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Gout: nutrition and lifestyle

by Glenn Cardwell*, Accredited Practising Dietitian (Dietitians Association of Australia)

Gout has been known for most of recorded history, being described by Hippocrates and even inflicting famous scientists such as Isaac Newton and Charles Darwin (Johnson 2004).

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Gout is a type of arthritis that is characterised by high levels of uric acid in the blood (hyperuricaemia) with levels above 450 micromoles/L (7.5mg/100mL) in men or 360 micromoles/L (6mg/100mL) in women (Fam 2005). These high levels of uric acid can trigger the deposition of sodium urate crystals in joints, causing great pain (Lee 2006).

Normally, the body eliminates enough uric acid in the urine or through the intestines to keep its concentration at a healthy level. In people with gout, however, the body either produces excessive amounts of uric acid or its ability to eliminate uric acid is impaired in some way. Only 5% of those with hyperuricaemia develop clinical symptoms of gout. Uric acid is an end-product compound from the breakdown of purines. About two thirds of purine is generated from within the body, while one third comes from the diet (Fam 2005). Over 90% of people with gout have a reduced ability to excrete uric acid via the kidneys.

Dr Choi, Professor of Medicine at the Section of Rheumatology and the Clinical Epidemiological Unit at Boston University has reviewed existing lifestyle advice for those with gout or at risk of gout (Choi 2010). In brief, he makes the following recommendations to minimize the risk of gout:

  • Exercise daily and reduce weight if you are overweight.
  • Limit red meat intake, especially fatty meats, and enjoy a modest amount of seafood as it can have cardiovascular benefits.
  • Choose low fat milk and yogurt as they seem to protect against gout.
  • Eat nuts, legumes and vegetables, even those that have a high purine level.
  • Reduce alcoholic beverages to a maximum of two for men and one for women. Beer and liquor, in particular, are linked to a higher risk of gout.
  • Limit sugar-sweetened drinks.
  • Allow coffee drinking in those who enjoy coffee.
  • Consider taking vitamin C supplements as they may help lower uric acid levels.

A review of gout management by the American College of Rheumatology recognised that dietary changes alone did not sufficiently lower plasma uric acid levels for many people with gout, and specifically encouraged the consumption of vegetables and low-fat dairy foods (Khanna 2012). Generally speaking, dietary advice has changed from “avoid foods that contain purine” to “eat for your overall health.”

Note: the above information is meant as general background information only. For specific, personal advice on any medical condition, please see your doctor.

References:

  1. Choi HK, Atkinson K, Karlson EW, Williett W, Curhan G. 2004. Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine; 350: 1093-1103.
  2. Choi HK. A prescription for lifestyle change in patients with hyperuricemia and . Current Opinion in Rheumatology 2010; 22: 165-172.gout
  3. Fam AG. Gout: excess calories, purines, and alcohol intake and beyond. Response to a urate-lowering diet. Journal of Rheumatology 2005; 32 (5): 773-777.
  4. Johnson RJ, Rideout BA. Uric acid and diet - insights into the epidemic of cardiovascular disease. New England Journal of Medicine 2004; 350: 1071-1073.
  5. Khanna D et al 2012. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research; 64 (10): 1431-1446
  6. Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Current Opinions in Rheumatology 2006; 18: 193-198.
  7. Yu KH, See LC, Huang YC, Yang CH, Sun JH 2008. Dietary factors associated with hyperuricemia in adults. Seminars in Arthritis and Rheumatism; 37: 243-250.

Gout Diet: Frequently Asked Questions About Foods to Eat

Q: I am trying to find out what kind of foods are good to eat to help your body if you have gout.

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A: Gout has long been associated with being overweight and alcohol consumption. Losing weight and avoiding alcohol is common advice for many people with gout as this reduces the incidence of gout attacks. Healthy eating is advised as many gout sufferers are also at a higher risk for heart disease and diabetes.

Uric acid is an end-product compound from the breakdown of purines made within the body and consumed in the diet. It is often recommended that gout sufferers avoid high purine foods, although this appears to have limited benefit. High purine foods include meat (especially offal, for example: liver and kidney), seafood (especially sardines and anchovies), legumes and some vegetables.

A review of the lifestyle changes for gout sufferers actually recommended the consumption of vegetables, including purine-rich vegetables, because people who ate the most vegetables had a 27% reduction in their risk of gout compared to those eating the least amount of vegetables (Choi 2010).

The consumption of excessive amounts of sugar-sweetened drinks may increase uric acid levels, while drinking coffee (both regular and decaffeinated) seems to lower uric acid levels and the risk of gout (Choi 2010). There is no recommendation as to the amount of each type of drink that can be helpful, although it seems wise from an overall health perspective to limit sugar-sweetened drinks to one a day and coffee to 3-5 cups a day.

The most common and effective treatment for gout is through medication such as uricosuric drugs that increase the excretion of uric acid via the kidneys.

References:

  1. Choi HK, Atkinson K, Karlson EW, Williett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine 2004; 350: 1093-1103.
  2. Choi HK. A prescription for lifestyle change in patients with hyperuricemia and . Current Opinion in Rheumatology 2010; 22: 165-172.gout
  3. Lyu LC, Hsu CY, Yeh CY, Lee MS, Huang SH, Chen CL. A case-control study of the association of diet and obesity with gout in Taiwan. American Journal of Clinical Nutrition 2003; 78: 690-701.

Q: I recently heard that eating a lot of protein in your diet can later increase your chances of getting gout. I was wondering if this is true.

A: It was originally thought that because purine is associated with protein that as protein intake increased, the extra purine would trigger higher levels of uric acid in the blood. High uric acid can become sodium urate crystals in joints causing the pain of gout.

This view is no longer current. In fact a review from the University of San Diego stated: "Neither total protein intake nor consumption of purine-rich vegetables was associated with an increased risk of gout" (Lee 2006). Those eating the most vegetable protein (legumes, mushrooms) had the lowest risk of gout. It also appears that dairy foods such as low fat milk and yogurt lower the risk of gout and this may be due to their dairy protein. Therefore, dairy protein is associated with a lower risk of gout.

If your protein sources are generally healthy (lean meats, low fat dairy foods, nuts, legumes and vegetables), their protein content is unlikely to negatively influence the risk of gout or uric acid levels.

Of greater influence on gout risk is being a healthy weight, drinking alcohol in healthy amounts (less than two drinks a day), being fit and eating sensibly.

References:

  1. Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Current Opinions in Rheumatology 2006; 18: 193-198.

*Glenn Cardwell is an Accredited Practising Dietitian with over 30 years experience in clinical and public health nutrition. He has written four books on nutrition including Gold Medal Nutrition (Human Kinetics). He runs a nutrition advisory company consulting to the fresh produce industry.

Posted: April 2011
Updated: January 2013

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