Diet for gout

by

Guest Author: Margareta Benković, M.Sc. Nutr.
Nutritionist at the Centre for Nutrition Counseling
Centre for psychological assistance of Association of women affected by cancer EVERYTHING for HER*

The availability of food and eating habits change throughout history. Once upon a time, meat and alcohol were reserved only for the wealthiest – and throughout history, the wealthiest were kings. Along with kings came, at that time, a socially desirable disease that distinguished them from the “lower” classes, which we now know as gout. We no longer view gout as anything royal. Quite the opposite. Gout has become a reflection of poor dietary habits and lifestyle.

Gout (arthritis urica, podagra) is a complex and frequent form of arthritis characterized by sudden attacks (1). Gout symptoms occur due to the deposition of crystals of uric acid and its salts in the joints. As a consequence, inflammation and intense pain occur. If left untreated, permanently elevated concentrations of uric acid in the blood lead to the formation of crystals in a greater number of joints and to more frequent and longer episodes.

Uric acid is formed as a byproduct of the digestion of food rich in purines. It is naturally present in the body and usually does not pose a health risk. However, problems arise when the body starts producing too much uric acid or when the kidneys do not excrete it efficiently enough. In both cases, the result is the same – hyperuricemia, or elevated concentration of uric acid in the blood.

Risk factors

Numerous factors can lead to an increase in uric acid concentration in the blood and cumulatively to the onset of gout. Fortunately, many of them we can influence. Diet, obesity, and lifestyle are some of them (2). Therefore, timely education on proper nutrition for people at risk, as well as those already ill, is necessary to achieve a desirable clinical outcome.

Dietary strategy and pills

The first step in treating gout is stopping an acute attack. An acute gout attack is stopped pharmacologically – with medication, predominantly non-steroidal anti-inflammatory drugs or, in more severe cases, corticosteroids. Shortly after, the first priority of therapy becomes diet, aimed at treating chronic uric arthritis and reducing the frequency of uric episodes. Gout symptoms are monitored and treated during all stages of the disease.

Dietary guidelines for gout include:

Reducing intake of…

· purines to a maximum of 100 mg per day (3). Foods rich in purines that should be avoided include: organ meats, oily fish (sardine, tuna, mackerel, salmon), canned fish, cured meat products, meat extracts, yeast, shellfish and crustaceans, mushrooms, and red meat (beef, pork, lamb, etc.)

· foods and drinks with added sugars, especially fructose. Soft drinks rich in fructose, as well as high-fructose corn syrup, increase uric acid levels in the blood (4)

· all forms of alcohol, with special emphasis on beer (4). Alcohol increases uric acid concentration in two ways – as a diuretic it stimulates water excretion from the body and at the same time stimulates the production of uric acid.

Increasing intake of…

· fluids in the form of water or unsweetened herbal teas. This stimulates the excretion of uric acid from the body (5)

· fruits and vegetables. Previously, vegetables such as broccoli, cauliflower, spinach, and peas, due to their relatively high purine content, were excluded from the diet. Today we know that purine-rich vegetables have a small or negligible role in the development of gout (6)

· low-fat dairy products and white meat as primary sources of protein (3,6). Numerous epidemiological studies link higher dairy consumption with lower serum uric acid concentration, and consequently lower gout risk (7,8).

The second step in treating gout is reducing body weight. People suffering from gout often have excess body weight or are obese. Weight reduction should be gradual. Using methods of rapid weight loss leads to an increase in serum uric acid (6).

The third step is permanent change of dietary habits and lifestyle. Maintaining adequate body weight while following individualized dietary recommendations is in focus. Since gout as a disease does not come alone (9), when an episode occurs, it is often necessary to put out fires in several places at once. Professional help is essential at that moment.

What is best for gout?

A diet for people with gout should simultaneously reduce uric acid concentration, gout symptoms, and comorbidities associated with gout.

In this context, due to characteristics that match key dietary guidelines for gout, a diet based on plant-based foods represents the “gold standard” (10).

Vegetarian nutrition, compared to the “Western” diet, reduces the risk of uric acid crystal formation by 93% (11). Moreover, vegetarian nutrition is associated with a reduction in comorbidities related to gout – obesity, metabolic syndrome, chronic kidney disease, high blood pressure, and cardiovascular diseases. Results are even better if a lacto-ovo version of vegetarian diet is followed, which includes dairy products (10). A vegan diet is also sometimes recommended.

However…

Limiting the intake of certain foods or changing the entire dietary pattern, no matter how medically justified in specific cases, can lead to dangerous nutritional deficiencies without professional supervision. A diet based solely on plant-based foods, without introducing adequate substitutes, can further complicate the existing clinical situation.

Optimal nutrition in gout requires individualization. Every case of gout is a story in itself, and every wrong dietary choice is an added risk for worsening the disease outcome, as well as overall health.

*Association of women affected by cancer EVERYTHING for HER created the Centre for psychological help for women affected by cancer. Through educational workshops as well as individual and group work with users, dietary topics take a significant place which is why the centre for diet counseling has been formed so that affected women can receive advice from a nutritionist about an individual diet system, adjusted to personal needs and possibilities.

References

  1. Mayo Clinic (2019) Gout. <https://www.mayoclinic.org/> Pristupljeno 29.10.2020.
  2. Ragab, G., Elshahaly, M., Bardin, T. (2017) Gout: An old disease in new perspective – A review. J Adv Res., 8(5), 495–511. https://doi.org/10.1016/j.jare.2017.04.008.
  3. Društvo reumatičara za djecu i odrasle (2012) Prehrana kod reumatoidnog i uričnog artritisa (gihta).<http://www.kbd.hr/odjeli/odjel-klinicke-prehrane/prirucnici-za-bolesnike/> Pristupljeno 30.10.2020.
  4. Kedar, E., Simkin, P. A. (2012) A perspective on diet and gout. Adv Chronic Kidney Dis. 19(6):392-7. doi: 10.1053/j.ackd.2012.07.011.
  5. Diamond, H. S., Lazarus, R., Kaplan, D., Halberstam, D. (1972) Effect of urine flow rate on uric acid excretion in man. Arthritis Rheum., 15(4), 338–346. https://doi.org/10.1002/art.1780150403.
  6. Kakutani-Hatayama, M., Kadoya, M., Okazaki, H., Kurajoh, M., Shoji, T., Koyama, H., Tsutsumi, Z., Moriwaki, Y., Namba, M., & Yamamoto, T. (2015) Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med., 11(4), 321–329. https://doi.org/10.1177/1559827615601973.
  7. Choi, H. K., Liu, S., Curhan, G. (2005) Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum., 52(1), 283–289. https://doi.org/10.1002/art.20761.
  8. Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W., Curhan, G. (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med., 350(11), 1093–1103. https://doi.org/10.1056/NEJMoa035700.
  9. Bardin, T., Richette, P. (2017) Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC medicine, 15(1), 123. https://doi.org/10.1186/s12916-017-0890-9.
  10. Jakše, B., Jakše, B., Pajek, M., Pajek, J. (2019) Uric Acid and Plant-Based Nutrition. Nutrients, 11(8), 1736. https://doi.org/10.3390/nu11081736.
  11. Siener, R., Hesse, A. (2003). The effect of a vegetarian and different omnivorous diets on urinary risk factors for uric acid stone formation. Eur J Nutr., 42(6), 332–337. https://doi.org/10.1007/s00394-003-0428-0.