purines Tag

Low Purine Diet Tips

A low purine diet is universally recommended as a way of reducing gout attacks. GoutPal has a few more tips and a note of caution to help you manage your diet.

Tip 1

Do not get bogged down with Numbers. The nutrition tables that you use for your low purine diet are only a guideline. Focus on what works best for you. Always consider the total nutrition value per serving. Many tables show values for nutritional density, and often rank foods that you are only likely to eat in small quantities very badly. A small quantity of a high purine food will not normally cause a problem in isolation, but you must consider your total purine intake.

Tip 2

Do not get bogged down with Purines. Just because uric acid is produced from the breakdown of purines does not mean that all foods with purines are bad. You can usually enjoy variety beyond a restrictive low purine diet. There is significant evidence to suggest that vegetables do not cause problems and that dairy products can actually help reduce uric acid levels.

Tip 3

Water is good for gout – drink as much as you can. Opinions vary on how much is enough, but it is important to be constant. Drink water before, with and after each meal. Keep a glass of water by the bed to drink when you wake during the night because of all the water you’ve been drinking! Your urine should be clear at all times – if it isn’t drink a large glass immediately. It might take a few days to get into the habit, but it is well worth the effort.

Milk or fruit juice make useful substitutes to relieve the boredom.

Tip 4

Gravy is bad for you – avoid it like the plague! Many gout sufferers can tolerate moderate amounts of meat and fish in their diets, but hit problems due to sauces. The meat and fish stocks that are used in many sauces and gravies are poison to the gout sufferer. (Sauces with lower amounts of purines, especially dairy-based sauces, should not be a problem as part of a well-balanced, vegetable rich meal.)

Tip 5

Watch your weight. There is evidence that being overweight is a major risk factor for gout. It is certainly much easier to cope with a gout attack when you don’t have extra pounds of body weight pressing on swollen joints. But remember – Do Not Starve – if your body has no food available it will breakdown it’s own tissues, which can lead to gout.

Tip 6

Balance your weight with exercise. Though not a diet tip as such, it is important to consider exercise at the same time as you consider diet. Light to moderate exercise is good for the gout sufferer. Vigorous exercise can actually cause gout attacks as the body consumes it’s own purine rich tissue to supply energy.

If you are following all this advice, but still cannot seem to manage your diet, then you should seriously consider keeping a food diary and seek the advice of a nutritionist who understands gout.

If you have any tips for a low purine diet or general tips for managing gout, please share them on the gout forum.

This page (first published 15th Jan 2006) is copied from the old style GoutPal website, as part of an ongoing upgrade. Most food, drink and lifestyle advice is now contained in the Gout Diet Section

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.

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

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