Gout and a diet high in uric acid are necessary to treat the disease and prevent the disease from worsening. The specialist told 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 thousands of years. Gout is caused by the deposition of uric acid crystals in the joints and various tissues and is associated with chronic hyperuricemia (increased uric acid levels in the blood).
Uric acid is usually broken down and excreted from the body through the kidneys. However, if the body produces too much of it or the kidneys cannot remove it from the body properly, uric acid builds up in the joints.
Gout is more common in men than women because estrogens increase the excretion of uric acid through the kidneys.
Diet and genetic predisposition seem to be the main triggers of gout.
Historically, gout has generally been associated with the diets of wealthy people (a sign of prosperity! ) and excessive alcohol consumption, and dietary guidelines for gout have been around for a long time.
In 1876, A. B. Gerrod was one of the first to recommend reducing consumption of purine-rich foods such as meat and seafood. A little later, 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 a person with gout, you must first 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 excreted from the body in the urine. If this process is interrupted, excess uric acid can build up in the joints and form sharp crystals, which can cause severe joint discomfort and lead to the formation of kidney stones.
The role of purines in the development of gout
Purines are chemical compounds found in certain foods that break down into uric acid when metabolized.
However, uric acid, which comes from foods high in purines, only makes up 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 more than 600 people, those on a high-purine diet were five times more likely to develop gout than those on a low-purine diet. The intake of purine bases was associated with an increase in the frequency of gout attacks, regardless of whether they drank alcohol or took medications.
Diet and lifestyle modification are the main aspects of non-pharmacological treatment of gout.
The dietary principles used during treatment may 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 to ensure the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. We are usually talking about the "table number 6" diet.
The diet should contain an optimal amount of protein with a balanced amino acid composition, a reduction in the total amount of animal fats (the ratio of animal and vegetable fats is 1. 2: 1) with an adequate ω polyunsaturated fatty acid content. -6 and ω-3 families, and reducing the carbohydrate portion of 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, primarily by consuming liquid foods (jelly, compotes, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drinking no more than 2 liters. fluid daily.
It is recommended to limit the consumption of table salt, as well as to ensure that the body receives an adequate amount of vitamins, especially vitamins with antioxidant effects (vitamin C, A, B-carotene).
The main goal of the gout diet for men and women is to reduce purine bases in the body, which is achieved in several ways:
- Restriction of foods rich in purine bases (meat, fish).
- Including foods in the diet that can regulate uric acid levels (cereals, milk).
- Adequate fluid intake.
- Losing weight, achieving a healthy weight and proper eating habits.
A good rule of thumb is to eat healthy foods in moderation, this will be the best treatment.
Antipurine diet
It is recommended to exclude from the diet foods containing a large amount of purines (more than 150 mg / 100 g of product).
These products are: beef by-products (brain, kidney, liver), meat extracts, sardines, anchovies, small shrimps, mackerel, fried legumes.
Limit the consumption of foods containing 50-150 mg of purine per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Considering that the purine content in the meat of young animals is higher than in the meat of adults, this should also be avoided.
If you want to include animal protein in your diet, it is recommended to consume it only in moderation. Avoiding large portions of purine-rich meats is recommended. A typical portion of meat is 85 grams, fish 110-115 grams.
When cooking meat, half of the amount of purine goes into the broth, so it is worth eating cooked meat. In any case, meat and fish dishes, if it is impossible to refuse them completely, are included in the diet no more than 2-3 times a week.
A significant reduction in the consumption of saturated fats is also recommended, since the excretion of uric acid by the kidneys deteriorates in the event of an increase in the blood cholesterol level. It is believed that the daily diet should contain no more than 200 mg of purine bases.
High purine foods to avoid if you have gout:
- Byproducts
It is recommended to avoid foods such as chopped 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 poultry and beef, which contain fewer purines. For example, you can try a vegetarian recipe for mushroom and walnut pâté, which mimics the taste of liver but contains ingredients that won't aggravate gout symptoms. - Cold drinks
Although fructose and sugar-based soft drinks do not contain large amounts of purines, they have been shown to increase the risk of developing gout. This happens because uric acid is a byproduct of fructose metabolism.
Evidence shows that consuming large amounts of fructose can increase the level of uric acid in the blood.
Soda consumed with high-fructose corn syrup is linked to an increased risk of developing 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 sodas that don't cause gout and can help you give up sweets. For example, you can try water with lemon and lime slices. - Seafood
Some seafood—anchovies, clams, crab, shrimp, sardines, herring, trout, mackerel, and others—are moderate to high in purines. A study at Vanderbilt University Medical Center in Nashville found that men who ate the most seafood had more than 50 percent higher uric acid levels than men who ate the least.
Alternative: Since fish is good for the heart and blood vessels, it is worth keeping it in the diet. One option is low-purine cod. You can also eat small, palm-sized portions of high-purine fish 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 by Boston University School of Medicine, drinking wine, beer, or spirits is associated with an increased risk of gout attacks. The more alcohol a person drank, the greater their risk, the researchers found.
Alternative: The truth is that avoiding alcohol is the best way to prevent gout attacks. But since quantity really matters, the less alcohol the better – no more than one (women) or two (men) drinks per day.
Foods to avoid:
- smoked meats, canned goods, frozen meats, fish;
- meat extracts, broths;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic drinks;
- dried cereals, excluding hulled rice, hulled wheat and hulled wheat;
- dried fruits, excluding prunes;
- biscuits, confectionery products made with salt and powdered sugar;
- salt, hot sauces, sauces, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and foods with low or no purine content. During an exacerbation, the gout diet should be particularly strict.
The general principles of the gout diet correspond to typical recommendations for a healthy diet.
Weight loss
Being overweight increases the risk of developing gout, and losing weight reduces the risk of gout. Research shows that cutting calories and losing weight—even without a low-purine diet—lowers uric acid levels and reduces the number of gout attacks. Losing weight reduces the overall stress on the joints and also reduces the risk of diabetes.
Eating complex carbohydrates
Eat more fruits, vegetables, and whole grains, which provide complex carbohydrates. Avoid foods and drinks containing high fructose corn syrup and limit your intake of naturally sweet fruit juices.
The drinking system
Maintain a proper water system. In order to speed up the removal of purine bases from the body, the total amount of fluid is increased to 2. 5 l per day (if there are no cardiovascular contraindications). You can drink weak tea, fruit, berries, vegetable juices, milk, alkaline mineral water. It is advisable to avoid strong tea and strong coffee: frequent use can make it worse.
Fat reduction
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
Interiors. Avoid meats such as liver, kidney, which contain high levels of purines and contribute to an increase in uric acid levels in the blood.Red meat. Medium portions for beef, lamb and pork.Seafood. Some seafood, such as anchovies, clams, sardines, and tuna, contain more purines than other types. However, the overall health benefits of eating fish may outweigh the risks for those with gout. A moderate portion of fish is an integral part of the gout diet.Vegetables with a 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 gout attacks and limit alcohol consumption, especially beer, between attacks.Sweet food and drinks. Limit or avoid sugary foods such as sweetened cereals, baked goods, and candy. Limit the consumption of naturally sweet fruit juices.Vitamin C. Vitamin C can help reduce uric acid levels.Coffee. Some studies suggest that moderate coffee consumption may reduce the risk of gout. At the same time, the presence of concomitant diseases must be taken into account.Cherry. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Food and drinks recommended for daily consumption
- 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 also reducing the amount of saturated fat found in high-purine animal proteins.
Thus, a vegetarian diet is recommended in case of gout. Gout is rare in countries where the traditional way of life is predominantly plant-based.
It is important to understand that a gout diet is not the only treatment. Rather, it's a lifestyle change that can help reduce or eliminate gout symptoms.
Diet, calorie restriction, and regular exercise can also improve your overall health and quality of life.