Alkaline Foods: More Myths Exposed

I originally published this article about alkaline foods and gout well before I realized the full value of an alkaline diet for gout. Since then, more evidence has been discovered by various gout studies to show that alkaline foods can encourage excretion of uric acid.

I have since developed a complete section of my gout diet guidelines to explain the value of an alkalizing gout diet menu. This early work is still relevant however, and so I retained it to explain the value of alkaline foods on uric acid kidney stones, which cause kidney damage to some gout sufferers.

Alkaline foods raise more controversy than they are worth.

People swear they are the holy grail of health – a magic cure for gout and every other health problem in the world.

Skeptics swear back: “You’re wasting your *#@!$&! time.

It’s time for us to see the real truth behind alkaline diet and gouty arthritis.

Myth 1: Alkaline Foods Turn Red Litmus Blue

Alkaline Foods Image
Alkaline foods are important to gout sufferers
Despite my best efforts to explain otherwise, people still believe that you can measure the power of alkaline foods by testing their pH. There are even lists of alkaline foods touted round the Internet that show the pH value for common foods. But these have nothing to do with the alkalizing effect, so why do they exist?

They stem from a US government table of pH values produced for the canning industry. Whilst they might help food packagers determine what balancing agents they need to avoid food reacting with it’s container, these values have absolutely nothing to do with the effect of food on our bodies.

The science of alkaline foods recognizes that elements and compounds in food cause different reactions in our body when digested. Some elements, e.g. proteins and phosphorous produce acidic salts. Other elements, e.g. potassium, magnesium and calcium, produce alkaline salts. These salts end up at our kidneys, where they alter the pH environment. This process has resulted in the Potential Renal Acid Load (PRAL) calculation, which is an approximate estimate of the effect of foods on the acidity/alkalinity of our bodies. Or more specifically, of urine, as this is the measurable result.

Still, people remain confused as to how an acidic food item, like lemons or vinegar, can have an alkalizing effect on urine and the kidneys. This happens because the acids in food are very weak acids, e.g. citric acid in lemons and acetic acid in vinegar. The alkalizing components in the fruits do not register on a pH test, or our taste buds. This all changes as we digest the food, and the alkalizing components combine with acid compounds in or bodies, thus reducing the acid load at the kidneys.

In fact, the only reliable way to test the value of alkaline foods is to measure the pH of urine, but beware of the obsession that leads to the second myth.

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Where Is The Gout Food To Avoid?

I am reorganizing the Gout Diet section by moving all the detailed nutritional information to a separate food and health website. This should reduce some confusion regarding certain aspects of the role that food plays in managing gout.

Under the old scheme, I used the “gout food to avoid” label to refer to acidic foods, but this led to confusion on two counts.

  • Confusion between an acid-alkaline balanced diet and uric acid.
  • Confusion about avoiding all acid forming foods.

Under the new scheme, I will use the “gout food to avoid” label to refer to excess calories. These are always bad for gout because excess calories leads to excess body tissue – the main source of uric acid. Excess calories also leads to excess weight, which adds to the load on gout-ridden joints.

Although food is not as important to gout as many people believe, there is always a case for good nutrition. Many gout sufferers have other health conditions that can be improved by diet. Particularly common amongst gout sufferers are:

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Heart disease

Planning a good diet should always start with an assessment of current nutrition, hence my decision to develop a separate nutrition and health website.
Continue to read about gout food to avoid

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Gout Diet Including Food, Drink & Lifestyle

Gout diet can be complicated, but do not worry.
I am here to make it easy for you to choose food that helps your gout.

Note, it’s YOUR gout diet.

Most of what you read about gout diet does not apply to you.
Gout diet must be personal.

Gout affects everyone differently, and everyone has different tastes.
I urge you to start with what you like to eat.
I will help you find ways to eat your favorite foods that make your gout better.

Everyone seems to think that gout is a disease caused by food. It is not! Your diet can affect gout, but it is only part of the story.

In these gout diet guidelines, I explain all the different ways that food can affect gout – good and bad. These are good reference pages that reflect current scientific research. But if you do not know where to start, then the best place starts with yourself. If you go to the gout forum, tell me some facts about your gout, some ideas about your favorite foods, or some of your worries about what you can eat, I will help you find the right guidelines that suit your situation. That way, you can focus on what matters to you, and safely ignore food facts that are not relevant to your gout. All you need to do is ask about your gout diet in the gout forum.

continue reading Gout Diet

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Gout Diet Menu: Pancakes and Gout

Pancakes and gout is today’s topic for my 97th most popular search for gout. Like many of the topics near the end of your Top 100 gout topics, pancakes were in detailed food charts designed to help plan an alkalizing gout diet menu. Pancakes are not particularly important to gout sufferers, but if you eat a lot of them, you should know one key fact.

I should mention the futility of worrying about single food items. However, as I covered it in yesterday’s topic, I will focus on one aspect of pancakes that might be slightly relevant to gout sufferers.

There is no direct connection between pancakes, or their ingredients, and uric acid. However, pancakes have one significant property that has an indirect bearing on gout. They tend to be acid-forming. Acid forming foods are required as 20-30% of what we eat, but typical Western diet has too many acid-forming foods, and too few alkaline-forming foods.

See how to make Pancakes and Gout safe

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Potential Renal Acid Load

Potential Renal Acid Load (PRAL) is a calculated value that estimates how foods might change acidity or alkalinity of the body.

PRAL is a precise calculation from 5 nutrient values in food, but it is not an exact measure. It is a shortcut measure to assess the affect of foods on the pH of the body.

When you are planning a gout diet menu, you need to include a wide range of foods. This ensures that you get enough different nutrients to be healthy. It also ensures that the menu is interesting, and can include your favorite foods. The menu must include some acid producing foods, but a good gout menu is a balanced menu.

PRAL For Gout Sufferers

PRAL is a widely used tool for estimating the acid load on your kidneys. This is the general pH level derived from many different compounds, not uric acid.

PRAL is not a measure of uric acid, but a higher pH makes uric acid more soluble. This means that crystals are less likely to form.

It is important to realize that pH of blood is tightly regulated by our body, and so following an alkalizing diet is not likely to have a dramatic effect on gout. However, an alkalizing diet is widely recognized as promoting good general health. For gout sufferers at risk of kidney stones, an alkalizing diet is very effective in preventing or dissolving uric acid kidney stones.

This happens because an alkalizing diet leads to alkaline urine. This creates the right conditions to stop uric acid forming kidney stones. As of 2012, there is some evidence that this may also improve uric acid excretion. This requires further study. I will monitor the investigations into the effects of an alkalizing diet on uric acid and gout.

What Is Potential Renal Acid Load?

Potential renal acid load experiments show that PRAL is a reliable approximation of the pH effect of foods. It is calculated from:

0.49 Protein + 0.037 Phosphorus
– 0.021 Potassium – 0.026 Magnesium – 0.013 Calcium

Acid forming foods have a positive range, alkaline forming foods have a negative range. For adequate nutrition it is important to chose a combination of foods with positive and negative PRAL values. You need some acid forming foods, but you must balance these with sufficient alkaline forming foods to give an overall negative total. As far as I know, there is no target value to aim at.

Your target is really to increase the pH of urine, so frequent testing will show if you need to improve your PRAL score.

PRAL Nutrients iconAs PRAL is more about nutrition than gout, I have moved my tables of individual food items to my Science of Healthy Eating website. There you can analyze your total diet, and then see which food items you should change to improve your gout diet.

Potential Renal Acid Load In A Gout Diet Menu

When you are planning a gout diet menu, the first principle is balance. I.e. you balance acid producing foods with a greater portion of alkalizing foods. I suggest you change this gradually. Your initial target should be 30% acid to 70% alkali. You can do this over several weeks, or all at once, depending on how you feel about dieting.

Please remember that PRAL is just a guide to foods that have alkaline or acid effects. The true measure depends on other factors, and must be monitored by testing urine with pH strips. The best approach is to test now, introduce your 30/70 gout diet menu, then test again to assess your improvement.

Your target pH will vary according to your circumstances, but the use of PRAL charts is always the same. Use them to assess your acid/alkali balance, and use them to improve the ratio of alkali to acid in your gout diet menu. Never set a PRAL target.

Your target is your urine pH, and Potential Renal Acid Load tables are one tool that you can use to help you achieve your target. See the Gout Diet Menu pages for more explanation, and if you need help, please ask in the gout diet forums.

Potential Renal Acid Load Improvements

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Potential Renal Acid Load Document Change History

Potential Renal Acid Load Document Change HistoryTo read the document change history, click the GoutPal History image on the right.

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High Alkaline Foods for Gout Diet Menu

High alkaline foods are an important part of your alkalizing gout diet menu.

Equally important is the need to be aware of pH balance. You must include acid-forming foods in your diet to ensure a wide range of nutrients. However, the typical Western diet is already far too acidic, so most of us need to introduce more alkaline foods.

This high alkaline foods table replaces earlier versions. I have removed many irrelevant foods by using the USDA key foods list. I add a few additional foods that are of particular interest to gout sufferers. I have added some other nutritional values that are of interest to gout sufferers. You should take time to read why these are important by reading the Gout Foods Tables Introduction before you use the table below.

The most important change is that I now present values for a 100 calorie serving rather than 100 gram. Listing by energy value rather than weight makes it much easier to adjust your gout diet menu so that your overall food intake has a lower PRAL score. By exchanging some acidic foods for items from the high alkaline foods table, you can easily improve your gout diet. Remember that these numbers are only a guide to improving pH balance. The only way to be certain that you have an alkalizing gout diet menu is to test urine pH.

High Alkaline Foods

Long Description 100 Kcal Serve(g) Vitamin C (mg) PRAL Score Iron (mg) GoutPal Index
Spinach, raw 435 122 -51 11.8 57.7
Spinach, cooked, boiled, drained, without salt 435 43 -45 15.5 23.7
Chicory greens, raw 435 104 -36 3.9 52.9
Endive, raw 588 38 -35 4.9 30.9
Spinach, canned, regular pack, drained solids 435 62 -34 10.0 31.1
Celery, raw 625 19 -31 1.3 27.1
Parsley, raw 278 369 -31 17.2 122.2
Lettuce, cos or romaine, raw 588 24 -25 5.7 19.9
Turnip greens, cooked, boiled, drained, without salt 500 137 -25 4.0 58.7
Tomato products, canned, sauce 417 29 -25 4.3 21.5
Tomato juice, canned, with salt added 588 108 -25 2.5 51.3
Tomatoes, red, ripe, raw, year round average 556 76 -23 1.5 40.6
Tomato products, canned, paste, without salt added 122 27 -22 3.6 16.9
Tomato products, canned, paste, with salt added 122 27 -22 3.6 16.9
Lettuce, green leaf, raw 667 61 -21 5.7 31.2
Tomatoes, red, ripe, canned, packed in tomato juice 588 55 -21 5.7 28.2
Spinach, frozen, chopped or leaf, cooked, boiled, drained, without salt 294 6 -20 5.8 8.5
Tomatoes, red, ripe, cooked 556 127 -19 3.8 53.2
Cucumber, peeled, raw 833 27 -19 1.8 24.7
Vegetable juice cocktail, canned 526 286 -17 1.5 107.3
Sauce, salsa, ready-to-serve 345 7 -16 1 12.3
Pickles, cucumber, dill or kosher dill 833 7 -16 3.1 15.1
Soup, stock, beef, home-prepared 769 0 -16 2 13.3
Lettuce, iceberg (includes crisphead types), raw 714 20 -16 2.9 18.4
Squash, summer, all varieties, cooked, boiled, drained, without salt 500 28 -16 1.8 20.0
Onions, spring or scallions (includes tops and bulb), raw 313 59 -16 4.6 25.4
Kale, cooked, boiled, drained, without salt 357 146 -15 3.2 56.4
Tomatoes, red, ripe, canned, stewed 385 30 -15 5.1 15.8
Melons, cantaloupe, raw 294 108 -15 0.6 45.7
Peppers, sweet, green, raw 500 402 -15 1.7 144.4
Cabbage, cooked, boiled, drained, without salt 435 163 -14 0.7 65.0
Carrots, raw 244 14 -14 0.7 13.4
Mushrooms, white, cooked, boiled, drained, without salt 357 14 -13 6.2 7.8
Squash, winter, all varieties, cooked, baked, without salt 270 26 -12 1.2 16.2
Carrot juice, canned 250 21 -12 1.2 14.3
Carrots, cooked, boiled, drained, without salt 286 10 -12 1.0 11.1
Broccoli, raw 294 262 -12 2.1 93.8
Sauce, pasta, spaghetti/marinara, ready-to-serve 204 4 -11 2 7.3
Cabbage, raw 400 146 -11 1.9 56.3
Broccoli, cooked, boiled, drained, without salt 286 185 -10 1.9 67.6
Asparagus, cooked, boiled, drained 455 35 -10 4.1 16.6
Mustard greens, cooked, boiled, drained, without salt 385 97 -9 3.3 37.3
Beans, snap, green, frozen, cooked, boiled, drained without salt 357 15 -9 2.4 10.4
Sweet potato, cooked, baked in skin, without salt 111 22 -9 0.8 12.1
Carrots, frozen, cooked, boiled, drained, without salt 270 6 -9 1.4 7.7
Potato, baked, flesh and skin, without salt 108 10 -9 1.2 7.7
Potato, flesh and skin, raw 130 26 -8 1.0 12.9
Orange juice, raw 222 111 -8 0.4 42.8
Orange juice, chilled, includes from concentrate, fortified with calcium and vitamin D 213 71 -8 0.3 29.7
Orange juice, chilled, includes from concentrate, fortified with calcium 213 71 -8 0.3 29.7
Peaches, raw 256 17 -8 0.6 11.5
Strawberries, raw 313 184 -8 1.3 66.9
Bananas, raw 112 10 -8 0.3 8.0
Oranges, raw, all commercial varieties 213 113 -8 0.2 43.5
Orange juice, frozen concentrate, unsweetened, undiluted 63 87 -8 0.2 33.1

High Alkaline Foods for Gout PhotoNote that, whilst these are more alkalizing, some foods, such as spinach, have high iron content, so a lower GoutPal Index. I will introduce personalized tools soon to allow you to generate your own Personal Index that is based on your nutrition goals. If you want to be included in the trials for this, please ask in the gout forums.

The tables for each food group show all the key foods. I will publish tables in GoutPal Index order soon. Please subscribe to my gout information update service to get notified when I publish them.

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The Benefits of Calcium When Living With Gout

Here’s an important article about calcium – a vital consideration when planning your gout diet.

The Benefits of Calcium When Living With Gout

One particular mineral that has gained some notoriety lately is calcium.

The effects of calcium, which when taken in moderate amounts can have an overall positive effect on the body, are being cited in anecdotal evidence as a way to combat some of the symptoms of gout.

Uric acid is one of the primary contributing factors to the painful symptoms experienced by gout sufferers. Therefore, controlling the production of this substance is key to getting symptoms under control. One of the techniques that are now being used to accomplish this is by changing the pH level of the body in order to manipulate its uric acid production.

Continue reading about benefits of calcium when planning your gout diet menu

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