A diet for gout and high uric acid is necessary to treat and prevent exacerbation of the disease. The expert told us which products should be included in the daily menu and which should be completely excluded.
Gout: symptoms and treatment
Gout is the most common form of arthritis and has been known for several thousand years. Gout is caused by the deposition of uric acid crystals in the joints and various tissues and occurs along with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is normally broken down by the kidneys and excreted from the body. But if the body produces too much of it, or if the kidneys can't remove it from the body properly, uric acid builds up in the joints.
Gout is more common in men than women because estrogens increase the excretion of uric acid by the kidneys.
The main factors that cause gout are diet and genetic predisposition.
Throughout history, gout has typically been associated with the diet of the wealthy (a sign of wealth! ) and excessive alcohol consumption, and dietary guidelines for gout have existed for a long time.
In 1876, A. B. Gerrod was one of the first to recommend reducing consumption of purine-rich foods such as meat and seafood. Later, Professor Ebstein recommended moderate food intake with plenty of water, fruits such as cherries and strawberries, and abstinence from alcohol.
Causes of gout
To understand how purines can affect a person with gout, you must first understand how gout occurs.
Gout develops when uric acid builds up in the body. Normally, uric acid dissolves in the blood, is filtered by the kidneys, and then excreted in the urine. When this process is disrupted, excess uric acid can build up in the joints and form sharp crystals that can cause severe joint discomfort and can also lead to the formation of kidney stones.
The role of purines in the development of gout
Purines are chemical compounds found in certain foods that break down into uric acid when metabolized.
Uric acid from foods high in purines makes up only 15% of the uric acid in the body. The rest occurs naturally in the body's tissues, and genes play a large role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those who ate a high-purine diet were five times more likely to develop gout than those who ate a low-purine diet. Intake of purine bases was associated with an increase in gout attacks, regardless of drinking alcohol or taking medications.
Diet and lifestyle changes are key aspects of non-pharmacological treatment for gout.
Diet principles during treatment should change depending on the severity of the process, the frequency of exacerbations, the level of uric acid in the blood plasma and body weight.
The main principles of diet therapy for gout are the full satisfaction of the body's physiological needs for energy, macro and microelements, dietary fiber, vitamins and minerals. We usually talk about the "Table No. 6" diet.
The diet should contain an optimal amount of protein with a balanced amino acid composition, a reduction in the total amount of fats from animals (the ratio of animal and vegetable fats is 1. 2: 1) and an adequate content of polyunsaturated fatty acids of ω. -6 and ω-3 families, as well as reducing the carbohydrate portion of the diet by reducing the amount of easily digestible and refined sugars.
During the period of exacerbation of gout, it is recommended to remove meat and fish products from the diet, to use mainly liquid foods (jelly, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and to drink up to 2 liters. fluid per day.
It is recommended to limit the consumption of table salt, as well as to ensure that the body receives an adequate amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of the diet for gout in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Limitation of foods rich in purine bases (meat, fish).
- Include foods (grains, milk) in your diet that can control uric acid levels.
- Drink enough fluids.
- Losing weight, achieving a healthy body weight and good eating habits.
A good rule of thumb is to eat moderate portions of healthy foods, which will be the best treatment.
Antipurine diet
It is recommended to exclude foods with a large amount of purines (more than 150 mg per 100 g of product) from the diet.
These products include: beef by-products (brain, kidney, liver), meat extracts, sardines, anchovies, small shrimp, mackerel, refried beans.
Limit the consumption of foods containing 50-150 mg of purine per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Considering that the meat of young animals contains more purines than the meat of adults, it should be avoided.
If you want to include animal protein in your diet, it is recommended that you consume it only in moderation. It is recommended to avoid large portions of purine-rich meats. A typical serving of meat is 85 grams, and fish is 110-115 grams.
When cooking meat, up to half of the amount of purines enters the broth, so it is recommended to eat boiled meat. In any case, meat and fish dishes are included in the diet no more than 2-3 times a week, if it is impossible to completely refuse them.
It is recommended to significantly reduce the consumption of saturated fats, because the excretion of uric acid by the kidneys worsens with the increase in the level of cholesterol in the blood. It is believed that no more than 200 mg of purine bases should be present in the daily diet.
High purine foods to avoid if you have gout:
- By-products
It is recommended to avoid foods such as chopped liver, as well as offal such as kidneys and heart, as they contain a lot of purines.
Alternative: You can eat other types of meat, such as poultry and beef, which contain less purine. For example, you can try a vegetarian recipe for mushroom and walnut pie that contains ingredients that mimic the taste of liver but won't aggravate gout symptoms. - Cold drinks
Although fructose and sugar-based soft drinks do not contain high levels of purines, they have been shown to increase the risk of developing gout. This happens because uric acid is one of the byproducts of fructose metabolism.
Evidence suggests that consuming large amounts of fructose can increase blood uric acid levels.
Drinking soda with high fructose corn syrup has been linked to an increased risk of developing gout. According to a study published in the journal BMJ, men who drank two or more servings of sparkling water per day had an 85% higher risk of gout than those who drank less than one serving per month.
Alternative: You can drink diet sodas that don't cause gout and can help you give up sweets. For example, you can try water with lemon and lime slices. - Sea products
Some types of seafood - anchovies, mussels, crab, shrimp, sardines, herring, trout, mackerel and others - contain moderate to high levels of purines. A study conducted at Vanderbilt University Medical Center in Nashville found that men who ate the most seafood had more than 50 percent higher uric acid levels than those who ate the least.
Alternative: Since fish is good for the heart and blood vessels, it makes sense to keep it in the diet. One option is low-purine cod. Since lemon juice helps neutralize uric acid, you can also eat small, palm-sized portions of high-purine fish balanced with large portions of vegetables like roasted squash or broccoli in lemon juice. - Alcohol
According to a 2014 study from Boston University School of Medicine, drinking wine, beer, or liquor was associated with an increased risk of gout attacks. Researchers have found that the more alcohol a person drinks, the greater their risk.
Alternative: The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity really matters, the less alcohol the better—one (women) or two (men) drinks a day.
Foods to avoid:
- smoked meat, canned goods, frozen meat, fish;
- meat extracts, broths;
- dry beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- except dried cereals, husked rice, husked wheat and milled wheat;
- dried fruits, except prunes;
- biscuits, confectionery made with salt and powdered sugar;
- salt, hot sauces, gravies, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and dishes with little or no purines. During an exacerbation, the diet for gout should be especially strict.
The general principles of the gout diet follow typical recommendations for a healthy diet.
Lose weight
Being overweight increases your risk of developing gout, and losing weight decreases your risk of gout. Studies show that cutting calories and losing weight—even without a purine-restricted diet—lowers uric acid levels and reduces the number of gout attacks. Losing weight also reduces the overall stress on your joints and also lowers your risk of diabetes.
Eating complex carbohydrates
Eat more fruits, vegetables, and whole grains that provide complex carbohydrates. Avoid foods and drinks with high fructose corn syrup and limit your intake of naturally sweetened fruit juices.
Drinking mode
Maintain an adequate water regime. In order to accelerate the removal of purine bases from the body in the diet, the total amount of fluid is increased to 2. 5 l/day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruit, berries, vegetable juices, milk, alkaline mineral water. It is advisable to avoid strong tea and strong coffee: frequent use can aggravate the condition.
Fat reduction
Reduce your intake of saturated fat from red meat, fatty poultry, and full-fat dairy products.
Choose lean meats and poultry, low-fat dairy products, and lentils as sources of protein.
Product Specific Recommendations
Offal. Avoid meats such as liver and kidney, which have high levels of purines and increase the level of uric acid in the blood.Red meat. Average portion sizes for beef, lamb and pork.Sea products. Some seafood, such as anchovies, clams, sardines, and tuna, contain more purines than other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish are part of a gout diet.Vegetables high in purines. Research shows that vegetables high in purines, such as asparagus and spinach, do not increase the risk of gout or recurrent gout attacks.Alcohol. Beer and alcohol are associated with an increased risk of gout and recurrent attacks. Moderate wine consumption does not increase the risk of gout. Avoid alcohol during gout attacks and limit alcohol consumption, especially beer, between attacks.Sweet food and drinks. Limit or avoid sugary foods such as sweetened cereals, baked goods, and candy. Limit the consumption of naturally sweet fruit juices.Vitamin C. Vitamin C can help reduce uric acid levels.Coffee. Some studies suggest that drinking moderate amounts of coffee may be associated with a reduced risk of gout. However, it is necessary to take into account the presence of concomitant diseases.cherry. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Recommended foods and drinks for daily consumption
- beans and lentils;
- legumes;
- low-fat dairy products;
- whole grains such as oats, brown rice, and barley;
- fruits and vegetables.
Beans and legumes are an excellent source of protein. Eating these plant sources can help meet your daily protein needs while reducing the amount of saturated fat found in high-purine animal proteins.
Hence, a vegetarian diet is recommended for gout. Gout is rare in countries where the traditional lifestyle is based mainly on plant-based foods.
It is important to understand that diet is not the only treatment for gout. Rather, it's a lifestyle change that can help reduce or eliminate gout symptoms.
Following a diet, along with calorie restriction and regular exercise, you can improve your overall health and quality of life.