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 in association with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is normally broken down and excreted from the body by the kidneys. However, if the body produces too much of it or the kidneys cannot adequately remove it from the body, 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 causative factors for gout appear to be diet and genetic predisposition.
Throughout history, gout has been commonly associated with the diet of the wealthy (a sign of affluence! ) and excessive alcohol consumption, and dietary guidelines for gout have been around 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. A little later, Professor Ebstein recommended a moderate food intake with plenty of water, fruits such as cherries and strawberries, and avoiding 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 is dissolved in the blood, filtered by the kidneys, and then excreted from the body in the urine. When this process is disrupted, excess uric acid can build up in the joints to form sharp crystals, which can cause severe joint discomfort and also trigger 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, which comes from foods high in purines, however, makes up only about 15% of the uric acid in the body. The rest is found 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 on a high-purine diet had five times the risk of developing gout than those on a low-purine diet. Taking purine bases is associated with an increase in gout attacks, regardless of whether they drink alcohol or take medication.
Dietary and lifestyle changes are the main aspects of non-pharmacological treatment of gout.
Dietary principles in treatment should vary 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 complete provision of the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. We usually talk about the "Table number 6" diet.
The diet should include an optimal amount of proteins with a balanced amino acid composition, a reduction in the total amount of animal fats (the ratio of animal and vegetable fats is 1. 2: 1) with an adequate content of polyunsaturated fatty acids of the 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 an exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mostly liquid foods (jelly, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drinking 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 a sufficient amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of a gout diet in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Limiting foods rich in purine bases (meat, fish).
- Include foods in your diet that can control uric acid levels (cereals, milk).
- Drinking enough fluids.
- Losing weight, achieving a healthy body weight and proper eating habits.
A good rule of thumb is to eat moderate portions of healthy foods, this will be the best treatment.
Antipurine diet
It is recommended to exclude from the diet foods containing large amounts of purines (more than 150 mg per 100 g of product).
These products include: beef offal (brains, kidneys, liver), meat extracts, sardines, anchovies, small shrimp, mackerel, fried legumes.
Limit the consumption of foods containing 50-150 mg of purines per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Given that meat from young animals is higher in purines than meat from adults, it should also be avoided.
If you want to include animal protein in your diet, it is recommended that you only consume it in moderation. It is recommended to avoid large portions of purine-rich meat. A typical portion of meat is 85 grams and fish is 110-115 grams.
When cooking meat, up to half of the amount of purines goes into the broth, so it is advisable to eat cooked meat. In any case, meat and fish dishes, if it is impossible to refuse them completely, are included in the diet no more than 2-3 times a week.
It is also recommended to significantly reduce the consumption of saturated fat, because with increased levels of cholesterol in the blood, the excretion of uric acid by the kidneys worsens. It is believed that the daily diet should contain no more than 200 mg of purine bases.
High-purine foods to avoid if you have gout:
- Byproducts
It is recommended to avoid dishes such as chopped liver, as well as other offal such as kidneys, heart, as they contain a lot of purines.
alternative: You can eat other types of meat, such as poultry and beef, which contain less purines. For example, you can try a vegetarian recipe for mushroom and walnut pate that mimics the taste of liver but contains ingredients that won't worsen 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 shows that consuming large amounts of fructose can increase uric acid levels in the blood.
Drinking soda with high fructose corn syrup is associated with an increased risk of developing gout. According to a study published in the journal BMJ, men who drink two or more servings of sparkling water per day have an 85% higher risk of gout than those who drink 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 slices of lemon and lime. - Seafood
Some types of seafood—anchovies, clams, crab, shrimp, sardines, herring, trout, mackerel, and others—contain moderate to high levels of purines. Men who ate the most seafood were more than 50 percent more likely to have high uric acid levels than those who ate the least, according to a study conducted at Vanderbilt University Medical Center in Nashville.
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. You can also eat small portions of high-purine fish balanced with large portions of vegetables, such as roasted zucchini or broccoli in lemon juice, as lemon juice helps neutralize uric acid. - Alcohol
According to a 2014 study from Boston University School of Medicine, drinking wine, beer, or alcohol is associated with an increased risk of a gout attack. The more alcohol a person drinks, the greater the risk, the researchers found.
alternative: The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity really does matter, the less alcohol the better—no more than one (women) or two (men) drinks a day.
Foods to avoid:
- smoked meats, canned goods, frozen meat, fish;
- meat extracts, broths;
- dried beans, lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dried cereals, except husked rice, husked wheat and milled wheat;
- dried fruits, except prunes;
- biscuits, confectionery prepared with salt and powdered sugar;
- salt, hot sauces, sauces, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and meals with low or no purine content. The gout diet during an exacerbation should be particularly strict.
The general principles of the gout diet correspond to typical recommendations for healthy eating.
Losing weight
Being overweight increases the risk of developing gout, and losing weight decreases the risk of gout. Research shows 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 reduces the 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 appropriate water regime. In order to accelerate the elimination of purine bases from the body with food, the total amount of liquid is increased to 2. 5 l / day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruit, berry, vegetable juices, milk, alkaline mineral water. It is recommended to avoid strong tea and strong coffee: frequent use can lead to deterioration.
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, kidney, which have high levels of purines and contribute to increased levels of uric acid in the blood.Red meat. Medium portions for beef, lamb and pork.Seafood. Some types of 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 an integral part of the 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 alcoholic beverages 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 foods and drinks. Limit or avoid foods containing sugar, such as sweetened cereals, baked goods and candy. Limit your consumption of naturally sweetened fruit juices.Vitamin C. Vitamin C can help lower uric acid levels.coffee. Some studies suggest that drinking coffee in moderation 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 excellent sources 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.
Thus, a vegetarian diet is recommended for gout. In countries where the traditional way of life includes eating mostly plant foods, gout is rare.
It is important to understand that gout diet is not the only treatment. Rather, it's a lifestyle change that can help reduce or eliminate gout symptoms.
Dieting, along with calorie restriction and regular exercise, can also improve your overall health and quality of life.