All about gout and diet

What is gout?

Gout is a type of arthritis. It is caused by having too much of the

chemical, uric acid, in your bloodstream. Uric acid is the waste

product created when the body breaks down purines (a type of

protein found in many foods and all of your cells). Increased levels

of uric acid in your blood may occur if, for example, your kidneys

cannot efficiently remove it, you have a rare genetic abnormality, or

because your diet and lifestyle increase the amount of uric acid that

you produce. If levels of uric acid are high for prolonged periods,

needle-like crystals can start to form in your tissues, resulting in

swollen, painful joints.

Your diet plays an important role in both causing gout and reducing

the likelihood of suffering further painful attacks of gout. If you

already suffer from gout, eating a diet that is rich in purines can

result in a five-fold increase in gout attacks.

Are other illnesses associated with the

development of gout?

Elevated uric acid is seen in many other conditions, and people who

have gout may also have raised cholesterol, raised triglycerides (a

type of fat in your blood), high blood pressure and poor glucose

tolerance. This may make it more likely that you have (or will

develop) type 2 diabetes, metabolic syndrome and kidney disease.

In addition, approximately half of all gout sufferers are overweight.

Central obesity (carrying weight around your middle) also increases

certain inflammatory substances in your blood. This can further

exacerbate gout attacks, as well as putting you at risk of developing

heart disease, diabetes and metabolic syndrome. For further

information on gout and related illnesses, download: All About Gout

and other health problems from www.ukgoutsociety.org

Can losing weight help my gout?

Losing weight alone can reduce blood uric acid levels, and the number

of acute attacks suffered. Weight-loss will also help to reduce the stress

on weight–bearing joints e.g. hips, knees, ankles and feet. However, it is

important to avoid any type of crash dieting, as going without food for

long periods and rapid loss of weight can increase uric acid levels and

trigger painful gout attacks. A combination of balanced healthy eating

and regular physical activity is the best way to lose weight safely and

maintain a healthy weight.

Which foods should be avoided?

As uric acid is made in the body from the breakdown of purines that

come from your diet, it is advisable to reduce the amounts of foods

that you eat that are high purines.

High purine foods include: (avoid)

•Offal - liver and kidneys, heart and sweetbreads

•Game - pheasant, rabbit, venison

•Oily fish - anchovies, herring, mackerel, sardines, sprats, whitebait,

trout

•Seafood - especially mussels, crab, shrimps and other shellfish, fish

roe, caviar

•Meat and Yeast Extracts - Marmite, Bovril, commercial gravy as

well as beer

Moderate purine foods (eat in moderation)

•Meat- beef, lamb chicken, pork

•Poultry - chicken and duck

•Dried peas, beans and legumes - baked beans, kidney beans,

soya beans and peas etc.

•Mushrooms and mycoprotein(Quorn™)

•Some vegetables - asparagus, cauliflower, spinach

•Wholegrains - bran, oatbran,wholemeal bread

Low purine foods

•Dairy - milk, cheese, yoghurt, butter

•Eggs

•Bread and cereals - (except wholegrain)

•Pasta and noodles

•Fruit and vegetables (see moderate purine list)

How much protein do you need?

Generally you need about 1g of protein per kg of body weight (70kg

man only requires 70g of protein daily), unless you on a protein

restricted diet e.g., some people with kidney disease may need to

restrict their intake.

Here are some examples of protein content of food:

•100g (3.5oz) chicken breast contains 22g protein

•100g cod fillet contains 21g protein

•Large egg contains 6g

•30g (1oz) hard cheese contains 8g protein

•30g cottage cheese contains 14g protein

•30g almonds contain 5g protein

Protein is very important part of your diet, it used for growth and

repair, as well as an energy source. Not only that, but eating

sufficient protein improves satiety (how full you feel) as well as

blood sugar control.

However, as its important to use high purine/moderate protein

foods with caution, then you are best to combine both animal and

vegetarian sources of protein. Studies have shown that vegetarian

diets that are high in purines (e.g. from lentils etc.) are much less

likely to lead to gout.

In addition, red meat is a very good source of iron and is easily

absorbed by the body. Other foods such as eggs and pulses contain

iron, but in a form that the body finds hard to absorb. However, the

absorption of iron can be improved if you also eat vitamin C - rich

foods in the same meal e.g., add green and red peppers to

scrambled eggs.

Some people find that certain foods such as strawberries, oranges,

tomatoes and nuts will trigger their gout even though they are not

high in purines. Although there is no clear evidence to suggest

why this happens, it is probably best to avoid them if you have

had this experience.

Are there any foods that are good for gout?

Studies have shown that men whose diet is higher in vitamin C are

less likely to develop gout. Also, taking additional vitamin C as a

dietary supplement (500 to 1500mg/day) can reduce blood uric

acid levels. This is achieved by helping to remove uric acid from the

body via the kidneys. If you’re considering supplementing your diet,

always discuss this with your doctor as vitamin C can (rarely)

interact with prescribed medications. High doses of vitamin C can

also cause loose stools in some people.

Sour cherries or sour cherry juice have been used as a natural

remedy for gout - and scientific research has shown that a certain

type of cherry can reduce blood uric acid levels as well as reduce

the inflammation that occurs with gout.

Eating healthily is key

Eating a balanced diet is important for everyone. A healthy diet

helps to control weight and provides all the necessary nutrients

needed for maintaining good health. A variety of foods from the

four main food groups should be eaten every day, this means:

•Plenty of fruit and vegetables – it’s very important to achieve at

least 5-a-day, as fruit and vegetables provide fibre, vitamins, minerals

and phytonutrients essential for good health

•Plenty of bread, other cereals and potatoes – try to eat some

whole grains, and use the skin on potatoes to ensure you get the

vitamins, mineral and fibre you need

•Moderate amounts of meat, fish and alternatives – avoid

eating large portions – beware restaurants often serve 8oz of meat

for a main

•Moderate amounts of dairy products – the recommended

amount is three portions of dairy products daily e.g. 200 ml glass of milk,

a pot of yoghurt and a 30 mg (matchbox-sized) piece of hard cheese

•Reduce or eliminate highly processed foods and drinks

(see below)

Beware sweetened foods and beverages

Foods and drinks sweetened with fructose (often seen labelled as

glucose-fructose syrup or corn syrup), as well as sweetened soft

drinks, increase the risk of developing gout, as well as the number

gout attacks.

Sweetened soft drinks, and many commercial fruit juices (especially

those from concentrate), are a poor substitute for fruit, as they do

not contain any fibre, and are effectively ‘empty- calories’.

Also be careful buying jams and sweetened condiments. Many

manufacturers are now using glucose-fructose syrup (also known as

high fructose corn syrup), as it is cheaper than cane or beet sugar.

Diets that are high in refined (easily digested) carbohydrates for

example, white bread, white pasta, white rice, biscuits and cakes,

also increase the risk of developing type 2 diabetes, and are linked

to obesity.

Therefore, try to avoid sweetened soft drinks, and reduce the

amount of sugar in your diet other than fresh fruit.

Can I drink alcohol?

Drinking alcohol can increase your risk of developing gout and can

bring on a sudden attack if you are already a gout sufferer. Alcohol

can raise the level of uric acid in the blood in a number of ways and

so trigger a gout attack. Many beers contain large quantities of

purines from the fermenting process and alcohol stimulates the

production of uric acid by the liver. More importantly, however,

alcohol is converted in the body to lactic acid which interferes with

the removal of uric acid from the body by the kidneys.

While it is certainly possible for people with gout to remain well

without becoming teetotal, reduction in alcohol consumption is very

important particularly if you are drinking more than the

recommended healthy limit of 21 units per week for men or 14

units per week for women.

1 unit of alcohol is provided by:

•½ pint of standard strength (3-4% alcohol by volume) beer, lager or

cider

•125ml glass of wine (11%, 100ml glass of stronger wine)

•Single measure of spirits (25ml)

•Single measure of sherry or fortified wine (50ml)

Are some types of alcohol better than others?

A study has shown that the risk of developing gout is greater in even

moderate regular beer drinkers than in those who drink equivalent

amounts of alcohol in the form of spirits or wine. Gout was two and

a half times more frequent in men who drink two bottles of beer a

day while two glasses of wine daily was not associated with an

increased risk of developing gout.

What about reduced alcohol beer?

We are not aware of any specific studies with low alcohol beers but

it seems probable that they are less likely to cause gout.

Is there a link between gout and binge drinking?

Some people say that their gout attacks follow quickly after a heavy

drinking session. Indeed, it is well established that binge drinking

may trigger attacks in people who suffer with gout, even when they

are taking medicines to prevent them.

Should I drink lots of water?

Yes, drinking fluids reduces the likelihood of crystals forming in the

kidneys. As a general rule, drinking 8 large glasses of fluids a day (1.5

litres) is recommended. All drinks, except alcohol, count towards

your fluid intake, including caffeine-containing drinks such as tea and

coffee. Caffeine can act as a mild diuretic, which means it causes you

to pass urine more often. However, regular tea and coffee drinkers

develop a natural tolerance to caffeine and will only experience mild

dehydration if they consume more than their usual amount. Caffeine

itself may have no direct influence on the risk of developing gout, as

research has shown that coffee intake, but not tea, may in some

people be associated with slightly lower blood levels of uric acid than

those drinking the same volumes of tea.http://www.ukgoutsociety.org/docs/goutsociety-allaboutgoutanddiet-0113.pdf