Beating Gout

Diet is the most common method dragged out as a means of controlling gout but as I have written in previous posts, diet alone can almost never eliminate gout. Research has shown that diet, even tightly controlled diets can reduce uric acid levels by at most 1-2mg/dL (55-110µmols/L). This can ‘cure’ gout only if your uric acid levels are just over the level where gout becomes possible. For example, gout is only possible in people with uric acid levels above 6.8mg/dL (380µmols/L). If your uric acid level is normally 8mg/dL(440µmols/L), then with a very tightly restricted diet, you might be about to pull it off, but if you slip up — you’re in trouble. If your uric acid level is normally 9mg/dL(500µmols/L) then the best you can manage is 7mg/dL(390µmols/L) which would definitely reduce the number of attacks, but can never eliminate them entirely.

What’s more interesting is that the most commonly referred to diet for people with gout is a “low purine diet” but few people, even medical professionals, really understand what this means.  Yes, they may pull out some old chart that tells you to stay away from shellfish, beer and asparagus — among others, but you need to know these lists are only just guesses.

The word ‘purines’ refers to a class of nine substances:

The nine substances known as 'purines'.

Unfortunately, we know very little about how each of these nine purines effects uric acid levels, except perhaps with the exception of uric acid itself and xanthine.  While researching my book I found no information on how much of each of these nine purines is in any given piece of food.  The best I could find is how much actual uric acid is found in food.

There was one study that looked at coffee and tea drinkers to see if caffeine increased uric acid levels or the risk of gout.  For the coffee and tea lovers out there you will be happy to know that neither coffee nor tea increased uric acid or gout.  In fact, heavy coffee drinking (4-5 cups/day) actually slighly decreased uric acid levels (only about .5mg/dL or 27µmols/L).  It seems in this case there is something in coffee other than caffeine that lowered uric acid levels because the effect was the same with decaffeinated coffee drinkers as in caffeinated coffee drinkers and uric acid levels where unchanged in tea drinkers no matter how much they drank.

So until someone does a study to look at the effects on uric acid levels of each of the different types of purines and someone also measures the levels of each of these purines in common foods, most recommendations on low purine diets are really just guesses.  If fact, until recently it was believed that vegetables that are high in purines caused a rise in uric acid levels and gout but new research has shown this not to be the case – so scratch asparagus and mushrooms of that list of things you can’t eat.

Research has also shown that a diet designed to avoid metabolic syndrome (a precursor to diabetes and other nasty diseases) is just as effective at lowering uric acid levels as a low purine diet.  Not only that, most people find this diet far more palatable.  It also has the benefit of actually being healthy for you.  Low purine diets tend to be high in carbohydrates and saturated fats.  Though these diets are less restrictive than low purine diets that are a bit more complicated.  Here is an outline of this type of diet:

• Reduce the number of calories you eat to lose weight as needed.
• Carbohydrates in foods are ranked on a scale called the glycemic index, based on their effect on blood glucose levels. Eat foods with a low glycemic index.
  • Examples of foods with a low glycemic index are: most fruits and vegetables (except potatoes, watermelon and sweet corn), whole grains, pasta, beans, lentils.
• Eat at least 20 grams of dietary fiber, especially soluble fiber, each day.
• Eat six small meals instead of three large ones. This will reduce the amount of insulin released with each meal and lessen your chance of developing insulin resistance.
• Minimize the intake of food and beverages with high-fructose corn syrup and added sugars.
• Avoid foods rich in magnesium.
• Eat foods rich in vitamin C, beta-carotene, folate and vitamin B₁₂.
• Focus on eating more nuts and olive oil, which are good sources of heart-healthy fat. Just be sure to keep control of your calorie intake.
• Limit the amount of saturated fat, trans fat, cholesterol and sodium in your diet.
• Normally this diet recommends regular seafood consumption. Since seafood consumption can cause elevated uric acid levels, however, some experts have recommend replacing seafood consumption with plant-derived Omega-3 supplements (such as flax seed oil) or supplements of DHA (docahexaenoic acid) and EPA (eicosapentaenoic acid).
• Switch to fat-free and low-fat dairy products.
• Increase your physical activity.
• Avoid the use of and exposure to tobacco products.

The key in all cases in moderation.  Moderation of your diet both in the amount and kinds of foods you eat and moderation in alcohol consumption.  And of course, maintaining a healthy weight with reduced calorie consumption and moderate exercise are all extremely important not only for avoiding gout but in staying healthy generally.

The bottom line however, is that for 90% of us, this disease is genetic and you will very likely need to control uric acid levels with medication while using diet to keep uric acid levels low and, more importantly, keeping them stable.

If you liked this post, you will love the book, Beating Gout: A Sufferer’s Guide to Living Pain Free. Get the whole story in one easy-to-understand book, get your copy of Beating Gout: A Sufferer’s Guide to Living Pain Free now. Over 500 research articles and texts where studied and dozens of world class experts on gout were interviews for this book yet it is written for the non-expert. No other book on gout is more up-to-date, comprehensive or easy-to-understand – guaranteed!