A diet for gout and high uric acid is necessary to treat and prevent worsening of the disease. The expert told us which products should be included in the daily menu, and which should be completely excluded.
Gout: symptoms and treatment
Gout is the most common form of arthritis and has been known for several thousand years. Gout is caused by the deposition of uric acid crystals in the joints and various tissues and occurs in combination with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is usually broken down and excreted from the body via the kidneys. However, if the body produces too much of it or the kidneys cannot adequately remove it from the body, uric acid builds up in the joints.
Gout is more common in men than women because estrogen increases the excretion of uric acid through the kidneys.
The main causes of gout appear to be diet and genetic predisposition.
Historically, gout has usually been associated with the diets of wealthy people (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 consumption of purine-rich foods such as meat and seafood. A little later, Professor Ebstein recommended a moderate intake of food 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 must first 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 disrupted, excess uric acid can accumulate in the joints and form sharp crystals, which can cause severe discomfort in the joints and also cause kidney stones to form.
The role of purines in the development of gout
Purines are chemical compounds found in certain foods that break down into uric acid when metabolized.
However, uric acid, which comes from purine-rich foods, only makes up about 15% of the body's uric acid. The rest is found naturally in the body's tissues, and genes play a large role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those on a high-purine diet were five times more likely to develop gout than those on a low-purine diet. Intake of purine bases was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medication.
Dietary and lifestyle changes are the main aspects of non-pharmacological treatment of gout.
Nutrition 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 dietary gout therapy are the complete provision of the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. We usually talk about the "Table number 6" diet.
The diet must include an optimal amount of protein with a balanced composition of amino acids, 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 polyunsaturated fatty acids of the ω-6 and ω-3 family, as well as a reduction in the carbohydrate part of the diet by reducingamounts of easily digestible and refined sugars.
In the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid food (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 to ensure that the body receives an adequate amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of the diet for gout in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Restriction of foods rich in purine bases (meat, fish).
- Include foods in your diet that can control uric acid levels (cereals, milk).
- Consuming adequate fluids.
- Losing weight, achieving a healthy body weight and proper eating habits.
A good rule of thumb is to eat moderate portions of healthy food, that will be the best treatment.
Antipurine diet
It is recommended to exclude from the diet foods that contain large amounts of purine (more than 150 mg per 100 g of product).
These products include: beef by-products (brain, kidney, liver), meat extracts, sardines, anchovies, small shrimp, mackerel, refried beans.
Limit the consumption of foods containing 50-150 mg of purine per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Given that the meat of young animals has more purines than the meat of adults, it should be avoided.
If you want to include proteins of animal origin in your diet, it is recommended that you consume them only in moderation. Avoiding large portions of purine-rich meat is recommended. A typical portion of meat is 85 grams, and fish 110-115 grams.
When cooking meat, up to half of the amount of purine goes into the broth, so it is preferable to eat cooked 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, because with an increased level of cholesterol in the blood, the excretion of uric acid through the kidneys worsens. It is believed that the daily diet should not contain more than 200 mg of purine bases.
Foods high in purines to avoid if you have gout:
- Byproducts
It is recommended to avoid dishes such as chopped liver, as well as other offal such as kidneys, heart, because they contain a lot of purines.
Alternative: You can also eat other types of meat, such as poultry and beef, which contain less purine. For example, you can try a vegetarian recipe for mushroom and walnut pâté, which mimics the taste of liver but contains ingredients that won'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 happens because uric acid is one of the byproducts of fructose metabolism.
Evidence has shown that consuming large amounts of fructose can increase blood uric acid levels.
Drinking soda with high fructose corn syrup is associated with 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% higher risk of 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 slices of lemon and lime. - Sea food
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 the 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 fish with high purine content, balanced with large portions of vegetables, such as roasted zucchini or broccoli in lemon juice, as lemon juice helps neutralize uric acid. - Alcohol
According to a 2014 study from Boston University School of Medicine, consumption of wine, beer or alcohol was associated with an increased risk of gout attacks. The more alcohol a person drinks, the greater the risk, the researchers found.
Alternative: The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity really matters, the less alcohol the better – no more than one (women) or two (men) drinks a day.
Foods to avoid:
- smoked meat, canned food, frozen meat, fish;
- meat extracts, soups;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dried cereals, excluding husked rice, husked wheat and milled wheat;
- dried fruit, except prunes;
- cookies, confectionery products prepared from salt and powdered sugar;
- salt, hot sauces, sauces, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and meals with low or no purine content. The diet for gout during an exacerbation should be particularly strict.
The general principles of nutrition against gout correspond to typical recommendations for a healthy diet.
Weight loss
Being overweight increases the risk of developing gout, and losing weight reduces the risk of gout. Research shows that cutting calories and losing weight—even without a purine-restricted diet—lowers uric acid levels and reduces the number of gout attacks. Losing weight also reduces the overall stress on the joints and also reduces the risk of diabetes.
Eating complex carbohydrates
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and drinks high in fructose corn syrup and limit your intake of naturally sweetened fruit juices.
Drinking regime
Maintain an adequate water regime. In order to accelerate the elimination of purine bases from the body through 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 recommended to avoid strong tea and strong coffee: frequent use can lead to worsening of the condition.
Fat reduction
Reduce your intake of saturated fat from red meat, fatty poultry and full-fat dairy products.
Choose lean meat and poultry, low-fat dairy products and lentils as sources of protein.
Recommendations for specific products
Offal. Avoid meats such as liver, kidneys, which have a high level of purines and contribute to an increase in the level of uric acid in the blood.Red meat. Medium size for beef, lamb and pork.Sea food. 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 diet for gout.Vegetables with a high purine content. Research has shown that vegetables with a high purine content, 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 a gout attack and limit alcohol consumption, especially beer, between attacks.Sweet food and drinks. Limit or avoid foods that contain sugar, such as sweetened cereals, pastries, 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 moderate coffee drinking 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 food and drinks for everyday 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 sources can help meet your daily protein needs while reducing the amount of saturated fat in high-purine animal proteins.
Therefore, a vegetarian diet is recommended for gout. In countries where the traditional way of life includes a predominance of plant foods, gout is rare.
It is important to understand that a gout diet is not the only treatment. Instead, it's 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.