Have you heard of the “disease of kings“? This mysterious name conceals a fairly common condition called gout. Do you know someone who has received this diagnosis from their doctor? It is, in fact, a quite common health problem that not only troubles with joint pain and swelling. The good news, however, is that it is not an issue that doesn’t have a solution. Today, we know what to do and what to eat to reduce the symptoms of gout.
What is Gout?
Gout is a chronic inflammatory disease that manifests primarily with pain and inflammation of the small joints. These joints hurt because crystals of uric acid salt accumulate in them. Perhaps you know someone who cannot sleep at night due to pain in their toe joints. This is precisely the typical problematic area. Further affected areas may include the ankles, knees, wrists, or fingers. However, these complications can also affect other parts of the body, such as tendons or kidneys.
It is not that gout appears out of nowhere. It is preceded by a sort of precursor in which there is an elevated level of uric acid in the blood. From now on, if you ever come across the term hyperuricemia in a medical report, you will know what it means. In this state, the joints and other parts of the body do not hurt and are not affected. Remember, not everyone with elevated uric acid levels suffers from gout. However, if the problem is not addressed at this stage, it’s only a matter of time before gout develops.
Whether we are talking about gout or hyperuricemia, it is quite a common health problem nowadays. According to the analysis of several studies, it affects roughly 1-10% of the world’s population. [3,8]
What are the Stages of Gout?
Gout, like many other diseases, develops gradually. It is preceded by the aforementioned hyperuricemia, which is an elevated level of uric acid in the blood. Only then do uric acid salts (urate) begin to accumulate in the body in the form of crystals. However, the disease can have a variable course and manifest differently.
- During the asymptomatic stage, uric acid crystals are present, but gout has no symptoms.
- Fully developed gout is characterized by accumulated urate crystals and painful and other symptoms.
- Asymptomatic intervals are a common feature, representing periods of calm when gout is present but not active. [10]
What are the Symptoms of Gout?
Gout typically presents a wide range of symptoms. The whole process begins with a stage where only the uric acid level in the blood is elevated, and no parts of the body hurt or swell. The only warning sign may be a raised finger of your general practitioner who conducted the tests. Gradually, as urate crystals accumulate in the joints, symptoms appear.
- Gout is known for so-called gout attacks, where the affected joints are red, swollen, and intensely painful. The most severe pain typically occurs at night or early in the morning. Often, these are so painful that they prevent a person with gout from getting a good night’s sleep.
- Gout attacks can last on average from several days to two weeks, then subside. The less gout is treated, the more frequent the attacks become.
- Chronic tophaceous gout is the most severe stage of the disease, where uric acid crystals are permanently deposited in the joints or even in the skin and other organs. They can gradually lead to damage to these organs. In addition to the toe joints, knees, fingers, or ankles can also be problematic. However, urates can also accumulate in soft tissues, such as the Achilles tendon. A significant problem is the accumulation in the kidneys, where kidney stones typically develop. [2]
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What Causes Gout?
As mentioned earlier, gout develops when urate crystals accumulate in the joints or other parts of the body. But how does it happen that they start to accumulate like this? It must be preceded by a prolonged elevation of uric acid levels. The body reaches this imbalance by either producing it excessively or, conversely, not excreting it. According to scientists, several factors may contribute to this imbalance.
- Genetic predisposition, which is typically revealed by a family history of gout
- Older age
- Overweight and obesity
- Metabolic syndrome
- Menopause
- Male gender
- Regular alcohol consumption
- Improperly balanced diet
- Use of certain medications [2,4]
Can Gout be Treated?
Gout is one of those diseases that can get under control if approached responsibly, ideally from the very beginning, meaning from the first elevation of uric acid levels. The first choice should definitely not be any old wives’ tales or recipes for getting rid of gout, but thoughtful lifestyle changes. Medications are also not out of the question. There are medications for gout therapy, as well as official recommendations that tell doctors under what conditions to prescribe them.
- Anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs or corticosteroids, are used during painful stages of gout to reduce inflammation.
- Medications for reducing uric acid levels in the body may be prescribed by a doctor even in cases of hyperuricemia, when gout is not yet developed. They are also used during quieter phases of the disease, not during gout attacks. One such medication is the commonly used allopurinol. In European Union countries, this active ingredient can be found under various drug names, one of which is Milurit.
![Medications for Gout and Elevated Uric Acid Levels Medications for Gout and Elevated Uric Acid Levels](https://gymbeam.sk/blog/wp-content/uploads/2024/05/iStock-1445197624_5059x3373_5000-1124x749.jpg)
How to Eat with Gout or Hyperuricemia?
The basis of the diet for gout or hyperuricemia is the selection of foods that do not lead to the formation of uric acid or do so only minimally. You may wonder how diet can increase uric acid levels in the blood? This is where so-called purines come into play, which are naturally found in the body and in foods. These substances are converted into uric acid in the body.
What are Purines?
Purines are a natural part of the human body. They are even very important substances because they are components of DNA and also play a role, for example, in transmitting information between nerve cells. The body produces these substances on its own, but you also receive them from food. Regardless of the source of purines, when you have too many, the body simply breaks them down. During this process, uric acid is formed, which is then excreted in the urine. [6]
This is a common physiological process that keeps uric acid levels in your body under control. However, when this mechanism is disrupted and does not work efficiently, the body needs a helping hand. Since it cannot cope with the dose of purines, it is appropriate to limit the intake of those foods that contain a large amount of them. [6]
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Low-Purine Diet
As the name of the diet suggests, for gout or hyperuricemia, it is advisable to limit foods with a high purine content. These substances are found in practically all foods, so it is advisable to focus on those with the highest share. However, some people may have such a serious course of the disease that it is advisable to reduce the intake of those with a moderate purine content as well. In the case of symptomatic gout, it is recommended to limit daily purine intake to a maximum of 400 mg. [6]
Which Foods are Most Risky?
The following foods have the highest purine content and are generally considered the most problematic in cases of gout:
What Other Foods to Be Cautious About?
Furthermore, there are also risky foods that, while not rich in purines, research shows may worsen the course of gout:
- Alcoholic beverages (especially beer)
- Foods high in fructose – fructose, in its concentrated form (e.g., glucose-fructose or fructose syrup), is associated with a worse course of the disease and higher levels of uric acid in the blood [9]
- Sweetened beverages and highly processed foods – various sweets and candies are commonly sweetened with fructose, so it is also advisable to limit them [1,5]
For people with fully developed gout and symptoms, it is recommended to completely eliminate these foods, as they can often trigger gout attacks and worsen the course of the disease. For example, a serving of fish can easily trigger an acute gout attack. If a person with gout has tried and tested that certain foods lead to this in their case, they should definitely avoid them.
In the case of a milder course or in the case of hyperuricemia, the diet is more lenient, and from time to time, it may be okay to indulge in some of these foods.
With the aforementioned fructose comes the question of whether it is okay to eat fruit or honey. These are also foods relatively rich in this simple sugar. Fortunately, however, it turns out that a person with gout can safely indulge in them. This is because fructose in these foods is combined with glucose and is additionally supplemented with fibre in fruits. In these sources, it is sufficiently diluted, so neither honey nor fruit are risky for gout. [9]
![Low-Purine Diet Low-Purine Diet](https://gymbeam.sk/blog/wp-content/uploads/2024/05/iStock-2149665830-1124x750.jpg)
Which Foods are Suitable for Gout?
On the other hand, there are also foods that have a protective effect or are neutral, and are known not to cause problems with gout.
- Dairy products
- Cereals and products made from them
- Eggs
- Fruit – contains a minimum amount of purines and is also full of antioxidant substances (cherries, as well as berries such as blueberries, raspberries, or currants, are excellent in this regard)
- Most types of vegetables
- Nuts
- Foods rich in vitamin C, such as bell peppers, kiwi, or berries
- Herbs and spices from herbs
- Garlic – contains bioactive substances such as allicin, which has been shown to have a positive effect on the course of gout [7]
- Coffee – according to some studies, coffee may have a protective effect in cases of gout [4,5]
![Which Foods are Suitable for Gout? Which Foods are Suitable for Gout?](https://gymbeam.sk/blog/wp-content/uploads/2024/05/cz_jakub_enzl_07-092023_14_5000-1124x843.jpg)
Average Purine Content in Foods
Fruit | Poultry meat (chicken, turkey, etc.) | Offal |
Vegetables (with a few exceptions with moderate purine content) | Red meat (beef, pork, etc.) | Trout |
Cereals and cereal products (white bread, rice, couscous, corn, pasta, etc.) | Legumes (lentils, chickpeas, beans, peas, etc.) | Sardines |
Nuts | Whole grains and products made from them (oats, rye, barley, etc.) | Salmon |
Dairy products (cheese, yogurt, fermented drinks) | Peanuts | Shrimp |
Eggs | Spinach*, asparagus | Tuna |
Oils | Peas | Caviar |
Cruciferous vegetables | Anchovies | |
Herring | ||
Chocolate, cocoa | ||
Meat extracts, soy sauce | ||
Spinach* |
*According to some sources, spinach has a moderate purine content, while others indicate a high proportion and classify it as a risky food. A similar discrepancy may occur with other foods, as the content of substances in plants can be variable. Therefore, it is always useful to observe the effects of a particular food on one’s own health.
How to Choose the Right Foods?
- Foods with a high purine content should only appear in the diet of a person with gout or hyperuricemia exceptionally.
- Those with a low purine content are generally allowed.
- The intake of foods from the middle column, such as legumes or whole grain foods, is highly individual and it really depends on the severity of the disease. For some, legumes may be prohibited, while others can have them twice a week without any issues.
- These foods can be included in the diet in smaller quantities while monitoring their impact on the course of the condition (worsening may manifest, for example, as joint pain or the onset of a gout attack). Whether the diet corresponds to the stage of the disease will also be revealed by the level of uric acid in the blood, which doctors can determine through tests.
Adhering to a low-purine diet can sometimes be complicated. It is necessary to limit a considerable amount of food, and for many others, it is not straightforward. Therefore, it is worth consulting with a doctor or nutrition therapist. Restrictions may vary depending on the severity of the condition. At the same time, everyone following this diet should be careful not to slip into a diet lacking in proteins while having an excess of sugar and fat. [4]
Sample Menu for a Low-Purine Diet
Although a low-purine diet can be quite restrictive in the more severe stages of gout, there are still plenty of foods available to create a healthy and varied menu. Let’s take a look at a one-day menu plan containing less than 400 mg of purines.
Breakfast | Bread 100 g | 12 mg |
Cottage cheese 100 g | 8 mg | |
Ham 40 g | 27 mg | |
Tomatoes 150 g | 10 mg | |
Snack | White yoghurt 100 g | 7 mg |
Banana 100 g | 3.5 mg | |
Almonds 15 g | 5.5 mg | |
Lunch | Rice 150 g (cooked) | 9 mg |
Chicken thigh 150 g (roasted) | 223 mg | |
Cucumber salad 150 g | 14 mg | |
Snack | Bread 60 g | 2.6 mg |
Hard cheese 40 g | 5.5 mg | |
Dinner | Omelet from 3 eggs | 0 mg |
Bread 90 g | 4 mg | |
Leafy green salad 40 g | 2 mg |
What Are Suitable Supplements for Gout?
While no specific dietary supplements are proven to be effective in treating gout, some substances show promising effects.
- In one study, vitamin C helped reduce uric acid levels. This study involved people with hyperuricemia who had not yet developed gout.
- In one study, cherry juice showed positive effects on reducing inflammation during the acute phase of gout. Its antioxidant properties may have played a role. [4]
From previous research, it seems that unlike medications, supplements cannot be heavily relied upon when attempting to treat gout. However, what is known to have a significant impact in this condition are changes in diet and lifestyle. These factors play a major role in controlling gout or hyperuricemia.
![Supplements Suitable for Gout Supplements Suitable for Gout](https://gymbeam.sk/blog/wp-content/uploads/2024/05/ua_evhenii_myhailenko_022024_27jj-1124x749.jpg)
Other Lifestyle Changes
However, dietary adjustment is not the only change to make when a doctor identifies elevated uric acid levels or diagnoses gout. Besides foods rich in purines, there are many other factors that can worsen this condition. How to limit them and what to do to control gout as best as possible?
- In the case of overweight or obesity, weight loss is recommended. For example, a meta-analysis from 2018 found that even first-degree obesity (BMI ≥30 kg/m2) is associated with double the risk of developing gout.
- It is important to limit alcohol. Alcoholic beverages do not contain purines, but their consumption has long been associated with a higher risk of gout. Beer and hard liquor are considered the most problematic. [4]
- Hydration is also very important. It reduces the chance of uric acid kidney stone formation. The foundation of hydration should be water, mineral water, and unsweetened tea. To add variety, they can be supplemented with artificially sweetened drinks. However, it is important to avoid sweetened beverages containing fructose. [12]
- Physical activity also plays a role, as it does in other metabolic disorders. It helps with weight loss, acts as an anti-inflammatory, and can improve joint mobility. Of course, it is important to consider one’s health status and adjust physical activity accordingly.
What should you remember?
Gout is a metabolic disorder that most commonly manifests as inflammation and pain in small joints. Crystals of uric acid salts are deposited in them, or in other parts of the body. Of course, these do not appear out of the blue, but are preceded by increased uric acid levels in the blood. The good news is that both this initial stage and fully developed disease are managable. Besides faithfully taking medications, it is important to make several lifestyle changes. It is recommended to follow a low-purine diet, avoid alcohol, or, in the case of overweight or obesity, reduce body weight. Living with gout will then be much easier.
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Sources:
[1] AFINOGENOVA, Y. et al. Update on gout management: what is old and what is new. – https://pubmed.ncbi.nlm.nih.gov/34907116/
[2] BRANCH, N.S.C. and O. Gout. – https://www.niams.nih.gov/health-topics/gout
[3] BUTLER, F. et al. The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis. – https://www.mdpi.com/2075-4426/11/3/231
[4] DANVE, A. et al. Role of diet in hyperuricemia and gout. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678356/
[5] DEHLIN, M. et al. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. – https://pubmed.ncbi.nlm.nih.gov/32541923/
[6] KANEKO, K. et al. Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia. – https://pubmed.ncbi.nlm.nih.gov/24553148/
[7] LESTARI, A.R. et al. Bioactive Compounds in Garlic (Allium sativum) and Black Garlic as Antigout Agents, Using Computer Simulation. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409881/
[8] PFIFFNER, M. Gout Research Analysis. – https://examine.com/conditions/gout/
[9] RAMLI, N.Z. et al. A Review on the Protective Effects of Honey against Metabolic Syndrome. – https://www.mdpi.com/2072-6643/10/8/1009
[10] RICHETTE, P. et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563586/
[11] Purine Content of Foods : USDA ARS. – https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/methods-and-application-of-food-composition-laboratory/mafcl-site-pages/purine-content-of-foods/
[12] UK Gout Society. – https://www.ukgoutsociety.org/