gouty arthritis diet Tag

Gout Food: The Good, The Bad & The Healthy

Gout food means the world to gout sufferers, but there are two different approaches.

Some gouties look for good foods to help their gouty arthritis. Others look to avoid foods that will raise uric acid, or increase inflammation.

I need to teach you how both these concepts are based on gout myths. The best approach to gout food is a healthy, balanced diet.

Good Gout Food

Good gout food is anything that helps reduce uric acid, or helps reduce inflammation.

I frequently update the Gout Diet Section with specific examples of these, but you need to be aware of the dangers.

It is wrong to think that just eating good gout foods will fix your gout. Over-reliance on a small group of food items usually leads to poor general nutrition. The last thing you need is adding other health complications to your gout.

Bad Gout Food

Avoiding bad food is vital, both to gout and your general health. This is a great idea when it is based on a firm understanding of how uric acid and inflammatory or acidic conditions affect gout. It is a very bad idea to avoid certain foods because of Internet hearsay, or outdated nutritional advice.

Adequate nutrition is a big subject, but for practical purposes, it’s enough to eat a varied diet where meat and fish are always balanced by twice as much fruit and vegetables.

Purines are rarely significant.

The only truly bad gout foods are trans-fats, iron, and flesh binges.

Trans-fats are common in processed foods to prolong shelf life. Look for hydrogenated on the label – even partially hydrogenated means poison.
Iron is only required by growing children and menstruating females. For everyone else, it just causes gout.
Flesh binges are excess meat or fish meals. 4oz on a plate balanced with other food items is enough. Any more is a binge. If you cannot make a tasty, satisfying, healthy meal with 4oz meat or fish, join the GoutPal Cookery School (actually, there isn’t one yet, but you only have to ask).

Healthy Gout Food

Gout is not an eating disorder! It is a uric acid metabolism imbalance. Stop obsessing about gout food, and start planning how to manage your uric acid levels.
Healthy gout food does not rely on consulting lists of good or bad foods. It is is anything, and everything that forms part of your gout diet, that in turn forms part of your gout management plan. You do have a gout management plan, don’t you?

More Great Gout & Uric Acid Info

I will leave you with the latest list of popular gout and uric acid articles – a short selection of the best from the hundreds of pages of great GoutPal gout support information.

Top Seven Gout & Uric Acid Articles

Gout Diet Question        (Main Gout Diet, Food, Drink, & Lifestyle Page)

Ask your gout diet questions in our forum. No more earing worries when you know what purines are.

Gout Diet Articles        (Main Gout Diet, Food, Drink, & Lifestyle Page)

Gout diet is the top topic of conversation for gout sufferers. This gout food medley should be top of your menu.

Diet For Gout Sufferers        (Main Gout Diet, Food, Drink, & Lifestyle Page)

Do not plan a diet for gout sufferers the wrong way. It's not all about purine foods. Use this gentle path to better gout diet.

Gout Diet Blog II        (Main Gout Diet, Food, Drink, & Lifestyle Page)

The second installment of the gout diet blog. All the news you need about food, drink & lifestyle for gouty arthritis sufferers.

Diet And Gout        (Main Gout Diet, Food, Drink, & Lifestyle Page)

Diet and gout should not focus on lists of foods to avoid. Plan your gout diet using simple guidelines

Home Remedies For Gout        (Main Gout Treatments, Cures & Remedies Page)

What is the best of all home remedies for gout? Cheap and effective with no side effects. It also helps other gout treatments.

Alternative Gout Treatments        (Main Gout Treatments, Cures & Remedies Page)

Regular gout treatments rely on drugs that have harsh effects. Many people prefer the gentler options in alternative treatments.

Diet & Gout: Fact & Fiction

I’m amazed at the number of questions I get about specific food items. A random selection from recent questions includes: tomatoes, beef, banana, fish, lemonade, salmon oil, potato chips, coconut, cherry juice, crab, tequila, and broccoli. This is in addition to associated requests for lists of good foods & lists of foods to avoid.

It is bad enough that gout sufferers are so obsessed with food, but even worse, is the way gout diet is approached. Looking for good or bad foods completely misses the point.

In fact, it misses two extremely important points. Foods only make sense in the context of a healthy balanced diet, and a gout diet only makes sense in the context of a good gout management plan.

Healthy Gout Diet Not Individual Foods

Although I publish several lists of foods for various purposes, these are not to tell you which individual foods are good, and which are bad for gout. They should be used to help you analyze your total food intake. After that, you might also use them to improve your overall diet.

Diet And Gout Table (click image for full size)

Terkeltaub & Edwards, two prominent rheumatologists, emphasize the need for overall diet management in their latest book, Gout: Diagnosis and Management of Gouty Arthritis and Hyperuricemia.

Apart from a few food groups, the emphasis is clearly on good balance of all nutrients. Important general diet advice includes:

• Maintain ideal body weight with a 40:30:30 carbohydrates:proteins:fats balanced diet.
• Moderate portion size and good hydration.
• Avoid binge eating and overeating.
• Eat plenty of vegetables in preference to starvation, fad, and strict low purine diets.

Interestingly, the book includes one of the best practical gout diet tips that I have used effectively. Reduce your plate size. They recommend a nine inch plate for main meals. Believe me, this really works, especially if you are born into a culture of “waste not, want not,” where lifetime habits mean you must clear your plate.
Read the rest of Diet And Gout: Fact And Fiction

To put it another way.

When most medics practicing today were in med school, the dietary control of gout was very simple: no high purine foods; limited medium purine foods; and unlimited low purine foods.

Then research in the 1970s and 80s began to question the simplicity of this view. In 1985, Zöllner[1] noted:

purine sources differ in their absorption rates, a fact not taken into account in our food tables.

[...] In summary it can be concluded that dietary purines are absorbed to a variable extent, depending on the degree of hydrolysis to nucleosides and/or nucleotides, and that they are oxidized to uric acid in the gut and excreted as uric acid, which is bad for gout but without influence on purine metabolism.

He concludes:

Supplements of dietary purines produce dose-proportional increases in plasma uric acid concentrations, uric acid pool size and renal uric acid excretion. The magnitude of these increases depends on the type of purine compound administered, which may limit the value of food tables for human dietetics. Purine content of food must be related not only to weight but also to energy and to protein, particularly if new foodstuffs or a vegetarian diet are ingested.

It is worth noting at this point, that foods never contain uric acid. Many do contain purines, which are a source of uric acid, but as Zöllner points out, there are different type of purine, and they metabolize to uric acid at different rates. He also points out that we do not really need to digest purines for uric acid, as we can make our own by reprocessing dead cells.

A turning point in our understanding of food high in uric acid came about in 2004. Choi and colleagues compiled statistics from a 12 year study of over 40,000 men. Though this statistical review adds nothing to our knowledge of how different purines affect gout in different ways, it certainly changed the way gout experts view diet.

Their conclusions set the foundation for today’s more effective gout diet plans:

Higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk. Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout.

Though not the total story, as they do not factor in risks such as obesity and excess iron, those words should be tattooed on the hearts of all gout nutritionists. My simple view of purine control is to balance small portions (up to 4 oz) of meat or fish with low-fat dairy products. Fill the plate with whatever vegetable foods you enjoy. Simple and effective.

Finally, though we can see that some form of purine control may help gout, it is absolutely pointless to attempt this if you do not monitor your uric acid numbers. There is no correlation between gout pain and purines. You might still experience gout pain when uric acid is lowering because old urate crystals can cause a gout reaction before they dissolve completely. Make sure that you know and understand your uric acid level.

Food High In Uric Acid References

1. Author: Zöllner N . Title: Purine and pyrimidine metabolism. Published: Sep 1985.
2. Authors: Hyon K. Choi, M.D., Dr.P.H., Karen Atkinson, M.D., M.P.H., Elizabeth W. Karlson, M.D., Walter Willett, M.D., Dr.P.H., and Gary Curhan, M.D., Sc.D. Title: Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men. Published: March 2004.

See more articles related to food high in uric acid in the Gout Diet section.

Stop Gout Triggers

In gout treatment you begin by removing any obvious triggers, such as diuretics or dehydration. Gout diets need the same planning and must stop irregular eating times and other bad eating habits. They should not classify high purine foods as forbidden – this is where most so-called gout diets fail. Food avoidance is fatally flawed; balanced food is vital, and will allow you to make the first steps in managing pain.

Manage Gout Pain

Food is not a painkiller, however gout and diet plans must recognize that pain relief is completely separate from reducing uric acid. Some foods, with anti-inflammatory properties, will reduce the severity of gout pain. Increase these foods and you will improve your natural defenses against gout pain. This puts you in a stronger position to manage the all important uric acid lowering.

Manage Uric Acid

Most uric acid in your body does not come directly from food – it comes from your own body tissue as cells die. Though excess animal protein can slightly raise uric acid levels, your body produces much more from poor diet. Irregular eating and poorly balanced meals cause your body to produce more uric acid than a plate of purine rich food.

Gout and diet starts with understanding the three phases of gout management. Your diet must stop gout triggers, help with gout pain and lower uric acid. It is also vital that the diet supports good general health, as many gout sufferers also suffer from heart disease, high blood pressure and other conditions. Specific diet guidelines only make sense when you can relate them to the three phases of gout management.

Please discuss your gout and diet experiences and problems on the GoutPal Forum.

Read more about gout and diet in the Gout Diet section.

Purines from food are a source of uric acid. The foods high in uric acid table below is now replaced by the Purine Rich Foods chart.

Foods High In Uric Acid Introduction

The table below lists foods high in uric acid first with purine concentration reducing as you move down the list. Many advisers tell gout sufferers to avoid anything over 400mg and restrict foods in the 100-400mg range, but you should treat this advice with caution.

Firstly, you must realize that typical portion sizes vary enormously.
Be sure to calculate the amount that applies to your typical serving size from the value shown for 100 grams.

Secondly, the effect of foods high in uric acid depends on direct absorption through the digestive tract. Most uric acid derives from the breakdown of your cells as part of normal metabolism. The overall contribution of foods high in uric acid is debatable – figures of between 5% and 15% are common.

Purines Warning

Please be careful about getting obsessed with the purine content of food. Though purines in food can have a slight effect on uric acid, there are many other factors to consider. Read more about the main food factors that can affect gout in the Gout Diet section.

Foods High In Uric Acid Table

You should use the information in the table below only as a guideline. Many other factors, besides foods high in uric acid, affect the risk of gout attacks.
If you do feel that it is important to manage foods high in uric acid, then you should measure your total intake. Multiply the weight of your food (in grams) by the value from the table and divide this by 100 to give your uric acid intake in milligrams. In this way you can calculate a total intake from the list of foods high in uric acid for every meal. You need to find the level that you can tolerate best by trial and error.

I took the data in this table from Food Composition and Nutrition Tables by Souci, Fachmann, Kraut [see box on right]. Their notes for the purine data states

Purines

The total of free and bound compounds is given for each component. The “total purines” column contains the total of all individual components calculated as uric acid.

The exact calculation of this is beyond the scope of this article, but you can easily see the relative purine count in the table. Remember, the table of foods high in uric acid shows the number of milligrams per 100 grams, so intake will depend on portion size.

GoutPal warns against taking these types of analysis too seriously. Firstly, gout food research indicates that vegetable purines do not increase the risk of gout, and dairy foods can actually reduce it. More importantly, people digest foods differently – a food that causes gout in one person might be tolerated by another, and different food combinations have significantly different effects. There is more information about dealing with foods high in uric acid in my Gout Diet section.

2010 Update

This information is under review. Please subscribe to the free gout update service to be informed when new articles are published.