A diet for gout and high uric acid levels is necessary to treat and prevent the disease from worsening. 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 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 normally broken down by the kidneys and excreted from the body. However, when the body produces too much of it or the kidneys cannot adequately remove it from the body, a buildup of uric acid occurs in the joints.
Gout is more common in men than women because estrogens increase the excretion of uric acid by the kidneys.
The main causes of gout appear to be diet and genetics.
Throughout history, gout has often been associated with rich people's diets (a sign of wealth! ) and excessive alcohol consumption, and dietary guidelines for gout have long existed.
In 1876 A. B. Gerrod was one of the first to recommend reducing consumption of foods high in purines, such as meat and seafood. A little later, Professor Ebstein recommended a moderate diet 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 occurs when uric acid builds up in the body. Normally, uric acid dissolves in the blood, is filtered out by the kidneys, and then excreted from the body in urine. When this process is disrupted, excess uric acid can build up in the joints and form 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 that are found in certain foods and are broken down into uric acid when metabolized.
However, uric acid, which comes from foods rich in purines, only makes up about 15% of the uric acid in the body. The rest occurs naturally in body tissues, and genes play a large role in how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, people who ate a diet high in purines were five times more likely to develop gout than those who ate a diet low in purines. Taking purine bases was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medication.
Diet and lifestyle changes are the main aspects of non-pharmacological treatment of gout.
The nutritional 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 to fully cover the body's physiological needs for energy, macro- and microelements, fiber, vitamins and minerals. Usually we talk about the "table number 6" diet.
The diet must contain an optimal amount of protein with a balanced amino acid composition, a reduction in the total amount of fat of animal origin (the ratio of animal and vegetable fat is 1. 2: 1) with a sufficient content of polyunsaturated fatty acids of the ω-6- and ω-3-Families as well as reducing the proportion of carbohydrates in the diet by reducing the amount of easily digestible and refined sugars.
During the exacerbation of gout, it is recommended to exclude meat and fish products from the diet, eat mainly liquid foods (jelly, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drink up to 2 liters of liquid perDay.
It is recommended to limit the consumption of table salt and ensure that the body receives enough 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:
- Restriction of foods containing purines (meat, fish).
- Include foods in your diet that can control uric acid levels (cereals, milk).
- Drink enough fluids.
- Losing weight, achieving a healthy body weight and proper eating habits.
A good rule of thumb is to eat moderate portions of healthy foods. This is the best treatment.
Antipurine diet
It is recommended 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 (brains, kidneys, liver), meat extracts, sardines, anchovies, small shrimps, mackerel, fried legumes.
Limit 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 has a higher purine content than meat from adult animals, it should also be avoided.
If you want to incorporate animal protein into your diet, it is recommended that you only consume it in moderation. It is recommended to avoid large portions of meat rich in purines. A typical serving of meat weighs 85 grams and fish 110-115 grams.
When cooking meat, up to half the amount of purine ends up in the broth, so it is recommended to eat boiled meat. In any case, meat and fish dishes, unless it is possible to avoid them altogether, 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 when there is an increased level 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.
Foods high in purines to avoid if you have gout:
- By-products
It is recommended to avoid dishes such as minced liver as well as other offal such as kidneys and heart as they contain high levels of purines.
Alternative:You can eat other meats such as poultry and beef that are lower in purines. For example, you can try a vegetarian mushroom and walnut pie recipe that mimics the taste of liver but contains ingredients that won't worsen gout symptoms.
- Cold drinks
Although fructose and sugar-based soft drinks are not high in 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.
There is evidence 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 bottled water per day had an 85% higher risk of gout than men who drank less than one serving per month.
Alternative:You can drink diet sodas that don't cause gout and can help you cut out sweets. For example, 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 amounts of purines. According to 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 high uric acid levels than those who ate the least.
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 portions of purine-rich fish 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, drinking wine, beer or alcohol was associated with an increased risk of a gout attack. The more alcohol a person drank, the greater their 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 per day.
Foods to avoid:
- smoked meats, canned foods, frozen meats, fish;
- meat extracts, broths;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic drinks;
- dried cereals, excluding husked rice, husked wheat and ground wheat;
- Dried fruits other than plums;
- biscuits, confectionery prepared with salt and icing sugar;
- Salt, hot sauces, gravies, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and dishes with low or no purine content. The diet for gout during an exacerbation should be especially strict.
The general principles of the gout diet correspond to typical healthy eating recommendations.
weight loss
Being overweight increases your risk of developing gout, and losing weight reduces your risk of developing gout. Research shows that calorie restriction and weight loss—even without a low-purine diet—lower uric acid levels and reduce the number of gout attacks. Losing weight also reduces the overall stress on your joints and also reduces your risk of diabetes.
Eat complex carbohydrates
Eat more fruits, vegetables, and whole grains that provide complex carbohydrates. Avoid foods and drinks containing high fructose corn syrup and limit your intake of naturally sweet fruit juices.
Drinking regime
Maintain an adequate water balance. To accelerate the excretion of purine bases from the body in food, 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, berry, vegetable juices, milk and alkaline mineral water. It is recommended to avoid strong tea and strong coffee: frequent consumption can lead to aggravation.
Reduce 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 portion sizes for beef, lamb and pork.
- Seafood.Some types of seafood, such as anchovies, mussels, 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 high in purines.Research has shown that vegetables high in purines, such as asparagus and spinach, do not increase the risk of gout or recurrent gout attacks.
- Alcohol.Beer and alcoholic beverages are linked to 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 sugary foods such as sweetened cereals, baked goods and candy. Limit consumption of naturally sweet fruit juices.
- Vitamin C.Vitamin C can help lower uric acid levels.
- Coffee.Some studies suggest that moderate coffee consumption may be associated with a lower 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 lower risk of gout attacks.
Recommended foods and drinks for daily consumption
- beans and lentils;
- Legumes;
- low fat dairy products;
- whole grains like oats, brown rice and barley;
- Fruits and vegetables.
Beans and legumes are excellent sources of protein. Consuming 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 lifestyle includes predominantly plant-based 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.