid consuming too much saturated fat.
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Lifestyle Changes May Help Lower Risk Of Gout Attacks
May 4, 2012
Dear Mayo Clinic:
Are there natural ways to prevent gout attacks or at least lessen the severity? I do not want to take medication if its not necessary.
Answer:
If you have been diagnosed with gout, you can make lifestyle changes that may help lower the risk of future gout attacks.
Gout is a form of arthritis that happens when sharp particles, called urate crystals, build up in a joint, causing severe pain, tenderness and swelling. One joint commonly affected by gout is located at the base of the big toe. Urate crystals form when high levels of uric acid are present in the blood.
Your body produces uric acid when it breaks down purines substances found naturally in the body, as well as in certain foods. Uric acid usually dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys flush out too little uric acid. When this happens, gout often results.
One of the most helpful ways to prevent gout attacks is to maintain a healthy body weight. Research has shown that excess weight is a major risk factor for developing gout. If you are overweight, losing weight can lower uric acid levels in your body and significantly reduce your risk of gout attacks.
Finally, if lifestyle changes arent enough to control gout, very effective medications are available. If you decide to try medication, talk to your doctor about which one is right for you.
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