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 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 joints and various tissues and occurs in association with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is usually broken down and excreted from the body through the kidneys. However, if the body produces too much or the kidneys fail to remove it adequately from the body, uric acid builds up in the joints.
Gout is more common in men than in women because estrogen increases the excretion of uric acid through the kidneys.
The main causal factors of gout appear to be diet and genetic predisposition.
Throughout history, gout has commonly been associated with rich people's diets (a sign of affluence! ) 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 purine-rich foods, such as meat and seafood. Shortly thereafter, Professor Ebstein recommended moderate food consumption 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 manifests itself.
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 build up in the joints forming sharp crystals, which can cause serious joint disorders and also trigger the formation of kidney stones.
The role of purines in the development of gout
Purines are chemical compounds found in some foods that are broken down into uric acid when metabolized.
However, uric acid, which comes from purine-rich foods, makes up only about 15 percent of the uric acid in the body. The rest 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 ate a high-purine diet were five times more likely to develop gout than people who ate a low-purine diet. Intake of purine bases was associated with increased gout attacks, regardless of whether participants drank alcohol or took medications.
Diet and lifestyle modifications are the main aspects of non-pharmacological treatment of 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 full provision of the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. Usually we talk about the diet "Table number 6".
The diet must include an optimal amount of proteins with a balanced amino acid composition, a reduction in the total amount of fats of animal origin (the ratio of animal and vegetable fats is 1, 2: 1) with an adequate content of polyunsaturated fatty acids of the class ω -6 and ω-3, as well as a reduction in the portion of carbohydrates in the diet by reducing the amount of easily digestible and refined sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid foods (gelatin, compotes, milk, lactic acid products, fruit and vegetable juices, liquid cereals) and drinking up to 2 liters of liquid per day.
It is recommended to limit the consumption of table salt and 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 correct 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 advisable to exclude from the diet foods containing large amounts of purines (more than 150 mg per 100 g of product).
These products include: beef by-products (brain, kidney, liver), meat extracts, sardines, anchovies, shrimp, mackerel, fried legumes.
Limit the consumption of foods containing 50-150 mg of purines per 100 g - meat products (beef, lamb), poultry, fish, shellfish, vegetables (peas, beans, lentils).
Since the meat of young animals is higher in purines than the meat of adults, this should also be avoided.
If you wish to include animal proteins in your diet, it is recommended to consume them only in moderation. It is advisable to avoid large portions of purine-rich meats. A typical portion of meat is 85 grams and of fish 110-115 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, since with increasing levels of cholesterol in the blood the excretion of uric acid by the kidneys worsens. It is believed that the daily diet should contain no more than 200 mg of purine bases.
High purine foods to avoid if you have gout:
- By-products
It is advisable to avoid dishes such as chopped liver and other offal such as kidney and 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 can try a vegetarian recipe for mushroom and walnut pâté, which mimics the flavor of liver but contains ingredients that don't aggravate 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 occurs because uric acid is one of the byproducts of fructose metabolism.
Evidence has shown 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 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, crabs, shrimp, sardines, herring, trout, mackerel and others) contain moderate to high levels of purines. In a study conducted at Vanderbilt University Medical Center in Nashville, men who ate the most seafood were more than 50 percent more likely to have elevated uric acid levels than those who ate the least.
Alternative:Since fish is good for the heart and blood vessels, it is advisable to keep it in the diet. One option is low-purine cod. You can also eat small, palm-sized portions of high-purine fish, 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 the Boston University School of Medicine, drinking wine, beer or spirits 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 drink (women) or two (men) a day.
Foods to avoid:
- smoked meat, canned food, frozen meat, fish;
- meat extracts, broths;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dry cereals, excluding hulled rice, hulled wheat and ground wheat;
- dried fruit, except plums;
- biscuits, confectionery prepared with salt and icing sugar;
- salt, hot sauces, gravies, mustard, marinades, relishes, olives, ketchup and pickles.
Patients are advised to use foods and dishes low in purines or without them. The gout diet during a flare-up 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 low-purine diet, lowers uric acid levels and reduces 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 containing high-fructose corn syrup and limit your intake of naturally sweet fruit juices.
Alcohol consumption regime
Maintain an adequate water regime. To accelerate the elimination of purine bases from the body through the diet, the total amount of fluids is increased to 2. 5 l/day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruits, berries, vegetable juices, milk, alkaline mineral water. It is advisable to avoid strong tea and coffee: frequent use can lead to worsening.
Reduce fat
Reduce your intake of saturated fat from red meat, fatty poultry, and high-fat dairy products.
Choose lean meats and poultry, low-fat dairy products and lentils as sources of protein.
Specific product 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 sugar-containing foods such as sugary cereals, baked goods, and candy. Limit the consumption of naturally sweet fruit juices.
- C vitamin.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 evidence that consuming 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 sources can help meet your daily protein needs while reducing the amount of saturated fat found in high-purine animal proteins.
Therefore, for gout, a vegetarian diet is recommended. In countries where the traditional lifestyle involves the consumption of predominantly plant foods, gout is rare.
It is important to understand that diet for gout 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.