- Purine-Rich Foods and Gout
- What is gout?
- What is uric acid?
- Low purine diets
- High-Purine Foods
- Low-Purine Foods
- Those kings of old must have known how to party.
- It has been known since the late 1960’s that fructose raises uric acid levels.
- So, how does fructose, which is not a purine, raise uric acid levels?
- But there’s more to the sugar story.
- Here are the reasons for my beef with the meat-purine-gout hypothesis:
- So, what do clinical studies of diet and gout have to teach us?
- So, what should you do if you have gout?
- Dietary Tips for Managing Gout
- What Are Purines?
- Purines Are in All Living Things
- Low Purine Diet
- What is a low-purine diet?
- What foods can I include?
- What foods should I limit?
- What other guidelines should I follow?
- Further information
- 7 Foods That Cause Gout
- Don’t Eat That! 9 Foods That Trigger Painful Gout Attacks
- Nine Foods to Avoid With Gout
Purine-Rich Foods and Gout
Purines are important substances necessary for making amino acids, which are the basic building blocks of the human body.
Purines are found in many foods, and at different levels. They are metabolized (broken down) into uric acid, a waste product that is usually excreted with urine. If there is too much uric acid in the blood, people can develop a condition called hyperuricemia.
Hyperuricemia is the precursor to gout, which is a rheumatic disease where excess uric acid develops into small, needle-like crystals in the soft tissues and joints. Hyperuricemia can occur if the kidneys are not properly excreting uric acid, but can also arise from over-consumption of purine-rich foods.
What Is the Link Between Purines and Gout?
Studies examining the relationship between diet and gout show that people who consume a lot of certain types of meat or seafood are more likely to have this medical condition. Calvin Brown, MD, professor of medicine in the division of rheumatology at Northwestern University says that “one of the ways which the body will have too much uric acid is if it’s breaking down foods that are very rich in the precursors to uric acid.”
“In the days of the Middle Ages and the Renaissance, the very wealthy kings and nobility had quite a taste for organ meats … and hence were quite commonly affected with gout,” Dr. Brown explains. Due to changes in diet, “gout due to excess is actually quite rare.”
Gout Treatment: What Foods Are High in Purines?
It is recommended that people diagnosed with gout follow a diet that does not include the following purine-rich foods:
- Seafood: Although it is recommended that a healthy diet includes a lot of fish, people who have gout should be aware that some seafood can increase levels of uric acid in the blood, and may make gout worse.
- High purine content: Anchovies, codfish, haddock, herring, mackerel, mussels, sardines, scallops, trout
- Medium purine content: Crab, lobster, oysters, shrimp.
- Meat: Though no longer part of a common diet in the United States, organ meats, such as liver, sweetbreads, and brains, are most dangerous for those with gout.
- High purine content: Bacon, turkey, veal, venison
- Medium purine content: Beef, chicken, duck, ham, pork
- Vegetables: Studies do not show an association between high-purine vegetables and gout to the same degree as with animal-based purines, suggesting other factors than purine content also play a role. However, there are some beans that are particularly high in purines, so people with severe gout may want to avoid them.
- Purine-rich vegetables: Asparagus, dried beans (especially fava and garbanzo), mushrooms, peas, spinach
Gout Treatment: Alcohol and Purines
“In this day and age the most common is certain alcoholic beverages,” Brown says. Beer and liquor (but not wine) lead to increased blood uric acid levels. The strongest evidence for a connection is with beer, possibly because it contains the highest amounts of purines, which come from its malt content. “To avoid gout, avoid stout,” he adds.
Gout Treatment: What Can a Low-Purine Diet Do?
In healthy individuals, it has been shown that a purine-free diet can reduce the levels of uric acid in the blood, and in a study that put participants on either a low-purine diet, a medication often prescribed for those with gout, or a combination of both, the diet led to similar reductions in uric acid levels as the medication.
Because of these factors, it is thought that a diet low in purines may help ease the symptoms and halt the development of gout. Organizations including the National Institute of Arthritis and Musculoskeletal and Skin Diseases recommend avoiding foods that have a high purine content, along with beer.
It is important to note that using diet as a means to help control hyperuricemia and gout should only be done after consultation with a medical professional. Never discontinue any medications for gout without talking to your doctor first.
Gout, once called “the ailment of kings”, because it mainly afflicted those who could afford a “rich” diet, now affects more than 8 million nonroyal Americans. To what do we owe this dubious honor? Is it because we are eating more meat than ever before?
What is gout?
Gout is a special type of arthritis in which certain joints fill up with microscopic shards of uric acid, becoming red, swollen, and exquisitely sensitive to the touch. Most people with gout have too much uric acid in their blood—higher than 6 mg/dl in women and 7 mg/dl in men (levels can reach 12 mg/dl or more in some cases). Uric acid crystals can also cause kidney stones and kidney damage. More than 20% of Americans now have abnormally high uric acid levels.
What is uric acid?
Uric acid is a breakdown product of purines. What are purines? Purines are molecules that help to make up some vitally important compounds present in the cells of all plants and animals, including DNA (genes), RNA (protein manufacturing) and ATP (energy source molecule). The following are the most familiar purines:
- Theobromine (cocoa beans, tea leaves, kola nuts, yerba mate)
Low purine diets
Low purine diets (in combination with medication) have been prescribed for gout since the middle of the 20th Century. This dietary advice is based on the belief that the cause of high uric acid in the blood is too many purines in the diet. Now, since all plants and animals are made of cells, and all cells contain purines, asking someone to eat fewer purines is a tall order. However, since most animal foods are higher in purines than most plant foods (animal foods are denser and contain more cells per unit weight), doctors advise people with gout to eat less meat. Now, you could also lower purines in your diet by simply eating fewer whole foods of all kinds. The below list is adapted from Emmerton 1996:
- All meats, including organ meats, and seafood
- Meat extracts and gravies
- Yeast and yeast extracts
- Beer, and other alcoholic beverages
- Beans, peas, lentils, oatmeal, spinach, asparagus, cauliﬂower, and mushrooms
- Reﬁned cereals and cereal products, such as cornﬂakes, white bread, pasta, ﬂour, tapioca, cakes
- Milk, milk products, and eggs
- Sugar, sweets, and gelatin
- Butter, polyunsaturated margarine, and all other fats
- Fruit, nuts, and peanut butter
- Lettuce, tomatoes, and green vegetables (except spinach and asparagus)
- Vegetarian cream soups made with low-purine vegetables
- Water, fruit juice, cordials, and carbonated drinks
In actuality, scientists admit that it is impossible to know the true purine content of any food, but even if we did, purines are not the only problem.
Those kings of old must have known how to party.
It has been known for centuries that alcohol consumption can trigger gouty attacks. This connection is now well supported by scientific studies. Two 12 oz beers can raise uric acid levels in healthy men by about 10%, and drinking to intoxication doubles uric acid levels in alcoholics. Most alcoholic drinks contain no purines, so how does alcohol raise uric acid levels?
- Alcohol cuts the kidney’s ability to rid the blood of excess purines by at least 50%.
- When the liver processes alcohol, lots of ATP (an energy molecule) is used up in the process; ATP contains purines that get broken down into uric acid.
- Beer is especially risky, because it contains alcohol AND purines (derived from brewer’s yeast).
It has been known since the late 1960’s that fructose raises uric acid levels.
Examples of foods which contain fructose are fresh fruit (max 10% fructose), dried fruit (max 40% fructose), table sugar (50% fructose) and corn syrup (55% fructose). Uric acid levels rise about 13% after eating meals containing fructose. People with gout have more exaggerated responses to fructose than healthy controls.
“…subjects prone to developing gout in the 1700s and 1800s tended to be wealthy and sedentary, often with the ability to afford sugar, the latter of which is known to raise uric acid. Indeed, today gout is increasing in all populations, and if anything is more common among the poor and less educated.”
Yet, as you can see in this 2007 New York Times article, fructose is not even on the list of possible dietary factors in gout, which may be why celebrated NY Times food writer Frank Bruni continues to suffer with some symptoms of gout, despite following his doctors’ advice to limit meat and alcohol, and to take medication:
“I’ve noticed discernible changes in my health — or at least in the way I feel. How much of that is attributable to my reduced alcohol intake and how much to the exodus of red meat is impossible to say. I haven’t lost more than a pound or two, because carbs have rushed in where protein isn’t permitted to tread… the flare-ups are subtle now that I’m medicated and reformed.” http://bruni.blogs.nytimes.com/2012/03/22/red-meat-blues/
Aye, there’s the rub! Mr. Bruni has gotten right to the meat of the problem—low purine diets can be high in refined carbohydrates, such as sugar and flour, which raise insulin levels, and now not only do you have gout, but you have a hard time losing weight, and you’ve further increased your risk for all kinds of other chronic diseases:
“Fructose is unique among sugars in that it rapidly causes features of metabolic syndrome both in experimental animals and humans. Fructose ingestion also leads to fatty liver and elevated triglycerides in humans and can also raise blood pressure. Intriguingly, fructose is a sugar that has the unique ability to raise serum uric acid. Serum uric acid levels rise within minutes of fructose ingestion… the increase in fructose intake closely parallels the rise in gout, obesity and metabolic syndrome that has occurred over the last two centuries. Serum uric acid levels increased from <3.5 mg/dl in the early twentieth century to over 6 mg/dl today in adult males.”
So, how does fructose, which is not a purine, raise uric acid levels?
“The specific reason why fructose is superior than glucose in increasing fat stores likely relates to the unique first steps in fructose metabolism. When fructose enters the hepatocyte, it is metabolized by a specific enzyme, fructokinase C. Unlike glucokinase, which has a negative feedback system to prevent excessive phosphorylation, the phosphorylation of fructose by fructokinase will proceed uninterrupted, and as a consequence intracellular phosphate depletion and ATP depletion frequently occur. The fall in intracellular phosphate results in the stimulation of AMP deaminase that helps accelerate the degradation of AMP to IMP and later to uric acid. In turn, the intracellular generation of uric acid results in oxidative stress.”
Translation: Fructose is especially good at turning into fat. The enzymes in the liver that turn fructose into fat use up lots of ATP in the process. ATP contains purines that get broken down into uric acid.
Both alcohol and fructose burn through ATP like kindling. Metabolically speaking, fructose and alcohol have a lot in common, which is why Dr. Robert Lustig mentions them both in the same breath as poisons.
But there’s more to the sugar story.
Rapidly digestible carbohydrates such as sugar, flour, starch, fruit juice, and white potato are notorious for causing insulin spikes. Insulin tells the kidneys to reabsorb uric acid into the blood instead of excreting it into the urine. So our dear meat-mourning Mr. Bruni is dutifully eating a low purine, high refined carb diet, which both lowers and raises uric acid. As comedian Steven Wright would have said, that’s like putting a humidifier and a dehumidifier in the same room and letting them fight it out.
So what is he supposed to do? What foods would he be left with if we told him he can’t eat carbs, meat, or alcohol? Fat and low-purine vegetables? Unfortunately that diet is dangerously devoid of nutrients. Which is worse for gout–meat or carbs?
Here are the reasons for my beef with the meat-purine-gout hypothesis:
- We are not eating any more meat now than we did 100 years ago.
- Some cultures eating lots of meat, including 19th century Arctic peoples who lived on a diet of nearly 100% animal foods, did not develop gout. “Gout is unknown in Eskimos and Northern Indians despite their purine-rich diet.”
- Animal foods are higher in protein than plant foods. Proteins increase the elimination of purines in the urine, which can actually lower uric acid levels.
- Some plant foods are rich in purines, including legumes, spinach, asparagus, and mushrooms .
- Purines in the diet do not have much of an effect on uric acid levels, because most of the uric acid in the blood comes from inside the body, as part of everyday cell turnover: “The purine content of the diet does not usually contribute more than 1 mg/dl to the serum urate concentration…” .
Studies tying animal foods to gout have been epidemiological studies which have observed that people who eat more meat tend to have higher uric acid levels and/or a higher risk of gout. These studies have not taken carbohydrate in general, nor fructose in particular, into consideration. Therefore we have no idea whether people who reported eating more meat also happened to eat more fructose, which is, in my opinion, a critical omission, given that we have known since 1967 that fructose can raise uric acid levels. Furthermore, there are some epidemiological studies that find no association whatsoever between meat and uric acid levels . Either way, as many of you know, epidemiological studies are not experiments and correlation does not equal causation.
So, what do clinical studies of diet and gout have to teach us?
Unfortunately, as is the case with so many diseases, when the use of drugs to treat gout became popular in the 1950’s, interest in dietary strategies fizzled, so we only have a wee handful of small, flawed studies to guide us:
There are ZERO studies that have attempted to prevent gout with diet.
I could only locate a grand total of ONE study of the oft-recommended low-purine, alcohol-free diet that is relevant to our question (Peixoto 2001). In this study, 55 Brazilian adults with both high blood pressure and high uric acid levels were divided into 3 groups— diet alone, low purine diet + medication, and medication alone—for 3 months. Uric acid levels fell by about 2 mg/dl in all 3 groups by week 6. However, people in this study were not gout patients, there was no control group, and the composition of the diet was not described (we are only told what was excluded from the diet), therefore we do not know if this diet contained less fructose and/or less refined carbohydrate than a standard diet. Without that information, we can’t be sure that it was the lack of purines that may have been responsible for the decrease in uric acid.
I located only ONE small pilot study exploring the role of refined carbohydrate in gout . 13 South African men with gout were placed on a 1600 calorie diet containing 40% unrefined carbohydrate, 30% protein, and 30 % (unsaturated) fat, including 4 servings of fish per week. Purines were unlimited and alcohol was not restricted. Here are the results, on average, after 16 weeks:
- uric acid levels fell by 18% , from 10.3 mg/dl to 8.5 mg/dl on average; 7 men had a normal uric acid level by the end of the study.
- frequency of gout attacks was reduced by 72%
- weight dropped by 17 lbs
This study is very promising, but unfortunately it is hard to know which of the interventions was the responsible for the positive benefits—was it the lack of refined carbohydrate, reduction in saturated fat, or the weight loss itself? Even more confusing is that it is unclear whether these patients were eating much less meat than usual, given that they were told to avoid saturated fat. Uric acid levels fell by about 2 points, which is about the same as in the Peixoto low-purine diet study, although that group had much lower uric acid levels to begin with.
So, what should you do if you have gout?
The answer is that the research doesn’t have a clear answer for you yet. Many questions remain unanswered. We still don’t understand exactly why alcohol raises uric acid levels, why only a small percentage of people with high uric acid levels get gout, or even which carbohydrates might aggravate gout and why. For example, a brand new analysis of all available fructose studies calls into question whether fructose raises uric acid any more than any other kind of sugar .
But here’s what we do know. When we combine the available science with common sense, we can say that:
- Human beings must be well-adapted, as all animals must be, to eating purines, which are found in all whole foods.
- It is highly likely that we are poorly adapted to be able to handle much refined carbohydrate or alcohol, which have never existed in nature in significant amounts.
Dietary Tips for Managing Gout
- Stabilize and lower your blood sugar and insulin levels by reducing carbohydrate intake, especially refined carbohydrate intake. A low glycemic index diet would be a good place to start. Depending on your chemistry, you may even need to consider a very low carbohydrate diet. Refined carbohydrate and high insulin levels have been strongly linked to metabolic syndrome and most diseases of Western civilization, and gout is probably just one more sugar-tipped arrow in the quiver of the Western diet. There is no evidence that lowering the amount of meat in your diet will protect you from these diseases, whereas there is plenty of evidence to suggest that lowering refined carbohydrate intake can. Even if it doesn’t completely cure your gout, you’ll be a lot healthier for it.
- Minimize alcohol intake, especially beer.
- Consider taking a vitamin C supplement. A single randomized controlled trial found that taking 500 mg of vitamin C per day for 2 months reduced uric acid levels by 1.5 mg/dl.
If you focus on these goals, you may be able to have your meat and eat it too:)
For more reassuring facts about meat and health, including information about kidney disease, heart disease, and nitrates/nitrates, please see my meats page.
To read about the history of mostly-meat diets, including the diets of Arctic and African peoples, please click HERE.
To read a critique of the latest study trying to connect the carnitine in red meat to heart disease, click HERE.
What about you? Have you tried any dietary strategies for gout that have worked?
Up next on DiagnosisDiet: Foods that Can Cause Hypothyroidism.
Tagged with: Fructose • Gout • Meat • Purines • Uric Acid
Choi HK et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NM 2004; 350:1093–1103.
Dessein PH et al. Beneﬁcial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539–543
Emmerson BT The management of gout. NEJM 1996; 334(7): 445-451.
Fam AG. Gout, diet and the insulin resistance syndrome. J Rheumatol 2002;29(7): 1350-1355.
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Ghadirian P et al. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol 1995;11:275-81.
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Johnson RJ et al. Uric acid: a danger signal from the RNA world that may have a
role in the epidemic of obesity, metabolic syndrome and cardiorenal disease: evolutionary considerations. Semin Nephrol. 2011; 31(5): 394–399.
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Lyu LC et al. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr 2003; 78(4): 690-701.
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Yamamoto T et al. Effect of ethanol on metabolism of purine bases (hypoxanthine, xanthine, and uric acid). Clinica Chimica Acta 356; 2005: 35-57.
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635 Shares Tagged with: Fructose • Gout • Meat • Purines • Uric Acid
What Are Purines?
Purines are a type of chemical compound found in foods and drinks that are part of a normal diet. A small number of foods contain concentrated levels of purines, such as seafood, organ meats and alcoholic beverages, especially beer.
People who have trouble metabolizing purines, such as people with hyperuricemia or gout, are advised to limit consumption of these foods.
See All About Gout – Symptoms, Diagnosis, Treatment
Purines Are in All Living Things
Purines can be found in the nucleus of any plant or animal cell. The name “purines” refers to a specific type of molecule made up of carbon and nitrogen atoms, and these molecules are found in cells’ DNA and RNA.
Essentially, purines are the building blocks of all living things. In the human body, purines can be divided into two categories:
- Endogenous purines that are manufactured by the body
- Exogenous purines that enter the body via food
Exogenous purines, the purines that a person eats, are metabolized by the body. Specifically, the liver breaks down the purines and produces a waste product called uric acid. The uric acid is released into the bloodstream and is eventually filtered by the kidneys and excreted in the urine.
If too much uric acid builds up in the bloodstream it is called hyperuricemia. In some people, hyperuricemia can cause kidney stones or lead to an inflammatory joint condition called gout. Other people have absolutely no symptoms of high uric acid levels, and they are referred to as “asymptomatic.”
People with hyperuricemia are encouraged to eat foods with low purine concentrations and avoid foods with high purine concentrations. In addition, foods and drinks that inhibit the body’s ability to metabolize purines, such as alcohol and saturated fats, should be limited or avoided altogether.
See Gout Prevention Diet
The table below shows foods that have relatively high, moderate and low concentrations of purines.
|High Purine Foods||Moderate Purine Foods: Eat Limited Quantities||Low Purine Foods|
|Meats, especially organ meats or “sweetmeats,” such as liver, brains, and beef kidneys, as well game meats, such as venison, which are typically fatty||Certain vegetables, including asparagus, spinach, mushrooms, green peas and cauliflower (no more than ½ cup per day)||Any vegetables that are not listed as moderately high in purines, such as leafy greens, carrots and tomatoes|
|Foods containing saturated fats: these tend to inhibit the body’s ability to metabolize purines||Beef, pork, lamb, fish and poultry (no more than 4-6 oz daily)||Condiments that contain oils, spices, and vinegars are generally acceptable|
|Seafood, particularly scallops and other shellfish, anchovies, sardines, herring, and mackerel||Wine* (1-2 glasses, when gout symptoms are absent)||Rice, enriched pastas and breads, potatoes, and popcorn|
|Foods and drinks made with high fructose corn syrup, such as sodas1||Wheat bran and wheat germ (1/4 cup dry daily)||Nuts and nut products, such as peanut butter|
|Supplements containing yeast or yeast extract||Dried beans, lentils and peas (1 cup cooked)||Dairy products (preferably low- or no-fat)|
|Gravy||Oatmeal (2/3 cup dry daily)||Eggs, particularly egg whites|
|Beer*||Fruit juice (no corn syrup)||Coffee and tea|
|Meat-based soup stocks||Fruits|
*Alcoholic drinks can inhibit the body’s ability to eliminate uric acid, so people with gout are advised to avoid alcohol or drink in moderation. Beer is notorious for bringing on gout attacks because it contains both alcohol and brewers yeast, which is high in purines.
People on a low-purine diet should drink plenty of water to aid with digestion and lower uric acid concentrations in the blood.
- 1.Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8.
Question: I have gout. Can you tell me which fruits, vegetables, meats or seafoods I should eat – or avoid? Is there any type of alcohol – wine, beer, spirits – that is better or worse for me than others?
Answer: Dietary management of gout is very restrictive and doesn’t always work to control gout, so a combination of medication and diet may be the best way to treat your gout. In addition to medications that treat the inflammation and other symptoms that occur during a gout attack, medications exist that can treat the underlying metabolic condition of hyperuricemia – too much uric acid in the blood. Hyperuricemia can occur either when the body produces too much uric acid or when the body does not excrete enough uric acid. Drugs exist to treat both causes.
Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Dietary management focuses on reducing the amount of uric acid in the system and attaining and maintaining a healthy bodyweight.
The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. You can learn by trial and error what your personal limit is and which foods cause you problems.
High-Purine Foods Include:
- Alcoholic beverages (all types)
- Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock
- Some meats, such as bacon, turkey, veal, venison and organ meats like liver
Moderate Purine Foods Include:
- Meats, such as beef, chicken, duck, pork and ham
- Shellfish, such as crab, lobster, oysters and shrimp
Ronenn Roubenoff, MD
Global Translational Medicine, Musculoskeletal Diseases
Novartis Institutes for Biomedical Research
Low Purine Diet
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What is a low-purine diet?
A low-purine diet is a meal plan based on foods that are low in purine content. Purine is a substance that is found in foods and is produced naturally by the body. Purines are broken down by the body and changed to uric acid. The kidneys normally filter the uric acid, and it leaves the body through the urine. However, people with gout sometimes have a buildup of uric acid in the blood. This buildup of uric acid can cause swelling and pain (a gout attack). A low-purine diet may help to treat and prevent gout attacks.
What foods can I include?
The following foods are low in purine.
- Eggs, nuts, and peanut butter
- Low-fat and fat free cheese and ice cream
- Skim or 1% milk
- Soup made without meat extract or broth
- Vegetables that are not on the medium-purine list below
- All fruit and fruit juices
- Bread, pasta, rice, cake, cornbread, and popcorn
- Water, soda, tea, coffee, and cocoa
- Sugar, sweets, and gelatin
- Fat and oil
What foods should I limit?
- Medium-purine foods:
- Meats: Limit the following to 4 to 6 ounces each day.
- Meat and poultry
- Crab, lobster, oysters, and shrimp
- Vegetables: Limit the following vegetables to ½ cup each day.
- Green peas
- Beans, peas, and lentils (limit to 1 cup each day)
- Oats and oatmeal (limit to ⅔ cup uncooked each day)
- Wheat germ and bran (limit to ¼ cup each day)
- Meats: Limit the following to 4 to 6 ounces each day.
- High-purine foods: Limit or avoid foods high in purine.
- Anchovies, sardines, scallops, and mussels
- Tuna, codfish, herring, and haddock
- Wild game meats, like goose and duck
- Organ meats, such as brains, heart, kidney, liver, and sweetbreads
- Gravies and sauces made with meat
- Yeast extracts taken in the form of a supplement
What other guidelines should I follow?
- Increase liquid intake. Drink 8 to 16 (eight-ounce) cups of liquid each day. At least half of the liquid you drink should be water. Liquid can help your body get rid of extra uric acid.
- Limit or avoid alcohol. Alcohol (especially beer) increases your risk of a gout attack. Beer contains a high amount of purine.
- Maintain a healthy weight. If you are overweight, you should lose weight slowly. Weight loss can help decrease the amount of stress on your joints. Regular exercise can help you lose weight if you are overweight, or maintain your weight if you are at a normal weight. Talk to your healthcare provider before you begin an exercise program.
You have the right to help plan your care. Discuss treatment options with your healthcare provider to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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Ask Dr. Leavitt–I have gout. What foods should I avoid?
Gout is an extremely painful form of arthritis. This condition is chronic in nature with severe, brutal acute attacks. Gout has long been associated with diet, particularly eating too much meat, seafood (shellfish) and alcohol. Because of this, treatment for gout used to involve severe dietary restrictions, which made the gout diet hard to stick with. Now that newer medications are available to treat gout, the need for a strict gout diet has been reduced, although following the guidelines is highly recommended.
The gout diet resembles the healthy eating plan recommended for most people in many ways. Besides helping maintain a healthy weight and avoiding many chronic diseases, this diet may contribute to better overall management of your gout.
How does gout occur?
Gout occurs when high levels of uric acid in your blood cause crystals to form and accumulate around a joint. Your body produces uric acid when it breaks down purines. Patients with gout either under excrete or over produce uric acid. Which one you are will determine the type of medicine needed to resolve the attack. Purines occur naturally in your body, but you also get them from eating certain foods, such as organ meats (processed lunch meat such as bologna, hot dogs, ham), anchovies, herring, shellfish such as crab and lobster, asparagus and mushrooms.
How does it help?
A gout diet helps to control the production and elimination of uric acid, which may help prevent gout attacks or reduce their severity. If you look at uric acid crystals under a microscope, they look like tiny round balls with spikes all around them. Many patients say gout flare ups feel like hot needles stabbing them. Most cannot even tolerate the weight or touch of a bedsheet on the affected area. The diet is not a treatment for gout, but may help you control the number and severity of attacks. Obesity also is a risk factor for gout, so losing weight can help you lower your risk of attacks.
How does it work?
The gout diet reduces your intake of foods that are high in purines, which helps reduce your body’s production of uric acid. If you are overweight or obese, it is important to lose weight. However, avoid fasting and rapid weight loss because these can bring on a gout attack. Drink plenty of liquids to help flush uric acid from your body. Avoid high-protein diets, which can cause you to produce too much uric acid (hyperuricemia).
To follow the diet:
- Avoid or severely limit high-purine foods, such as organ meats, herring, anchovies and mackerel. Red meat (beef, pork and lamb) that has been cured or processed, and seafood (shrimp, lobster and scallops) are associated with increased risk of gout. Because all meat, poultry and fish contain purines, limit your intake.
- Eat more plant-based proteins. Increase protein by including more plant-based sources, such as beans and legumes. Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid from your body. Drinking beer, in particular, has been linked to gout attacks. If you’re having an attack, avoid alcohol. When you’re not having an attack, drinking one 5-ounce serving a day of wine is not likely to increase your risk.
- Drink plenty of water. Fluids can help remove uric acid from your body. Aim for 8-16 eight-ounce glasses of water a day.
- Choose low-fat or fat-free dairy products. Some studies have shown that drinking skim or low-fat milk and eating foods made with them, such as cheese or yogurt, help reduce the risk of gout.
- Choose complex carbohydrates. Eat more whole grains and fruits and vegetables and fewer simple, refined carbohydrates, such as white bread, cakes and candy.
- Limit or avoid sugar. Too many sweets can leave you with no room for plant-based proteins and low-fat or fat-free dairy products — the foods you need to avoid gout. Sugary foods also tend to be high in calories, so they make it easier to eat more than you’re likely to burn off. Although there’s debate about whether sugar has a direct effect on uric acid levels, sweets are definitely linked to overweight and obesity.
- There’s also some evidence that drinking four to six cups of coffee a day lowers gout risk in men.
Following a gout diet can help you limit your body’s uric acid production and increase its elimination. It’s not likely to lower the uric acid concentration in your blood enough to treat your gout without medication, but it may help decrease the number of attacks and limit their severity. Following the gout diet and limiting your calories — particularly if you also add in moderate daily exercise, such as brisk walking — also can improve your overall health by helping you achieve and maintain a healthy weight.
Be sure to call your family doctor and discuss your gout symptoms. By working with your primary care physician you can create a plan to minimize the frequency and severity of your gout attacks.
At Leavitt Family Medicine, we are here for you, for all of your health care needs. We appreciate your questions and comments; Please let us know how we can help you today!
7 Foods That Cause Gout
One of the biggest reasons for getting gout is eating a diet high in purines. This is because purines turn into uric acid which can accumulate in your joints leading to painful attacks. One of the best ways to prevent this disease is to eat properly. The following is a list of 7 common foods that cause gout:
1. Bacon. This popular breakfast food can lead to very painful problems because it is very high in purines and nitrates. Not to mention the sodium can dehydrate you which increases your risk of having a flare up.
2. Hot dogs. Hot dogs, whether turkey, chicken, or beef can be very detrimental to your treatment efforts. All three of these meats are at least moderately high in purines. Hot dogs also contain organ parts. This is where the highest levels exist.
3. Game Foods. Wild game such as venison, pheasant, squirrel, and grouse should also be avoided due to their high amounts . While you would think that these animals would not cause us havoc, especially since they are not steroid filled as some meat products are, unfortunately, they tend to have fairly high levels. In fact, the most severe and longest lasting case of gout I ever had was due to eating venison every day for a few days for a change of pace since I was unaware it was not good for my condition at the time I ate it. My attack lasted a month.
4. Poultry. As mentioned earlier, turkey and chicken are considered to have moderately high amounts. They are also person dependent. I know of people who cannot eat chicken at all, whereas, it is my staple meat and I do not recall ever having had an attack because I ate chicken, however I have had an attack after eating turkey. So again, eat in moderation if you are unsure if chicken or any of these foods will cause you to have an attack.
5. Certain Seafood. Certain fish and shellfish are not good at all for you if you are susceptible to gout. Salmon has high levels as does shrimp and crab. In fact, salmon has twice the levels as chicken. It is a shame salmon is bad for gout patients, as this otherwise excellent food has healthy doses of omega 3 oils that actually help in treating gout. I suggest you use supplements instead.
6. Alcoholic Beverages Alcohol is perhaps one of the most common causes of gout. Beer tends to cause more problems than wine. Beer contains almost 8 times as much purines as it does alcohol.
7. Peas/Lentils Legumes are not good for you to eat if you suffer from gout. Peas are slightly higher in purines than chicken, however black eye peas are considerably higher than chicken. Again, every one is different. Some can eat these foods without any trouble and some will suffer greatly for it.
It is important to test foods in moderation until you figure out what your body can handle. Knowing what foods can cause you to have a gout flare up will definitely help you with your gout prevention diet.
Don’t Eat That! 9 Foods That Trigger Painful Gout Attacks
Nine Foods to Avoid With Gout
For centuries, gout was called a “rich man’s disease” because it most frequently afflicted wealthy, overweight men. In years past, most “lower class” people could not afford expensive products like meat and butter. Only the wealthy could purchase the expensive, fat-laden foods, such as marbled steaks and organ meats, that were popular at the time.
As people with gout know all too well, crippling pain can occur when high levels of uric acid accumulate in the blood and cause crystals to form around a toe or other joint. This acid is formed in these joints when purines, which occur naturally in the body, break down.
Reducing your intake of foods that are high in purines, like the meats that were so popular with the wealthy men of days gone by, helps to control your production of the acid and reduce the likelihood of an attack of gout.
Take note of these foods to avoid for gout sufferers.
What Not to Eat When You Have Gout
Gout is quite a tricky condition to manage especially when it comes to diet. Eat the wrong kind, and you may just find yourself suffering from an unbearable gout attack. To help you out, I have listed the top foods you must absolutely avoid if you have gout:
- Sugar, fructose, high fructose corn syrup
- Organ meats
- Fried and processed foods
- Canola Oil
I’ll explain why these foods are not good for your gout and provide you with some alternatives for the types of food you can eat to help you manage your condition better.
Sugar, Fructose, High Fructose Corn Syrup
Ah, sugar. Many of us are addicted to it but why are we to blame? It’s found in just about any kind of food – your soft drink, juice, ice cream, bread, coffee, cereal, yogurt, and dressing. Heck, even your ketchup probably has sugar in it! It’s no wonder why so many Americans suffer a number of diseases related to sugar.
As a gout sufferer, sugar is one of those things that you need to watch out for; otherwise, you run the risk of worsening your condition.
Dr. Hyon Choi conducted a 12-year study of men drinking different kinds of food and beverages including soft drinks, fruits, and fruit juices. He found out that the more a subject drank sweet drinks that were high in fructose, the higher their risk was of developing gout.
Now, this doesn’t mean you should completely avoid sweet foods. You can still consume fructose coming from fresh fruits, but you should take no more than 25 grams of sugar.
Pay attention to what you’re eating/drinking and do all you can to avoid sugary foods and drinks such as soft drinks, fruit juices, cookies, cereals, and more. At first, it’ll be hard to avoid, but you’ll be surprised by how fast your body adapts to a diet that’s low in sugar.
Just about any kind of seafood including shrimps, lobster, oysters, mussels, scallops, and crab, is not good for gout. If you like to eat seafood, a study conducted in 2004 might just convince you to stop eating it.
The research, they found that men who ate seafood had a 51 percent increased risk of developing gout and each weekly serving led to a 7 percent increased risk. This is because seafood increases your uric acid levels.
It’s probably one of the dirtiest foods you can eat. Lobsters are scavengers that eat the waste of other animals and other pollutants. Shrimps are scavengers too, and they live off eating flesh from dead creatures. Tuna also carries high mercury levels.
So to avoid exacerbating your gout symptoms, it’s best to avoid seafood altogether.
Organ meats include kidneys, liver, heart, brains, tongue, tripe, and many other animal parts. This is another type that you must entirely avoid as it is high in toxins that can trigger a gout attack.
For example, the liver is responsible for safely removing toxins or storing it if removal is not possible. By eating it, you’re eating all the toxins the animal wasn’t able to expel in its lifetime. Organ meats are also high in saturated fats and cholesterol which is not good for your gout as it raises your blood’s uric acid levels.
Remove organ meats completely from your diet to prevent your gout symptoms from worsening.
Pork is another scavenger animal that eats just about anything including garbage. If you want to improve your gout condition, you’re better off not eating pork products like bacon, hot-dogs, sausages, ham, and pork chops.
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Also, consider the fact that today’s meat is full of antibiotics, growth hormones, pesticides, herbicides, high levels of adrenaline, and nuclear wastes. Your kidneys would be required to work harder just to process these dangerous compounds which in turn affects its ability normal eliminate uric acid.
Fried and Processed Foods
Do you know why more and more people are suffering from gout? It’s because fried and processed foods have become so easily accessible. They’re at your nearest convenience store, the mall, in stands, and in your neighborhood. You can even cook it in your home.
Fried and processed foods are just not good for your gout as they take a toll on your kidneys. They’re also quite addictive just like sugar. If you can avoid fast food and other processed foods, please do.
Next Page: More foods to avoid eating with gout, and foods you can eat to help manage gout.
Foods to Avoid Eating With Gout (Cont.)
Alcohol – especially beer – is one of the biggest triggers for gout. It contains a large number of purines which turn into uric acid and lead to gout symptoms.
One study published in the online journal BMC found that patients who drank alcohol more excessively were at higher risk for gout.
In another study published in the online publication, The Lancet, they found that men who drank the most alcohol daily doubled their risk of developing gout. Those who drank beer had a higher risk by 50 percent for every serving while those who drank hard liquor had an increased risk of 15 percent for each serving.
If you want a drink, opt for wine instead. The same study showed that those who drank less than two glasses of wine daily did not increase their risk their gout.
If you want beer, choose the non-GMO ones. Most of today’s mainstream beer contain GMO corn syrup which can have hazardous effects on your health. Corn syrup is similar to high fructose corn syrup which increases uric acid levels and causes gout attacks to occur.
Marketed as one of the healthiest cooking oils, canola oil deserves a second look in your gout diet as there is a growing number of reports regarding its negative effects.
Canola oil comes from rapeseeds which have been modified to have lower erucic acid, so it’s “safe” to consume by humans. What was once used for cosmetics, candles, soap, biofuels, and even insecticides (that’s right!) is now heavily marketed as a healthy alternative to other cooking oils. Nothing could be further from the truth.
Most of the hype for canola oil comes from the fact that it supposedly has omega-3s and omega-6 and that’s low in saturated fat.
If you look at how canola oil is produced, you might want to turn away from it forever after reading is. It first uses a toxic solvent called hexane to extract oil from the rapeseeds before it is degummed, neutralized, bleached, winterized, and deodorized.
Now I don’t know about you, but my body wants nothing to do with a food product that’s as heavily processed as that! It’s unnatural, and the fact that it’s genetically modified means you should be more wary of it.
In one study published in the Springer Link, they found that mammal’s kidneys and liver were affected after consuming genetically modified soybeans and corn. If you care about your gout condition, you should be avoiding anything that can affect your liver and kidneys as these two are essential for processing uric acid properly.
A good alternative would be extra virgin olive oil. Don’t believe people who say you can’t cook with olive oil because you definitely can if you buy the right types. Check the label always making sure it has:
This guarantees that you are purchasing real extra virgin olive oil.
You’ve probably already read articles in the past that warn you of the dangers of MSG or monosodium glutamate.
There’s a good reason why this flavor enhancer is negatively portrayed in the media. It’s found in many of today’s foods, and although it temporarily satisfies your taste buds, it harms your health in the long run. It causes a long list of health issues such as fatigue, dizziness, muscle and joint pain.
If you have gout, you also want to watch out for MSG as it contains guanylates which, when metabolized in the body, turns into purines.
By now, you already know that high-purine foods are a big no-no in your gout diet. As if that’s not bad enough. MSG comes in different names which can make it quite confusing for the regular consumer.
The FDA requires manufacturers to disclose whether a product has MSG or not. However, corporations are sneaky and will use alternative names for it instead.
Seemingly harmless labels such as yeast food/extract, gelatin, textured protein, calcium glutamate, magnesium glutamate, or monosodium glutamate all contain processed free glutamic acid.
There are over 40 more labels for MSG, too many to mention here but can check this list and use it as reference the next time you go grocery shopping.
It sounds like a lot of hard work to avoid a common ingredient such as MSG. Also, most restaurants, no matter how good their food is, may use MSG in their dishes unless you tell them not to.
Your best bet is to start making your own recipes using whole foods and spices, and avoiding processed foods as much as possible.
Salt is another popular ingredient found in most of the dishes that we eat, but did you know that certain types of salts are bad for gout? Table salt is one of them.
Table salt has been processed at 1,200 Fahrenheit and is mostly made up of sodium chloride which comes from crude flake leftovers! So not only does the high temperature kill all of the salt’s benefits, but it’s also made of a something that could potentially worsen your gout symptoms.
Table salt is bad for your health and can contain additives that cause addiction which means the more you consume it, and the more your body will be addicted to it.
Instead, use sea salt in your recipes. It’s much healthier compared to table salt, but then again, you should still try to minimize salt intake in general just to be safe.
One study published in National Institutes of Health shows that those who consumed more salt had a higher risk of hypertension as well as higher uric acid levels and albumin content in their urine.
Albumin is a protein manufactured by the liver and should remain within the bloodstream. If it leaks into your urine, that’s a sign that your kidneys are damaged. And if your kidneys can’t properly excrete uric acid, your gout symptoms might only get worse and potentially develop into tophi. Not fun!
Save yourself the pain and use sea salt, Himalayan salt, or NoSalt. NoSalt is an excellent substitute for salt as it’s made from potassium, which is naturally salty, but offers benefits for your gout by regulating acid levels, helping crystals dissolve, and prevent them from forming.
Foods You Can Eat to Help Manage Gout Better
If you like meat, go for ones that are lean where the fat is taken off. Beef, goat, lamb, rabbit, and deer are examples of good meat that you can eat at least twice a week as they contain 70 percent to 75 percent fat.
Don’t believe the hype that you need a lot of protein to build muscle. You do, but not much of it. Four ounces of meat a day is often enough.
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Keep gout attacks away by drinking half a gallon of water a day. Water helps dilute uric acid and prevents dehydration which has been found to trigger acute gout attacks.
If you eat meat, water helps flush out the harmful toxins you consume. So the next time you feel thirsty, don’t go for a beer, soft drink, or juice. Instead, grab a glass of water. Your kidneys will thank you.
Complex carbohydrates can be found in the healthiest food items like fruits, vegetables, and whole grains. Even if you eat vegetables high in purine such as asparagus, peas, cauliflower, and spinach, your risk of suffering a gout attack does not increase.
Low-purine foods you can eat which are beneficial for your gout include cherries, dark berries, tofu, salmon, peanuts, eggs, lettuce, coffee, whole wheat bread, and rice.
This by no means an exhaustive list, but it should give you a general idea of what you should completely cut out from your gout diet to prevent your gout symptoms from worsening.
I do my best to avoid these foods myself, and I’m happy to say that gout attacks have been less frequent compared to before. Are there other foods that you would recommend a gout sufferer should avoid? Share your thoughts in the comments!
Now you know what to avoid, learn about what are the good foods for gout you should include in your diet.