The Correct Gout Diet Is Essential

Gout Foods To Avoid

As we’ve discussed in a previous post, moderation in all things is important when you adopt a diet for gout. To recap, the foods highest in purines (a major cause of gout) include organ meats, shellfish, fish roe, and certain oily fish such as anchovies and mackerel. The foods which contain high to medium levels of purines are most meats, poultry, beans and lentils, certain vegetables such as mushrooms, cauliflower and asparagus; and the foods lowest in purines are dairy products, pasta, refined bread and cereals, ice cream and fats.

Alcohol does increase the risk of developing gout, and it may precipitate a sudden and unexpected attack of gout if you’ve experienced a previous attack.

Alcohol has a number of effects on the metabolism of the body: first, it contains high levels of purines; second, it interferes with the removal of uric acid from the body; and third, heavy drinking can produce ketones, which also interfere with the removal of uric acid from the body.

So, as you can imagine, a reduction in alcohol consumption is pretty important: the standard advice is to have three alcohol free days per week, and on the days that you do consume alcohol not to have more than one or two small glasses of wine or a pint of beer. It is true that beer presents a higher risk than wines or spirits: in fact, drinking two glasses of wine a day has not been linked to an increased risk of gout.

In a correctly balanced gout diet, it’s also helpful to consume large quantities of water because this reduces the chance of uric acid crystals forming inside the kidneys. As anyone who has had them can tell you, kidney stones can be extremely painful. The generally recommended quantity of liquid to drink per day is around 1.5 liters: this will include all drinks except alcohol.

There is a limited amount of evidence that coffee has some protective effect against gout. What you should avoid, however, are sweetened soda drinks and fruit juices because the sugar syrup and fructose they contain may well stimulate a gout attack. The best drinks for a diet for gout are pure fruit juice, possibly diluted with water, and semi-skimmed and skimmed milk.

What Causes Gout? (Hint – The Wrong Diet, Among Other Things)

And What Are The Best Remedies For Gout?

One of the most common questions about gout is how much any abnormalities of purine metabolism are responsible for gouty arthritis.

Purine metabolism is essential to the body’s well-being, since it is essential to the production of proteins. Nonetheless, it is the dysfunction of this metabolic pathway which is responsible for the development of hyperuricemia (high uric acid in the blood). High uric acid causes the formation of urate crystals in the joints, and these crystals cause gout pain..

The fact is, gout can be caused by several deficiencies or abnormalities of purine metabolism. There is one type of abnormality which focuses upon decreased excretion of uric acid; there is another type which focuses upon an increased synthesis of uric acid. It is this latter group where enzymatic abnormalities appear to be responsible for the formation of high levels of uric acid and the consequent development of gout. But how much of this purine overload comes from the wrong gout diet?

Well, to recap, gout has a number of causes, the primary one being under-excretion of uric acid by the kidneys. This is not a biochemical issue, but it is, even so, one of the predominant causes of gout in adult males and females. Enzymatic deficiencies are the other cause of high levels of serum urate. You can read more about this here.

More mundane factors which are responsible for the development of gout include consuming excessive quantities of alcohol, an association which has been known for over 100 years. Taking a simplistic view, and assuming that alcohol is indeed closely related to the occurrence of gout, both in anecdotal evidence and scientific studies, the question is – what could possibly be causing this association? Well, the answer, of course, is that you are not consuming the correct gout diet.

Alcohol as a cause of gout

There are, in fact, several reasons why alcohol can contribute to the development of chronic gout and the inflammation and pain of acute gout attacks. To start with, alcohol contains high levels of carbohydrates which can predispose an individual towards obesity; and we know that there is an association between obesity and gout. (Losing weight and reducing consumption of foods to avoid with gout is often offered as a gout treatment strategy).

Furthermore, excessive consumption of alcohol induces higher than normal levels of triglycerides or hypertriglyceridemia, which is associated with hyperuricademia and gout. Both long and short-term consumption of alcohol increases the synthesis of urate through an increase in metabolism of adenine nucleotides. Beer, in particular, contains high levels of purines. So the complexity of the correct gout diet is revealed in the interaction of a number of seemingly unrelated factors.

All in all, a number of studies suggest that alcohol effectively induces an increase in urate synthesis, while simultaneously working to reduce the excretion of urates.

And while it’s often said that certain types of alcoholic drink are more likely to induce an attack of gout than others, there is no known explanation as to why this should be so, or indeed if it is true at all.

The first line of treatment for gout therefore should undoubtedly be directed at suitable gout dietary and lifestyle changes, with drug treatment given to men and women who remain hyperuricemia despite these lifestyle modifications.

What makes the investigation of the causes of gout more challenging is that hyperuricemia often occurs in association with other metabolic disorders. And if gout is present, then treatment of gouty arthritis may require, nay depend on, the physician determining the cause of that hyperuricemia. The doctor should also offer some kind of treatment which will reduce serum uric acid levels to less than 360 µmol per liter while simultaneously diminishing the number and size of uric acid crystals deposits in the body. Treatment options for gout.

Summary of the causes of gout

So what we know is that gout tends develop when hyperuricemia occurs, and is associated with levels of serum urate (uric acid) higher than 390 µmol per liter. It is often accompanied by obesity, diabetes, and insulin resistance – all of which tend to increase the risk of cardiovascular problems. We also know that gout affects between 1% and 2% of the population; which represents around 20% of people with hyperuricemia.

The term “gout” actually refers to the outcome of excessive levels of uric acid in the body: the deposition of crystals of monosodium urate in the synovial space of the joints (and perhaps urate nephropathy and possibly tophi formation). A gout diet helps to avoid this by reducing uric acid in the blood serum.

If a hereditary disorder is eliminated, then we also know that the main factors responsible for the development of gout include foods rich in purines, obesity, and alcohol consumption. The chance of an individual developing gout increases markedly when serum urate levels rise above 480 µmol per liter.

Possibly because of the Western lifestyle, gouty arthritis is the most common form of arthritis in the population, and its incidence increases rapidly with age. It is about 50% more common than rheumatoid arthritis.

 

One of the factors responsible for the increase in gout in recent years is the use of drugs that inhibit uric acid excretion such as thiazide. Men have a much greater risk of developing gout than women do; this appears to be because of the uricosuric action of estrogen.

As we have observed already, uric acid, or urate, production is the end result of purine metabolism. A notable step in this process is the metabolism of xanthine and hypoxanthine by the enzyme xanthine oxidase. The resulting urate is excreted by the kidneys. Read more here. This is a mechanism susceptible to many different influences, including low-dose aspirin treatment, which reduces the excretion of urate.

The saturation point of uric acid is 400 µmol per liter at 37°C and pH 7.4; once it’s concentration goes beyond this, monosodium urate crystals to precipitate out in those parts of the body where the ambient temperature tends to be lower — such as the foot (or occasionally the fingers). Urate crystals promote an inflammatory response in the body, activating the NALP3 inflammasone and promoting the release of pro-inflammatory cytokines, including interleukins 1, 18 and 8.

A gout attack is usually the result of an unexpected and rapid rise in serum urate levels. This can be the product of excessive alcohol consumption or eating a meal high in purines. It appears to be the inflammation of an immune response caused by the release of uric acid from the edge of crystal deposits which triggers an attack of gout. For the sufferer, the usual appearance of gout is an acute episode of monoarticular arthritis at the metatarsophalangeal joint of the big toe: such attacks tend to be self-limiting but are extremely painful, usually start at night, and last for between seven and 10 days.

It is the presence of urate crystals in the joints and connective tissue, and possibly also inside the kidneys, that is responsible for the chronic nature of this problem. Around 90% of men and women who experience an attack of gout will have repeat episodes in five years. The finger joints may be affected, and oligoarticular or polyarticular arthritis may be seen. There are many other conditions which resemble gout, including pseudogout (chondrocalcinosis) where the deposition is calcium pyrophosphate dihydrate crystals, and a condition where calcium oxalate is deposited within the joints.

 gout tophi elbow

gout arthritis

Foods to avoid with gout

Usually, a diagnosis of gout can be made when the large toe displays characteristic signs of gout, and the serum urate level is increased. It’s also possible for crystals to be extracted from the joint and examined under a polarizing microscope.

Diagnosis is not difficult, but establishing the causes of gout may be more challenging. As we have observed, there is a genetic predisposition to gout. There is also an association between metabolic syndrome and gout. The guidelines for risk assessment recommend measuring fasting blood sugar, and possibly levels of HbA1c, as well as levels of fasting blood lipids/cholesterol, and checking thyroid parameters.

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Cherries Really Are An Essential Part Of A Gout Diet!

Posted on July 18, 2022 by Rod

Cherries and the gout diet

It’s always reassuring to get scientific proof of home remedies for gout! And a study reported in the Journal of Nutrition about the effect of cherry consumption on the incidence of gout proves what some of us always knew….. eating cherries helps with gout!

More accurately, the study looked at the effect of cherry consumption on plasma urate level, because, as you know, plasma urate level is linked very closely to the formation of urate crystals in the joint, and the subsequent pain of gout.

The researchers, led by Robert A Jacob, studied the effect of eating 280 g cherries on plasma urate levels in 10 healthy women between the ages of 22 and 40. They found a really significant drop from around 214 – 183 micromoles per litre. The amount of urate in the women’s urine increased as well. All of this seems to conclusively show that the anecdotal evidence of cherries as an essential part of a gout diet is absolutely true.

The question is, what part of the cherry is responsible for this health benefit? While we know that eating cherries and drinking cherry juice has a widespread reputation as being very good for you, particularly where arthritis is concerned, what part of the cherry is responsible for the anti-gout and anti-inflammatory effect?

Studies using gout sufferers, rather than non-gout-sufferers, also show a significant reduction in urate levels and gout attacks. In actual fact, it really is the anthocyanins that are responsible, and also a compound called cyanidin. We know that these compounds have antioxidants and anti-inflammatory properties are almost as effective as commercial medications!

Work by Naomi Schlesinger and Michael Schlesinger has confirmed this. They studied the effect of cherry juice concentrate on gout attacks.

They specifically set out to study whether or not cherry juice concentrate was useful for preventing gout flareups. One study compared the effectiveness of pomegranate juice and cherry juice concentrate. In another study they studied the effect of taking cherry concentrate for 4 months. And finally they conducted a study to investigate the effect of cherry juice concentrate on the interleukins secreted by monocytic cells when they were exposed to urate crystals in experimental conditions.

A fruity diet for gout!

When you think about it, this is an absolutely superb piece of experimental work to conduct. I can imagine it was both fun and satisfying – very useful to millions of people, I’d say, having had many gout attacks myself! As a matter of fact I actually used cherry juice in the form of cherry juice concentrate, the variety known as “Cherry Active”.

This comes as either capsules or liquid concentrate, and I have found it to be very effective in preventing my own attacks of gout. And that’s without scientific studies are be recommending it! In fact I think it’s actually an essential part of any gout diet.

You may be particularly interested to read this study, which certainly does provide a lot of evidence to support the idea that cherries are a useful prophylactic against gout attacks. Let’s look at the conclusions.

To start with, it was known as long ago as 1950 that eating cherries could reduce serum urate levels and prevent flareups. In the first study by the Schlesingers, as mentioned above, cherry juice concentrate was compared with pomegranate juice concentrate as a way of preventing gout flareups.

In a group of 18 people who were known to have gout (proved by analyzing the crystals in the joints), two groups of people received a tablespoon of cherry juice twice daily or a tablespoon of pomegranate juice twice daily. They also continued taking any of their existing medication. The average number of flareups in people taking cherry juice concentrate reduced from around 5 every four months to an average of 1.5 every four months after taking cherry juice for 120 days. This was a highly significant result.

In the pomegranate juice group, the effect was much less marked: in fact, only one in five of the people in the pomegranate juice avoided flareups while they were taking it, although there was a slight reduction overall.

Indeed, so successful was the cherry juice is a medication against gout flareups that around half of the patients in the cherry juice group stopped taking their painkillers within 60 days of starting the cherry juice drink!

What’s interesting about this is that the serum urate levels did not reduce very much, so the reduction in gout attacks must be caused by a reduction in inflammation produced by the urate crystals in the joint, or a reduction in the number of urate crystals in the joint. (It also probably means the older experiments were invalid.)

In the second study, people who had been taking cherry juice for 4 months or more were studied to see what effect it had on their gout.

In a group of 24 people who had crystals in the joints, one tablespoon of cherry juice twice daily reduced the number of gout flareups from around 7 a year to 2 per year.

And because some of these people were actually not able to take urate lowering therapy (ULT), this must have been an immense relief to them. Even among the men and women who were taking ULT, the average of 7 gout flareups per year before they started cherry juice concentrate went down to around 2.5 after starting cherry juice. Once again, cherry juice did not alter the level of serum urate in these people.

In the third study, as you might recall, the investigators looked into the effect of cherry juice on inflammatory responses in the body. They cultured immune cells in experimental conditions, and added both urate crystals and dilutions of cherry juice concentrate at body temperature.

They discovered was that cherry juice concentrate inhibited the secretion of inflammatory substances by up to 60%. (Pomegranate juice didn’t really have any effect at all.) So this all demonstrates that cherry juice really is an effective part of a gout diet.

Cherry juice concentrate is, apart from being delicious, actually well tolerated by most people, allows people to stop taking anti-inflammatory drugs, and reduces gout flareups by 50% or more.

Bear in mind that this was an average across the whole group, and in fact 36% of the patients who were not taking ULT were actually free of gout flareups after four months of consuming cherry juice! In fact cherry juice actually reduces gout flareups whether or not people are on ULT!

Obviously this report contradicts previous ones which have suggested that cherries actually reduce serum urate levels. But there you go – at least we know it works! And it seems to work with both sweet and bitter cherries. We know that gout inflammation is caused by urate crystals stimulating interleukin release by monocytes (which are part of the immune system’s cells). And we also know that cherry juice inhibits the secretion of interleukins.

This is a wonderful discovery — although of course if you’ve been taking cherry juice yourself as part of a gout diet, you probably don’t think of it as a discovery! But the news will bring massive hope to all gout sufferers.

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Advice On A Good Gout Diet

Posted on July 15, 2022 by Rod

As you know, gout is a form of arthritis, caused by too much uric acid present in the bloodstream. When this condition exists for long enough, the uric acid can crystallize into sodium urate crystals within the joints. You probably also know that your diet is a major influence on both the causation of gout, and also on ways to reduce the likelihood of any further gout attacks.

Before we go any further, it’s essential to say that obesity is also a major cause of gout; or, more accurately, it certainly makes existing gout worse. Therefore if you are obese, or indeed “merely” overweight, slowly losing weight will not only help to reduce the levels of uric acid in your blood, but it will also quite obviously reduce the load that your joints have to bear.

Having said that, crash dieting is a seriously bad idea, as it can actually increase uric acid levels in the bloodstream and temporarily trigger attacks of gout which can be very painful. Everything should be done in moderation: the best way to deal with gout is a combination of healthy eating and regular physical exercise.

The Ideal Gout Diet

Foods To Avoid With Gout

Since purines are the cause of gout, the obvious answer is to avoid foods that contain high purine content. High purine foods include many types of meat, but especially organ meats such as liver, kidneys, sweetbreads and heart. Game is also particularly high in purines: this would include meats such as pheasant and venison and rabbit.

Seafood is a notorious source of purines, but besides mussels, crab and shrimps, there are ordinary fish which have a high level of purines: the suspects here include herring, mackerel, sardines, sprats, and fish roe. You may be surprised to learn that foods which contain yeast also have a high level of purine, so Marmite, for example, is a food to avoid with gout. You probably also know that beer and many types of alcoholic drink are not good gout “foods”.

Strangely enough a number of vegetables also contain high quantities of purines: mushrooms, mycoproteins such as Quorn, asparagus, cauliflower, soybeans, some lentils, and spinach are also reasonably high in purines and are therefore gout foods that should be eaten in moderation.

The best way to deal with gout foods such as these is to eat those which are lower in purines: for example, milk and eggs and cheese. Most of us in the Western world consume far more protein than is required — you may be surprised to learn, for example, that an average man requires only 70 grams of protein daily.

This is roughly equal to a chicken breast, one egg and half a pint of milk. So you can easily get your full protein requirements in a diet for gout, while ensuring that you don’t eat foods containing high levels of purines. Even so, you can incorporate small amounts of meat and fish in your diet to ensure you get the nutrient value they offer. Advice on a balanced diet.

Good And Bad Gout Foods

Now, I don’t want to lead you to believe that only high purine foods will trigger gout. If you speak to anybody who has experience of gout, you will know that individual metabolism varies, so you may find other foods — strawberries, oranges, tomatoes, and nuts are often mentioned in this context — may promote an attack of gout in you. There’s no clear indication of why this happens, but when you get the sense that certain gout foods are triggering an attack, then you should obviously avoid them.

Diet For Gout – The Good Gout Foods

The good news is that science has now confirmed that cherries are indeed a good gout food – in the sense that they can help to prevent attacks. Furthermore, it appears that a diet rich in dairy products (preferably low fat or zero fat versions) offers some degree of risk reduction around the possibility of developing gout.

Other compounds and substances which seemed to help include vitamin C. it appears that when you take vitamin C supplements, you reduce the risk of developing gout because vitamin C seems to assist the kidneys in removing uric acid from the body. However, high doses are required – in the order of 500 mg to 1000 mg per day – and you must consult with your doctor before you take these supplements because vitamin C can interfere with some prescription medications.

Overall, you need to limit your purine intake to about 200 mg a day: you can get an idea of what this means from the table elsewhere on this page.

As you know, dietary recommendations these days are always about eating a balanced diet. What this means in practice is that you should consume plenty of fruit and vegetables, plenty of wholemeal bread, wholegrain cereals, and starchy vegetables. Your intake of meat and fish should be limited, and so should your intake of milk and dairy products.

While people with gout often try and avoid food with a high purine content, the truth is that a balanced diet is essential for good health for everyone, and by ensuring that your diet for gout include moderate amounts of the correct gout foods, you don’t have to endure a dreary diet.

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What To Do About Your Gout

Posted on July 13, 2022 by Rod

Details Of The Best Diet For Gout

The British Society of Rheumatology has issued guidelines for the management of gout.

Gout is a common disease, and you might think a common treatment strategy would have emerged. However, it appears that there is a lack of agreement about the exact treatment methods that should be used, and in fact there is great deal of variability ion how different doctors treat gout.

This is unfortunate for anyone seeking to control gout, whether with the help of a doctor or not. For one thing, if medical professionals can’t agree on the best drug regime, they are not likely to be able to come up with a suitable diet for gout or recommended gout foods. The patient in this situation has to fall back on information from the Internet, which may not always be entirely reliable: that’s especially true where someone is looking for information on a diet for gout or information about good gout foods (i.e. the ones which reduce the likelihood of an attack).

The British Society of Rheumatology is trying to produce evidence-based guidelines that can offer improved standards of medical care. It is also scientifically assessing the potential of xanthine oxidase inhibitors or urate oxidases in the tretament of gout. And in addition the Society offers clear recommendations and guidelines about alcohol consumption, as well as recommending dietary and lifestyle modification, and recommends strategies for the treatment of gout in unusual cases such as renal insufficiency, purine overproduction, or allopurinol hypersensitivity.

The Recommended Approach for the Management of Acute Gout

1) The joints which are affected by gout are to be rested in an elevated position.
2) Fast acting anti-inflammatory drugs at the maximum possible dosage should be administered immediately and continued for 1 to 2 weeks.
3) Naturally, in men and women where there is a risk of stomach problems, some protective agents such as proton pump inhibitors should be prescribed along with the painkiller of choice, which is usually a fast acting NSAIDs.
4) Colchicine is an effective alternative to NSAIDs but takes longer to work.
5) Allopurinol should not be started during an acute attack of gout, but should be continued if someone is already being treated with it and they develop an acute attack of gout.
6) Corticosteroids are an effective medication which may take the place of NSAIDs.

When allopurinol is given to dissolve urate crystals within the joint, there is a risk of a person suffering an acute attack for almost a year. Furthermore, the dose needed depends on the serum urate level. A dosage as high as 900 mg may be needed every 24 hours. The full recommendations can be found here.

Suggestions for A Good Diet For Gout

Lifestyle Modification & Recommendations for Non-drug Based Therapy

As emphasized before, the best remedy is to find a diet for gout which aims to take a person to their ideal body weight in a gradual fashion.

  • Crash dieting, or diets which involves consumption of high levels of protein and low carbohydrate, need to be avoided.
  • Good  gout foods include skimmed milk, low-fat yogurt, soy beans, fruit and vegetables, and particular vegetable protein, and cherries.
  • With gout, foods which should be restricted include liver, kidneys, other organ meats including brains, yeast extract, and shellfish, asparagus, anchovies and mackerel.
  • Protein intake should be reduced.
  • Those who have gout in the history of urolithiasis need to drink over 2 liters of water daily. When kidney stone formation happens repeatedly, potassium citrate may be given.
  • As far as alcohol consumption is concerned, this is definitely part of a good diet for gout. In general, alcohol intake needs to be less than 21 units a week in men, and even lower in women (14 units per week). Having 3 alcohol-free days per week is recommended, and completely abstaining from beer, port, fortified wine and stout is best practice.
  • Affected joints should be elevated and exposed in a cool environment (advice which, on the face of it, seems a little hard to understand, since lower temperatures encourage the precipitation of uric acid crystals). Ice packs and birdcages to prevent bed linen touching the affected joint are also effective ways of reducing pain. (Though low temperature is one of the precipitating factors for a gout attack, so ice packs should be used for a limited time only.)
  • Moderate physical exercise is a good idea, but strenuous activity should be avoided.

Recommended Approaches to Caring For Gout

The aim of all medical treatment is to maintain a plasma urate level below 300 µmol per liter. This will require uric acid lowering therapy with drugs if more gout attacks occur within 12 months of the first. There are suitable therapies available for all men and women, including people with tophi, renal impairment, and kidney stones. The initial treatment is always allopurinol, as a low dose of 50 – 100 mg, which can be increased by between 50 and 100 mg every few weeks until the target of serum uric acid level below 300 µmol per liter is achieved.

For individuals who are resistant to allopurinol, or who show reduced levels of excretion of uric acid, uricosuric agents can be used: sulphinpyrazone or benzbromarone. Colchicine is often prescribed alongside allopurinol and uricosuric drugs.

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