Less Foods That Cause Gout Or More Confusion?

I fell into the trap of trying to avoid foods that cause gout, a long time ago.

Reams of information, some official, and some fantasy, pushed me towards diet obsession.

But, the more I studied, the more I realized that trying to identify foods that cause gout is futile. Worse than futile, it can lead you to looking in the wrong direction. A direction where you will never find a way to control gout, but you might find joint destruction and organ damage.

Foods That Cause Gout Report

Regular readers are aware of my gout report summaries. I take scientific evidence, and summarize it in a way that ordinary gout patients can understand. This gives you the means to discuss your gout properly with your doctor, and provide the evidence you need for proper uric acid control and gout management.

I’ve just read a report about foods that cause gout, which I will not bother summarizing. It is simply too flawed in it’s approach, in it’s arguments, and in it’s conclusions.

The investigation is from June 2012, titled “The Association of Dietary Intake of Purine-Rich Vegetables, Sugar-Sweetened Beverages and Dairy with Plasma Urate, in a Cross-Sectional Study.” The full version is online, so if you want to find it, please go to the full Internet search box. Whilst you are there, please bookmark that link, and use it whenever you need to find information of any kind. The boxes near the top and bottom of each page are just for gout information, but that link will find anything.

Foods That Cause Gout Report: Flawed Approach

We investigated plasma urate concentrations of 2,037 healthy individuals […] The mean urate concentration in this population was 283.79 mmol/dL.

What is the point of conducting a gout study on people who do not have gout? Several studies show that the effects of food or supplements varies with uric acid concentration.

Objective of this study was to investigate the association between plasma urate concentration and: a) food items: dairy, sugar-sweetened beverages (SSB) and purine-rich vegetables; b) related nutrients: lactose, calcium and fructose.

All these items have been studied before. We now know enough about the effects of food on gout to know that, beyond the recommendation to avoid excess calories, excess iron, and excess meat/fish purines, gout diet has to be planned on a personal case-by-case basis. There are few specific foods that you should avoid. However, if all your meals and snacks each day lead to excess calories, excess iron, or excess animal purines, they are definitely foods to avoid with gout.

There is a genetic element to gout that cannot be ignored. However, classification by genotype is not really an option at this stage, as scientists have yet to identify exactly which genes are responsible for over-production, or under-excretion of uric acid. Hence, I say that only a personal, case-by-case approach is relevant.

With enough evidence, we might build profiles of specific food items and combinations in gout, but it is pointless to study general food effects on people who do not have gout.

Foods That Cause Gout Report: Flawed Argument

Our results suggest that limiting purine-rich vegetables intake for lowering plasma urate may be ineffectual, despite current recommendations.

The problem with that claim is that there is no current recommendation to limit purine-rich vegetables. The report quotes two sources: UK gout management recommendations, and the UK Gout Society.

It is true that the UK gout management guidelines include the recommendation to restrict intake of high-purine foods to less than 200 mg per day. However, the associated commentary makes it clear that vegetable purines are not a problem.

I do not see The UK Gout Society as an authoritative source of gout recommendations. It is actually a gout awareness campaign funded by the pharmaceutical industry. It quotes no sources for it’s dietary recommendations, and despite a 2009 date, it is clearly not current.

Foods That Cause Gout Report: Flawed Conclusion

Further studies are necessary to establish which nutrients and food products causally affect plasma urate.

No! Further studies of this type are not necessary. We need to provide data that proves that fiddling about with one or two food items is an unnecessary waste of time, and a dangerous distraction.

In their “Limitations” section the authors note the difficulty of accurate diet assessment, and the propensity for participation bias to render the results inappropriate for gout patients. Absolutely! So, what is the point of wasting more resources?

Foods That Cause Gout Report: Next Steps

The best thing you can do for your gout, and for your general health, is to eat a well-balanced diet that maintains healthy weight. Once you are at that point, you might want to assess your diet in detail to try to identify foods that raise uric acid, or you might simply take allopurinol and stop worrying about food.

General lists of foods that cause gout are pointless. You have to get a treatment plan first that identifies your target uric acid level. Uric acid excretion tests might reveal that you need to make some diet adjustments to switch to foods with uricosuric properties. If your diet assessment (once you have reached a healthy weight) shows that you have more than one third of calories from meat or fish, then you need to change that. Apart from that, there are no foods that cause gout, and you should stop wasting time trying to find them.

If you want to chat about foods that cause gout, please join the gout help forum.

Read more in the Foods That Cause Gout Guidelines.

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