Gout and Diet

You probably know someone who “has the gout” as I’ve heard it said dozens of times. If you have gout, you have a painful form of arthritis that develops when uric acid in the blood crystallizes, and these crystals then infiltrate and surround the joints. Uric acid is usually transported by the blood to the kidneys and is eliminated in the urine. Some people, however,  either overproduce the uric acid or their kidneys are unable to process a normal amount of uric acid. The joints become very painful and tender, red, warm, and swollen. During an attack, even a sheet or sock is capable of causing excruciating pain. Once you’ve had a gout attack, you’ll unfortunately likely have another. In fact,  60% of people will have another attack in a year, and 84% will have another attack within three years.

Individuals who don’t get their uric acid level under control can develop chronic gout, which results in permanent joint damage and loss of mobility, and can cause the formation of tophi, painless but disfiguring lumps of uric acid under the skin, as well as the creation of kidney stones. Gout is mainly a genetic disease, but a gout attack usually follows something that causes the uric acid level to spike or causes the uric acid crystals to shift, such as a night of drinking, an illness, or an injury. Crash diets and fasting, dehydration, and certain medications and treatments can also precede the development of gout. Gout usually develops in the big toe, but can also appear in another lower-body joint, like the ankle or knee. Subsequent attacks can involve the wrists and elbows.

Diet alone won’t cure gout because roughly two-thirds of the uric acid in your body is produced naturally. Only one-third is generated based on the foods that you eat. Individuals with gout need to take urate-lowering drugs to treat the problem, and then a diet can help to avoid another flare. Being overweight is a significant risk factor for developing gout, so especially if it runs in your family, you would be wise to try to keep your weight in a reasonable range. People with gout are more likely to have high cholesterol, high blood pressure, diabetes, and heart disease. Individuals that have had a gastric bypass surgery are also at higher risk than the general population.

The uric acid that crystallizes in gout sufferers is produced when the body breaks down a chemical called purine, and so, for years, health professionals have put patients on extremely restrictive low-purine diets when they present with gout. These days, experts suggest that patients limit these high-purine foods (rather than completely avoid them as patients have been told in the past), follow a Mediterranean diet, and try to lose weight.

High-purine foods to limit include:

  • Red meat – beef, pork, venison and other game meats, and lamb
  • Organ meats – liver, kidney, tongue, sweetbreads
  • Shellfish – shrimp, oysters, mussels, lobster, crab, scallops, clams
  • Some other types of seafood – anchovies, sardines, tuna, trout, mackerel, haddock, herring
  • Alcohol- more than two cocktails, glasses of wine, or beers a day can increase risk
  • Soda and other fructose-sweetened beverages, which have recently been found to increase risk
  • Sugar-sweetened cereals, pastries, candy, and other foods

High-purine vegetables such as spinach, mushrooms, and cauliflower did not seem to increase the risk of gout in recent studies. Sometimes people are told to choose low-fructose fruit such as strawberries and cherries., but even fruits that are higher in fructose are nowhere near as risky as drinks containing concentrated fructose, such as soda. Some research shows that vitamin C supplements (500-1,000 mg a day), drinking regular caffeinated coffee in moderation, and cherries help to reduce the risk of gout attacks. It’s a good idea to drink lots of fluids – between eight and 16 cups a day. People with gout should keep a food diary to find a pattern in foods that precede an attack.

The medications that lower uric acid, such as Allopurinol, can’t be taken until the most recent gout attack is over; in the meantime, patients are often prescribed Colchicine, nonsteroidal anti-inflammatory drugs, or corticosteroids to relieve pain and swelling. Elevating the affected joint, using an ice pack, or using a cane or crutches can also help.

Another health condition, pseudogout, which is caused by the accumulation of calcium pyrophosphate dehydrate (CPPD) is not helped with diet the way that gout is, although an anti-inflammatory diet (similar to the Mediterranean diet) might be somewhat helpful.