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The over 8 million people suffering from gout don’t only experience recurrent bouts of excruciating pain, but they are also at a higher risk of joint damage, immobility and even premature death (1-2).
Many of the answers to both preventing and treating gout can be found in what we eat.
What is Gout?
Gout is the most common inflammatory arthritis in the world, characterized by episodes of severe joint pain (2).
These episodes are often referred to as ‘flares’ or ‘attacks’ that happen when uric acid levels become too high in the body. A flare happens when uric acid settles into affected joint spaces and forms crystals that cause both inflammation and pain.
How Do You Get Gout?
How does uric acid acid get in your body?
Uric acid is a waste product produced when our body breaks down chemicals called purines. Purines are found in our tissues as well as in some types of food we eat.
It builds up (in a condition called hyperuricemia) when we are either making too much uric acid or when we aren’t able to get rid of it quickly enough.
Some common chronic diseases make this more likely and are risk factors for this type of inflammatory arthritis.
Risk factors that can be decreased with lifestyle changes (3):
- Unhealthy Diet
- Hypertension (High Blood Pressure)
- Obesity
- High Cholesterol
- Diabetes Mellitus
- Chronic Kidney Disease
- Excessive Alcohol Use
- Heart Disease
- Metabolic Syndrome
- Some Medications
- Diuretics aka water pills (lasix and hydrochlorothiazide)
- Immunosuppressants (tacrolimus & cyclosporine)
Risk factors we are unable to influence:
- Older Age
- Ethnicity
- Genetics
- Male Gender
Signs of Gout
The joints most commonly affected are the big toe (ie: called podagra), feet, hands, knees and elbows.
Gout Symptoms
- Pain
- Redness
- Warmth
- Swelling
These symptoms often come in waves with an acute attack lasting days to weeks at a time. Repeated attacks can lead to more chronic gouty arthritis, in which people feel pain that is ongoing although usually less severe than the classic flares.
How to Get Rid of Gout with Your Diet
Gout has literally been referred to “The Disease of Kings” because it has been associated with indulging excessively in food and alcohol, which was historically thought to be a privilege of royalty.
Acute flares of pain usually require anti-inflammatories and other medications in addition to diet.
Learning how to decrease flairs or prevent gout all together requires focusing on food.
Foods that Cause Gout
It’s thought that foods and drinks high in purines can directly increase the uric acid and increase the risk of gout attacks. Part of the recommended treatment and prevention of future flairs is to consume a low purine diet.
And it’s just as important to avoid foods that contribute to the many other risk factors of the disease (ie: hypertension, diabetes, congestive heart failure) in daily meal planning.
Purine Rich Foods
- Some Meat
Beef
Lamb
Pork - Some Seafood
Anchovies
Lobster
Shrimp
Cramp
Tuna
Sardines
Mackerel
Haddock - Organ Meat
Sweetbreads (thymus or pancreas of an animal)
Liver
Tongue
Kidney
Heart
Tripe (animal stomach lining)
Brain - Fructose / High Fructose Corn Syrup (added sugar)
Candies
Baked Goods
Processed Foods
While some of these foods can be healthy in people who do not have gout, it is recommended that they are in general minimized in people who suffer from the disease. For example, fish can be a very healthy part of a balanced diet. Gout diets may include fish lower in purines or small amounts of purine rich fish mentioned above.
Drinks You Should Avoid on Gout
It’s so easy to forget that what we drink is an important part of our diet. Drinks can contribute important hydration and nutrients. However, it’s easy for calories and additional additives like fructose to slip by and all too quickly add up.
Alcohol
Excessive alcohol use should be avoided, well in everyone. However, people with gout should be even more careful with how much they alcohol they consume.
The American College of Rheumatology recommends no more than 2 drinks daily for men and no more than 1 drink daily for women with the disease. It’s also recommended to completely eliminate alcohol during active flares (4).
Beer and hard alcohol seem to much bigger culprits than wine at aggravating the disease (5).
Diet Tip: If you are affected by gout and still want to enjoy an adult beverage, a controlled amount of wine is the best choice for minimizing negative health effects.
Sugary Drinks
Almost any ‘non-diet’ drink contains a significant amount of added sugar, often in the form of fructose. Not only does added fructose contribute to uric acid build up, it also contributes negatively to making the other chronic diseases worse. Added sugar is one of the biggest enemies of the obesity epidemic, and comorbid conditions that go along with it.
This includes any soda that’s not ‘diet’ along with most fruit juices and energy drinks.
Diet Tip: Start trying the ‘diet’ or ‘zero-calorie’ versions of your favorite soda or energy drink. Drink juices in moderation and make sure they don’t contain any added sugar.
Foods Contributing to Chronic Disease
Remember, the development of gout is also influenced by other chronic diseases including high blood pressure, diabetes, kidney disease, heart failure and obesity. Studies have shown that losing weight lowers the risk of the disease.
Therefore preventing and treating gout means preventing and treating these other chronic diseases as well as effective weight management. While there are certainly some exceptions, the development and treatment of these chronic diseases is also strongly rooted in diet.
Salt
High salt diets are strongly associated with hypertension and congestive heart failure. A diet low in salt is a well described treatment for people with these conditions and is literally prescribed for this purpose.
The DASH (dietary approaches to stop hypertension) diet is the most popular of these to date, and people who follow the DASH diet have been shown to have lower rates of gout (6).
Saturated Fats
Saturated fats such as fried foods are generally unhealthy choices. They contribute a significant amount of cholesterol and calories while providing very little positive nutritional value. They are a large culprit in the obesity epidemic and the associated comorbid disease.
Processed Foods
It’s recommended to use caution with processed foods because they so frequently contain either high levels of salt, sugar, saturated fat, empty calories or a combination of some or all of the above.
Diet Tip: Get into the habit of looking at the nutrition panel of your food before you eat it. Avoid foods with added sugar, those that are high in saturated fats and food that is overall high in calories compared to the relative nutrition you’re taking in.
Foods to Help Gout (7)
Plenty of healthy options are available to prevent the disease.
Cherry Juice for Gout
Cherry juice has surprisingly been found to decrease levels of uric acid. Incorporating cherries or cherry juice (without added sugar of course!) into the diet may help prevent disease flares.
Coffee
There is some evidence that coffee may contribute to helping to lower the total levels of uric acid.
Of course don’t drink coffee if your doctor has instructed you to abstain from it for other medical reasons.
Vitamin C
Vitamin C has also been shown to help decrease uric acid levels. You can get vitamin C from all sorts of natural sources, or of course supplement with pills in the form of vitamins.
Foods High in Vitamin C
- Guavas
- Cherries
- Spinach
- Broccolli
- Kale
- Lychees
- Grapefruit
- Lemon
- Cauliflower
- Persimmons
- Brussel Sprouts
- Papaya
Skim Milk & Other Lowfat or Nonfat Protein Sources
The American College of Rheumatology supports that a glass of skim milk daily may help lower uric acid (4). This probably applies to most lowfat or nonfat dairy products as they are a good source of protein that may be protective against the disease by lowering overall uric acid levels (7).
Healthy Whole Food Diet
In the end, the best gout diet also shares the same principles all diets need to follow.
Consistent calorie control is always key to weight loss and maintaining a healthy weight.
And eating a well balanced calorie controlled diet incorporating adequate amounts of protein, healthy unsaturated fats and unrefined carbohydrates is crucial to preventing and treating gout and so many other disease.