A gout diet is a nutritional routine that includes eating foods low in purines to help reduce the occur-ance and severity of gout attacks. Gout is a form of arthritis with symptoms of sudden and severe pain, redness, and tenderness in joints.
There has been an association between gout and diet for at least two thousand years. It is the oldest known type of arthritis and was described by Greek physican Hippocrates 2,500 years ago. It subsequently became known as the disease of kings due to its association with eating rich foods and alcohol consumption, a lifestyle only the wealthy had access to. The association between gout and the production of uric acid has been known since the 1800s. In his 1861 medical book, Gunn’s New Domestic Physician: Home Book of Health, American physician John Gunn describes gout as, “a peculiar disease, somewhat resembling rheumatism, affecting the joints, most generally those of the foot or toes.” It states the cause of gout is excess uric acid in the blood. That description is generally accurate today, although much more is know about gout, including how it develops, what causes it, and how it can be treated
It wasn’t until the 1960s that researchers developed an accurate understanding of the biochemistry of uric acid production in the human body. With this understanding came effective medical and dietetic therapy for
Gout risk factors
- Family history of the disease
- Excessive alcohol
- Purine-rich diet
- Enzyme defect that makes it difficult for the body to break down purines
- Exposure to lead in the environment
- Organ transplant recipient
- Use of medicines such as diuretics, aspirin, cyclosporine, or levodopa
- Take niacin (vitamin)
Signs of gout
- Presence of uric acid crystals in joint fluid
- More than one attack of acute arthritis
- Arthritis that develops in a day, producing a swollen, red, and warm joint
- Attack of arthritis in only one joint, often the toe, ankle, or knee
source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, U.S. Department of Health and Human Services.
(Illustration by GGS Information Services/Thomson Gale.)
the condition. In the 1800s, a rudimentary gout diet was developed that recommended avoidance of “rich foods” generally defined as cream and other high-fat dairy products and alcoholic beverages. In the 1960s and 1970s, as more become known about gout and uric acid production, the diet was revised and refined. It encouraged avoiding high-fat and high-protein foods, alcohol, coffee, and soft drinks, along with anchovies, asparagus, legumes, mushrooms, meat, animal organ meat such as heart and liver, and shellfish.
A gout diet is low in purines (part of what makes up DNA), especially those from red meat and seafood. Traditionally, doctors have recommended people avoid or limit eating foods high in purines. Foods that are highest in purines include sardines, mackerel, organ meats (such as brains, kidneys, and liver), scallops, mussels, goose, caviar, and yeast extract. Foods that are high in purines that can be eaten in moderation include, crab, shrimp, red meat, poultry, trout, legumes, beans, lentils, peas, asparagus, cauliflower, mushrooms, spinach, wheat germ, and bran. There are no restrictions on eating foods low in purines, including dairy products, nuts, eggs, pasta, non-whole grain breads and cereals, chocolate, and fats (such as butter, margarine, and cooking oils). Medical research released in 2004–2006 suggest vegetarian diets that are high in purines from vegetables and soy products are less likely to lead to gout than diets containing meat and seafood.
Atherosclerosis— Hardening of the arteries.
Chronic renal disease— The permanent loss of kidney function.
DNA— Deoxyribonucleic acid (DNA) is a nucleic acid molecule in a twisted double strand, called a double helix, that is the major component of chromosomes. DNA carries genetic information and is the basis of life.
Hyperuricemia— High levels of uric acid in the blood.
Purines— Substances in DNA that can be metabolized into uric acid.
Rheumatism— A painful condition of the joints or muscles.
Uric acid— An acid found in urine and blood that is produced by the body’s breakdown of nitrogen wastes.
By eating less meat, poultry, and seafood while taking in more low-fat or non-fat dairy products, men can cut their chances of getting gout by 50 percent, according to the results of a 12-year study of nearly 50,000 men who had no history of gout. The study is the most definitive and comprehensive research done on gout. It was conducted by rheumatologist Hyon K. Choi and other researchers at Massachusetts General Hospital in Boston. The study followed men aged 40–75 years. During the study, the men, all health care professionals, were quizzed periodically on how much of 130 foods and beverages they had eaten along with questions on weight, medications they had taken, and their medical condition. At the end of the study, 730 (about 2 percent) of the men had developed the condition.
The study found that men with the highest consumption of seafood were 51% more likely to develop gout than those who consumed the least amount of seafood. It also found that men with the highest consumption of beef, pork, and lamb had a 41% higher incidence of gout than those who ate the least amount of these meats. Men who had the highest consumption of low-fat dairy products had a 42% lower rate of developing gout compared to those who consumed the least amount of dairy products. Vegetables that are high in purines that were previously associated with an increased risk for developing gout were found to not increase the risk of getting the disease. These vegetables include peas, beans, mushrooms, cauliflower, asparagus, and spinach.
The study also looked at the role alcohol consumption plays in gout. The risk of gout increased by 30% by consuming one drink a day, compared to people who did not drink alcohol at all. Two drinks a day increased the risk to 50% and three drinks a day increased the risk by 100 percent. There were some differences in the types of alcohol consumed. Two glasses of wine a day did not increase the risk of gout at all when compared to men who drank no wine. Alcohol other than beer or wine increased the risk by 15% per serving. Beer increased the risk by 49 % per serving. Researchers are uncertain why the risk of gout varies depending on the type of alcohol consumed. Some suggest that other non-alcoholic ingredients in beer that are not found in wine or spirits may be responsible for increased risk of gout.
What is gout?
Gout, also called gouty arthritis, is a painful but treatable form of arthritis that affects up to five million Americans, primarily men over the age of forty. The disease is characterized by sudden and severe pain, redness, swelling, heat, stiffness, and inflammation in one or more joints. It most commonly affects the big toe first. Subsequent attacks of gout, usually limited to a single joint at a time, can occur in the instep, ankles, heels of the feet and hands, knees, wrists, fingers, and elbows.
Gout is caused by needle-like crystals of uric acid, a substance that results from the metabolic breakdown of purines, which are found in many foods and are part of normal human tissue.. Uric acid is normally dissolved in the blood and filtered through the kidneys into the urine. If uric acid production is increased by the body or it is not sufficiently eliminated from the kidneys, it can build up in the blood., resulting in a condition called hyperuricemia (high uric acid). This can lead to gout. High amounts of uric acid can also collect in the kidneys, causing kidney stones.
General dietary guidelines
People with gout should consult their doctors about developing individualized meal plans. Diets should take into account all aspects of medical nutrition therapy, especially for people with heart disease, high blood pressure, or diabetes. General dietary guidelines for people with gout include:
- Limit protein consumption from meat and replace it with low-fat or non-fat dairy products and soy products, such as soybeans and tofu.
- Consume dairy products low in fat rather than those high in fat.
- Since carbohydrates help increase the excretion of uric acid, carbohydrates should be about 50% of total calories consumed. To accomplish this, persons should eat six to ten servings a day of breads, pasta, cereals, and other starchy foods, and five servings of fruits and vegetables daily.
- Fat consumption should be limited to 30% of total calories consumed.
- Cholesterol intake should be limited to 300 milligrams (mg) per day.
- Maintaining a healthy body weight is essential.
- Alcohol, especially beer, should be avoided.
- It is important to stay hydrated by drinking eight to ten eight-ounce glasses of fluids, preferably water, every day.
Dietary management of gout is centered around reducing uric acid in the body and managing conditions that often occur in people with gout, including diabetes, obesity, high cholesterol, high blood pressure, and atherosclerosis (hardening of the arteries). A diet of foods low in purines is recommended for most people with gout, although it is not possible to completely eliminate purines from the diet. The Arthritis Foundation recommends that people with gout learn by trial and error which foods cause problems and what their personal limits of these foods are.
Laura Rall, a nutrition researcher at Tufts University in Boston, advocates the trial and error method of developing a gout diet. “Begin by eliminating foods in the high-purine category, while reducing your intake of foods in the moderate-purine category, If you don’t have gout attacks after trying this, you may add more foods from the moderate category, or occasionally try a food from the high category. Using these guidelines, you may be able to determine a safe level of purine consumption and enjoy some of your favorite foods without experiencing (gout) attacks.”.
The function of a gout diet is to lower uric acid levels in the blood by eating less meat that is high in purines, which increase uric acid levels in the blood. Uric acid is a waste product formed as purines breakdown in the body. By reducing uric acid levels in the blood, people with gout usually experience a decrease in pain and swelling in joints afflicted with the disease. Without treatment, gout can lead to joint damage and disability. Gout is also associated with an increased risk of heart disease and kidney disease., according to the American College of Rheumatology.
QUESTIONS TO ASK YOUR DOCTOR
- Will I need to take any vitamin, mineral, or other nutritional supplements while on a gout diet?
- How do you feel about the trial and error approach to individualizing a gout diet as recommended by the Arthritis Foundation?
- Do I have any risk factors associated with gout, such as a high body mass index, high blood pressure, or chronic renal disease?
- Can I drink wine or other alcoholic beverages while on a gout diet?
- Will being on a gout diet effect my energy level?
- Will an exercise routine enhance my gout diet?
The main benefit of a gout diet is a decrease in the pain, tenderness, swelling, redness, warmth, and inflammation of joints associated with the condition, and prevention of joint damage and disability. It also improves the quality of life in gout sufferers by helping prevent repeat attacks.
The gout diet is designed for people who have gout or who may be prone to developing gout since it can be genetically inherited. People who do not have gout or have no predisposition to the condition do not need to be on the diet. There are no precautions associated with the diet. However, since the diet recommends a severe curtailment or elimination of meat and seafood from the diet, people on or planning to go on the diet should consult a dietician in addition to their physician or rheumatologist. People who eliminate meat and seafood from their diets should make sure they are getting adequate protein and other nutrients found in meat. This may include adding vitamin, mineral, and other nutritional supplements to the diet, similar to those taken by non-vegan vegetarians. These may include iron, calcium, zinc, vitamin D, riboflavin, vitamin B-12, vitamin A, iodine, and Omega-3 and Omega-6 amino acids derived from non-fish sources, such as flaxseed oil, evening primrose oil, and borage oil.
There are no known risks associated with a gout diet..
There is general acceptance among health care professionals of the low-purine diet for people with gout or those who have a family history of the disease.
Diets that are high in purines and high in proteins had long been thought to cause an increased risk of gout. For that reason, a gout diet was more about what foods to avoid rather than what foods to eat. However, in the March 11, 2004 issue of The New England Journal of Medicine, gout researcher Hyon Choi reported on the results of a 12-year study of nearly 50,000 men comparing those who got gout with those who didn’t. It confirmed conventional medical opinion that eating meat, especially red meat, significantly increased the risk of gout and that eating seafood carried the greatest risk for getting gout. However, the study disproved previously held assumptions that gout was also associated with eating vegetables high in purines, such as asparagus, having a high body mass index, or eating high-protein foods. The study also found that consuming beer poses a greater risk for gout that drinking wine or other types of alcohol.
A 2004 study by the Arthritis Foundation concluded that drinking alcohol and eating any food high in purines increases the risk of repeat gout attack. The study was conducted by Dr. Yuqing Zhand, professor of medicine and public health at Boston University School of Medicine and was reported at the American College of Rheumatology Annual Scientific Meeting on Oct. 17, 2004 in San Antonio.
Statistics show that African American men have twice the risk of getting gout compared to Caucasian men, according to the Arthritis Foundation.
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American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345-4300. Telephone: (404) 633-3777. Website: http://www.rheumatology.org
American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Telephone: (800) 877-1600. Website: http://www.eatright.org
Arthritis Foundation. P.O. Box 7669, Atlanta, GA 30357-0669. Telephone: (800) 568-4045. Website: http://www.arthritis.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 31, Room 4C02, 31 Center Drive, MSC 2350, Bethesda, MD 20892-2350. Telephone: (301) 496-8190. Website: http://www.niams.nih.gov
The Arthritis Society. 393 University Ave., Suite 1700, Toronto, ON M5G 1E6, Canada. Telephone: (416) 979-7228. Website: http://www.arthritis.ca
Ken R. Wells