A diet for gout and high uric acid is necessary to treat and prevent exacerbation of the disease. The expert told us which products should be included in the daily menu and which ones should be excluded altogether.
Gout: symptoms and treatment
Gout is the most common form of arthritis and has been known for thousands of 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 generally broken down and excreted from the body by the kidneys. However, if the body produces too much or the kidneys cannot properly remove it from the body, uric acid builds up in the joints.
Gout is more common in men than women because estrogens increase the excretion of uric acid by the kidneys.
The main factors causing gout appear to be diet and genetic predisposition.
Throughout history, gout has been commonly associated with wealthy people's diets (a sign of wealth! ) 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 foods high in purines, such as meat and seafood. A little later, Professor Ebstein recommended moderate intake of foods with plenty of water, fruits such as cherries and strawberries, and avoiding alcohol.
Causes of gout
To understand how purines can affect a person with gout, you first need to understand how gout occurs.
Gout develops when uric acid builds up in the body. Normally, uric acid dissolves in the blood, is filtered by the kidneys, and then excreted from the body in the urine. When this process is interrupted, excess uric acid can build up in the joints, forming 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 are broken down into uric acid when metabolized.
Uric acid, which comes from purine-rich foods, however, only makes up about 15% of the uric acid in the body. The remainder is found naturally in the body's tissues, and genes play an important role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those who followed a high-purine diet had a five times greater risk of developing gout than people who followed a low-purine diet. Ingestion of purine bases was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medications.
Diet and lifestyle modifications are the main aspects of non-pharmacological treatment for gout.
Dietary 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 complete provision of the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. Usually we are talking about the "Table number 6" diet.
The diet should include an optimal amount of proteins with a balanced amino acid composition, a reduction in the total amount of animal fat (the ratio of animal and vegetable fat is 1. 2: 1) with an adequate content of ω polyunsaturated fatty acids -6 and ω-3, as well as a reduction in the carbohydrate part of the diet, reducing the amount of refined and easily digestible sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid foods (jellies, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drinking up to 2 liters of liquid per day.
It is recommended to limit the consumption of table salt, as well as ensure that the body receives an adequate amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of a gout diet in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Limit foods rich in purine bases (meat, fish).
- Include foods in your diet that can control uric acid levels (cereals, milk).
- Drink adequate fluids.
- Lose weight, achieve 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 treatment.
Antipurine diet
It is recommended to exclude foods containing large amounts of purines from the diet (more than 150 mg per 100 g of product).
These products include: beef by-products (brains, kidneys, liver), meat extracts, sardines, anchovies, small shrimp, mackerel, fried vegetables.
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 richer in purines than meat from adults, it should also be avoided.
If you want to include animal protein in your diet, it is recommended to only consume it in moderation. It is recommended to avoid large portions of meats rich in purines. A typical serving of meat is 85 grams and of fish is 110 to 115 grams.
When cooking meat, up to half the amount of purines goes into the broth, so it is advisable to eat boiled meat. In any case, meat and fish dishes, if it is impossible to refuse them completely, are included in the diet no more than 2-3 times a week.
It is also recommended to significantly reduce the consumption of saturated fats, as the increase in blood cholesterol levels worsens the excretion of uric acid by the kidneys. It is believed that the daily diet should contain no more than 200 mg of purine bases.
Purine-rich foods to avoid if you have gout:
- By-products
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:You can eat other types of meat, such as poultry and beef, which contain fewer purines. For example, you could try a vegetarian recipe for mushroom and walnut pâté, which mimics the taste of liver but contains ingredients that don'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 developing gout. This is because uric acid is one of the byproducts of fructose metabolism.
Evidence shows that consuming large amounts of fructose can increase uric acid levels in the blood.
Drinking soda with high-fructose corn syrup has been linked to an increased risk of developing gout. According to a study published in the journal BMJ, men who drank two or more servings of sparkling water per day had an 85% greater risk of developing gout than those who drank less than one serving per month.
Alternative:You can drink diet sodas, which don't 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, mussels, 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 compared to those who ate the least, in a study conducted at Vanderbilt University Medical Center in Nashville.
Alternative:Since fish is good for your heart and blood vessels, it makes sense to keep it in your diet. One option is low-purine cod. You can also eat small, palm-sized portions of purine-rich fish balanced with large portions of vegetables such as roasted zucchini or broccoli with lemon juice, as lemon juice helps neutralize uric acid.
- Alcohol
According to a 2014 study from the Boston University School of Medicine, drinking wine, beer or liquor was associated with an increased risk of a gout attack. The more alcohol a person drinks, the greater the risk, researchers found.
Alternative:The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity is really important, 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 (beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dry cereals, excluding hulled rice, hulled wheat and ground wheat;
- dried fruits, with the exception of plums;
- biscuits, confectionery products prepared with salt and icing sugar;
- salt, hot sauces, sauces, mustard, marinades, seasonings, olives, ketchup and pickles.
Patients are advised to consume foods and dishes low in purines or without them. The diet for gout during an exacerbation should be especially strict.
The general principles of the gout diet correspond to typical recommendations for a healthy diet.
Weight loss
Being overweight increases your risk of developing gout, and losing weight reduces your risk of gout. Research shows that cutting calories and losing weight—even without a purine-restricted diet—reduces uric acid levels and the number of gout attacks. Losing weight also reduces overall stress on your joints and also reduces your risk of diabetes.
Eat 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 sweet fruit juices.
Drinking regime
Maintain an adequate water regime. To accelerate the elimination of purine bases from the body in the diet, the total amount of fluid is increased to 2. 5 l/day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruit, berries, vegetable juices, milk, alkaline mineral water. It is advisable to avoid strong tea and coffee: frequent use can cause aggravation.
Reducing fat
Reduce your intake of saturated fat from red meat, fatty poultry and full-fat dairy products.
Choose lean meats and poultry, low-fat dairy products, and lentils as protein sources.
Product-specific recommendations
- Offal.Avoid meats such as liver and kidney, 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, clams, 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 rich in purines.Research has shown that purine-rich vegetables, 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 sweetened cereals, baked goods, and candy. Limit your consumption of naturally sweet fruit juices.
- Vitamin C.Vitamin C can help reduce uric acid levels.
- Coffee.Some studies suggest 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 concomitant 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;
- fruits and vegetables.
Beans and legumes are excellent sources of protein. Eating these plant-based 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 way of life involves predominantly eating plant foods, gout is rare.
It is important to understand that a gout diet is not the only treatment. Rather, it is 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.