What causes gout, what are purines and are there any natural food remedies for the condition? Dietitian Emer Delaney explains which foods to eat and avoid.
Gout is an arthritic condition that can cause sudden, severe joint pain. If you are experiencing symptoms of gout, the NHS recommends that you see a doctor for treatment during an attack and to help prevent further attacks.
We asked Emer Delaney, a dietitian who has worked in some of London's top teaching hospitals, to explain how diet and lifestyle can affect the condition.
What is gout?
Gout is a form of arthritis that occurs when high levels of uric acid cause crystals to form in the joints such as toes, ankles, wrists, elbows or fingers. Uric acid is usually broken down, and removed from the body by the kidneys. However, if the body produces too much, or the kidneys are unable to excrete it, uric acid builds up in the joints. It is also more common in men than women, because oestrogen increases the removal of uric acid through the kidneys. Diet and lifestyle modifications are core aspects of the non-pharmacological management of gout.
What are the symptoms of gout?
Gout is a very painful condition and a typical gout attack usually develops over a two to three hour period and often resolves within two weeks. The NHS advises that you always see a doctor if you experience the symptoms of gout, which include sudden, severe pain in any joint or red, hot, swollen skin over any joint.
Which foods should you avoid when you have gout?
Purines are compounds that are found in specific food and drink and they change to uric acid in the body. Most meat and seafood are high in purine and can increase uric acid levels in the body. These therefore should be limited during episodes of a gout attack and portion size should be reduced. Common examples of foods high in purine include anchovies, sardines, offal foods such as liver, kidney, sweetbreads, game, goose, minced meat, mussels, partridge, roe, scallops, herring, gravies, stock cubes and meat and yeast extracts.
What is the recommended diet for gout sufferers?
There are no foods that can completely prevent the symptoms of gout, but a diet low in purines may help to reduce the frequency of attacks. Following a nutritionally balanced, healthy diet that is low in saturated and trans fats and rich in unprocessed foods can help to reduce the risk of gout attacks. Care needs to be taken with certain vegetables such as asparagus, beans, cauliflower, lentils, mushrooms and spinach as these contain medium levels of purines.
While these don’t need to be avoided completely, portion size is important – a moderate intake should not increase the risks of gout. All other vegetables should be eaten freely. There is also evidence to suggest that a high consumption of low-fat dairy products (two 240ml glasses of skimmed milk per day), limiting sugary drinks and having a daily vitamin C supplement of 500mg may reduce the risk of gout. Speak to your GP before starting new supplements or altering your diet to manage gout.
It is important to note that it is the quantity of purine-rich food consumed that is more important than the purine content in each food. However, if a patient is keen to measure quantities of food, a maximum total daily purine intake of around 200mg is recommended.
How does drinking alcohol affect gout?
Alcoholic drinks tend to be high in purines and consuming more than the recommended amount can increase the risk of a gout attack. It is therefore recommended to limit alcohol intake, avoid binge drinking and avoid all alcohol if you have painful gout or are having a gout attack. Try limiting alcohol to a maximum of 14 units per week for both men and women and 1-2 units per day with a minimum of two alcohol-free days a week. Beer, stout, port and fortified wines tend to be higher in purines and should be restricted. Moderate consumption of wine (two glasses per day) is not associated with a significant increased risk.
Which other lifestyle factors can affect gout?
While there are no controlled studies or evidence on the effect of lifestyle changes on the incidence of gout, expert opinion is that positive changes in lifestyle can be beneficial to the management of gout. Being overweight is not recommended for gout suffers and the available evidence indicates that losing weight may helpful. Dietary modifications to achieve a healthy body weight are recommended, however the use of crash, high-protein and low-carbohydrate diets should be avoided. Slow and steady weight loss is ideal and support from a dietitian should be sought to help develop a sustainable and balanced weight loss plan. Rapid weight loss is not recommended as it can increase the amount of uric acid in the body leading to an increased chance of a gout attack.
Regular exercise such as swimming or walking is also recommended as it may help reduce the frequency of gout attacks. In addition, it may have a beneficial effect on associated co-morbidities such as type 2 diabetes, hypertension and insulin resistance.
This article was published on 6th February 2018.
Emer Delaney BSc (Hons), RD has an honours degree in Human Nutrition and Dietetics from the University of Ulster. She has worked as a dietitian in some of London's top teaching hospitals and is currently based in Chelsea.
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