Questions Being Raised About the Importance of Diet on Gout

An article that will appear in the September Issue of the Journal of the American Dietetic Association calls into question the long held belief that those with gout need to maintain a “purine-restricted” diet.  This article points out that some foods, such as some vegetables are very high in purines, yet research has consistently shown that consumption of these vegetables is strongly correlated with a reduction in uric acid levels and in gout attacks.  Research has also shown that beer is strongly correlated with higher instances of gout even though modern beers often have very low levels of purines.

Although diet has long been assumed to be associated with hyperuricemia, this association remains to be verified. Studies that have reviewed the relationship of diet and hyperuricemia have found it to be a difficult and complex issue.

Additionally, the exact purine contents of individual foods is often unknown.  Most data on the purine content of food only lists uric acid content and ignores the other eight substances that are classified as purines making it impossible to plan a diet that is truly low in purines (see, The ‘Skinny’ on Gout Diets).  Also, classical purine restricted diets are often very restrictive and difficult to follow.  They are also high in saturated fats and carbohydrates making them generally unhealthy.

The article then quotes the recommended diet from the American Dietetic Association Nutrition Care Manual which makes it’s recommendation based on the latest science and not based on traditional beliefs:

During an acute attack:
1. Consume 8 to 16 cups of fluid/day, at least half as water.
2. Abstain from alcohol (should be discussed with physician).
3. Limit animal foods. [Meaning foods that come from animals.]
4. Eat a moderate amount of protein. Recommended sources: low-fat or nonfat dairy, tofu, eggs, and nut butters.
5. Limit meat, fish, and poultry to 4 to 6 oz/day.

During remission:
1. Consume 8 to 16 cups of fluid/day, at least half as water.
2. Abstain from alcohol (should be discussed with physician).
3. Follow a well-balanced eating plan following the Dietary Guidelines for Americans. As tolerated, consume animal foods. Continue to eat a moderate amount of protein.
4. Maintain a desirable body weight. Avoid fasting or high-protein diets for weight loss.

Unfortunately, this confuses a great many people.  Purine-restricted diets have been recommended for many decades yet the overwhelming evidence is that they have very limited effect on uric acid levels and on reducing gout attacks.  I am always amazed at the hostility I encounter when making this argument.  Most people insist that a highly restricted diet has “cured” their gout.  However, when I probe a bit deeper, I often find that these people usually are still suffering attacks, although less frequently.  When gout is properly managed, gout attacks should stop entirely!

Diet does have an effect and can reduce attacks, but it is almost always insufficient to stop attacks entirely.  The only means to reliably stop attacks is by lowering uric acid levels to below 6mg/dL (333µmols/L).  Eating a highly restrictive diet can only lower uric acid levels by 1-2 mg/dL (56-111µmols/L).  So if your uric acid level is normally 9mg/dL (500µmols/L) the best you can do is 7mg/dL (389µmols/L) which will reduce attacks but not make them stop!

It’s time for the medical community to stop talking about low-purine diets and start talking about healthy diets that avoid foods that have been proven to increase gout while controlling uric acid levels with medication.  Unfortunately, most doctors are not up-to-date on the correct protocols to manage gout.  It is important for those suffering from gout to arm themselves with the correct information to make sure they get the best care possible.

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  1. #1 by TammyB on February 23, 2010 - 11:58 am

    You have an inaccuracy in your book which you need to correct/address.

    The section called LOW PURINE DIET has a summary of the foods to avoid because of high purine content, and the first item listed is “Food Made With Baker’s or Brewer’s Yeast.”

    Of course, the #1 food we eat made with Baker’s Yeast would mean BREAD. I wondered what you were basing that on so I flipped to Appendix A: Purine Content of food. Sure enough, it shows Baker’s Yeast yielding a whopping 680 mg of uric acid, as compared to a pork chop with 145 mg.

    However, like so many of these listings, it’s not based on realistic portion sizes, it’s just 100 grams across the board. 100 grams is about 3.5 ounces, or roughly the equivalent of 4 Reese Peanut Butter Cups! Who would ever eat that much Baker’s Yeast?

    On the other hand, checking under the Grains section of the list, 100 grams of actual BREAD (roughly 2 slices, but it will vary widely by type) is only 16 mg, as compared to an apple with 14.

    Since you fail to point out this distinction, I now don’t trust any of the other summaries this book offers.

  2. #2 by Gout Foods on September 12, 2010 - 10:22 pm

    I have found that not all foods containing certain purine levels (high or low) affect all people in the same way. I read in an article recently that one person was fine drinking beer and eating red meats but suffered gout attacks shortly after drinking tea, so keeping a record of what is consumed and how it affects you personally is quite a sensible thing to do.

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