A diet for gout and high uric acid is necessary to treat and prevent the disease from getting worse. Experts tell 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 conjunction with chronic hyperuricemia (increased uric acid levels in the blood).
Uric acid is normally broken down and removed from the body by the kidneys. However, if the body produces too much 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 estrogen increases the excretion of uric acid through the kidneys.
The main causative factors of gout appear to be diet and genetic predisposition.
Throughout history, gout has typically been associated with the diets of the wealthy (a sign of luxury! ) and excessive alcohol consumption, and dietary guidelines for gout have existed for a long time.
In 1876 A. B. Gerrod was one of the first to recommend reducing the consumption of foods rich in purines, such as meat and seafood. Soon, Professor Ebstein recommended a moderate diet with plenty of water, fruits such as cherries and strawberries, and avoiding alcohol.
Causes of gout
To understand how purines can affect someone with gout, you first need to understand how gout occurs.
Gout develops when uric acid builds up in the body. Normally, uric acid dissolves in the blood, is filtered by the kidneys, and then removed from the body in the urine. When this process is disturbed, excess uric acid can accumulate in the joints to form sharp crystals, which can cause severe joint discomfort and even trigger the formation of kidney stones.
The role of purines in the development of gout
Purines are chemical compounds found in certain foods that are broken down into uric acid when metabolized.
Uric acid, which comes from high-purine foods, 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 over 600 people, those who ate a high-purine diet had a five times higher risk of developing gout than those who ate a low-purine diet. Purine base intake was associated with increased gout attacks, regardless of whether they drank alcohol or took medication.
Diet and lifestyle modification are the main aspects of non-pharmacological treatment for gout.
The principles of nutrition 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 basic principle of diet therapy for gout is the full provision of the body's physiological needs for energy, macro and micro elements, dietary fiber, vitamins and minerals. Usually we talk about the "Table Number 6" diet.
The diet must include an optimal amount of protein with a balanced composition of amino acids, a reduction in the amount of animal fat (the ratio of animal fat and vegetables is 1. 2: 1) with a sufficient content of unsaturated fatty acids ω. -6 and ω-3 families, as well as a reduction in the proportion of carbohydrates in the diet by reducing the amount of easily digestible and refined sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, use mainly liquid foods (jelly, compote, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drink up to 2 liters of liquid per day.
It is recommended to limit the use of table salt, as well as ensure that the body receives a sufficient amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of the diet for gout in men and women is to reduce the purine base in the body, which is achieved in several ways:
- Limit foods rich in purine bases (meat, fish).
- Include foods in your diet that can control uric acid levels (grains, milk).
- Drink enough fluids.
- Lose weight, achieve a healthy weight and proper eating habits.
A good rule of thumb is to eat moderate portions of healthy food, this will be the best treatment.
Antipurine diet
It is recommended to exclude from the diet foods that contain a large amount of purines (more than 150 mg per 100 g of product).
These products include: beef by-products (brain, kidney, liver), meat extract, sardines, anchovies, small shrimp, mackerel, fried beans.
Limit the consumption of foods containing 50-150 mg of purines per 100 g - meat products (beef, lamb), chicken, fish, crustaceans, vegetables (peas, beans, lentils).
Since 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 to consume it only in moderation. It is recommended to avoid most purine-rich meats. A typical serving of meat is 85 grams, and fish is 110-115 grams.
When cooking meat, up to half the amount of purine goes into the soup, so it is advisable to eat boiled meat. In any case, meat and fish dishes, if it is impossible to refuse them altogether, 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 an increase in the level of cholesterol in the blood, the excretion of uric acid by the kidneys becomes worse. It is believed that the daily diet should contain no more than 200 mg of purine base.
High purine foods to avoid if you have gout:
- By-products
It is recommended to avoid dishes such as minced liver, as well as other offal such as kidney, heart, as they contain a lot of purines.
Alternative: You can eat other types of meat, such as chicken and beef, which contain less purines. For example, you can try a vegetarian recipe for mushroom and walnut pate, which mimics the taste of liver but contains ingredients that won't worsen gout symptoms. - Cold drink
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 has shown that consuming large amounts of fructose can increase uric acid levels in the blood.
Drinking soda with high fructose corn syrup has been linked to an increased risk of gout. According to a study published in the journal BMJ, men who drank two or more servings of sparkling water per day had an 85% higher risk of gout than those who drank less than one serving per month.
Alternative: You can drink diet soda, which does not cause gout, and can help you give up sweets. For example, you can try water with lemon and lime slices. - Seafood
Some types of seafood—anchovies, clams, crabs, 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 in 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, palm-sized portions of high-purine fish balanced with a large portion 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 liquor is associated with an increased risk of gout attacks. The more alcohol a person drank, the greater their risk, the researchers found.
Alternative: In fact, avoiding alcohol is the best way to prevent gout attacks. But since quantity is so important, less alcohol is better—no more than one (women) or two (men) drinks per day.
Foods to avoid:
- smoked meat, canned food, frozen meat, fish;
- meat extract, soup;
- dried beans (lime beans), lentils, beans, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dry grains, excluding husked rice, husked wheat and milled wheat;
- dried fruits, except prunes;
- biscuits, confectionery products prepared with salt and powdered sugar;
- salt, hot sauce, gravy, mustard, marinade, seasoning, olives, tomato sauce and pickles.
Patients are advised to use foods and dishes that are low in purines or without them at all. Diet for gout during exacerbation should be very strict.
The general principles of the gout diet correspond to the usual recommendations for a healthy diet.
Weight reduction
Being overweight increases your risk of developing gout, and losing weight reduces your risk of gout. Research shows that reducing 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.
Eat complex carbohydrates
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and drinks with high fructose corn syrup and limit your intake of naturally sweetened fruit juices.
Drinking regime
Maintain an adequate water regime. To accelerate the elimination of purine bases from the body in the diet, the total amount of fluid is increased to 2. 5 l / day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruit, berries, vegetable juice, milk, alkaline mineral water. It is advisable to avoid strong tea and strong coffee: frequent use can cause aggravation.
Reduce fat
Reduce your intake of saturated fat from red meat, fatty poultry and full-fat dairy products.
Choose lean meat and poultry, low-fat dairy products and lentils as sources of protein.
Product Specific Recommendations
offal. Avoid meat such as liver, kidney, which have high purine levels and contribute to increased uric acid levels in the blood.Red meat. Medium serving size for beef, lamb and pork.Seafood. Some types of seafood, such as anchovies, scallops, sardines and tuna, contain more purines than others. But the overall health benefits of eating fish may outweigh the risks for gout sufferers. A moderate portion of fish is part of a gout diet.Vegetables with high purine content. Research has shown 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 a gout attack and limit alcohol consumption, especially beer, between attacks.Sweet food and drinks. Limit or avoid sugary foods such as sweetened cereals, baked goods and sweets. Limit the intake of naturally sweet 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.
Food and drinks recommended for daily use
- 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.
Therefore, for gout, a vegetarian diet is recommended. In countries where the traditional way of life involves eating mainly plant foods, gout is rare.
It is important to understand that diet for gout is not the only treatment. Instead, it's lifestyle changes that can help reduce or eliminate gout symptoms.
Following a diet, along with calorie restriction and regular exercise, can also improve your overall health and quality of life.