A diet for gout and high uric acid is necessary to treat and prevent exacerbation of the disease. The expert told us which products should be included in the daily menu and which should be excluded altogether.
Gout: symptoms and treatment
Gout is the most common form of arthritis and has been known for several thousand years. Gout is caused by the deposition of uric acid crystals in the joints and various tissues and occurs in association with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is usually broken down and excreted from the body through the kidneys. However, if the body produces too much or the kidneys cannot properly remove it from the body, uric acid builds up in the joints.
Gout is more common in men than women because estrogen increases the excretion of uric acid through the kidneys.
The main factors causing gout appear to be diet and genetic predisposition.
Throughout history, gout has been commonly associated with rich people's diet (a sign of wealth! ) 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 the consumption of foods rich in purines, such as meat and seafood. A little later, Professor Ebstein recommended a moderate intake of foods 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 is then excreted from the body through urine. When this process is disrupted, excess uric acid can build up in the joints to form sharp crystals, which can cause serious joint discomfort and also trigger 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 purine-rich foods, makes up only about 15% of the uric acid in the body. The rest is found naturally in the body's tissues, and genes play an important role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those who followed a high-purine diet had a five times greater risk of developing gout than people who followed a low-purine diet. Ingestion of purine bases was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medications.
Diet and lifestyle modifications are the main aspects of non-pharmacological treatment of gout.
Dietary principles in treatment should 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 principles of diet therapy for gout are to fully satisfy the body's physiological needs for energy, macro- and microelements, dietary fiber, vitamins and minerals. We usually talk about the "Table number 6" diet.
The diet should include an optimal amount of protein with a balanced composition of amino acids, a reduction in the total amount of animal fat (the ratio of animal and vegetable fat is 1. 2: 1) with an adequate content of polyunsaturated fatty acids of the type ω. -6 and ω-3, as well as a reduction in the carbohydrate part of the diet by reducing the amount of refined and easily digestible sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid foods (jellies, compotes, milk, products with lactic acid, fruit and vegetable juices, liquid cereals) and drinking up to 2 liters. of liquid per day.
It is recommended to limit the consumption of table salt, as well as ensure that the body receives an adequate amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main objective of a diet for gout in men and women is to reduce the purine bases in the body, which is achieved in several ways:
- Limit foods rich in purine bases (meat, fish).
- Include foods in your diet that can control uric acid levels (cereals, milk).
- Drink adequate fluids.
- Lose weight, achieve a healthy body weight and proper eating habits.
A good rule of thumb is to eat moderate portions of healthy foods, this will be the best treatment.
Antipurine diet
It is recommended to exclude from the diet foods containing large amounts of purines (more than 150 mg per 100 g of product).
These products include: beef by-products (brain, kidneys, liver), meat extracts, sardines, anchovies, small shrimp, mackerel, fried legumes.
Limit consumption of foods containing 50-150 mg of purines per 100 g: meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Since meat from young animals has more purines than meat from adults, it should also be avoided.
If you want to include animal protein in your diet, it is recommended to consume it only in moderation. It is recommended to avoid large portions of meats rich in purines. A typical serving of meat is 85 grams and that of fish is 110 to 115 grams.
When cooking meat, up to half the amount of purines goes into the broth, so it is advisable to eat boiled meat. In any case, meat and fish dishes, if it is impossible to completely refuse them, are included in the diet no more than 2-3 times a week.
It is also recommended to significantly reduce the consumption of saturated fats, since with increased blood cholesterol levels the excretion of uric acid by the kidneys worsens. It is believed that the daily diet should not contain more than 200 mg of purine bases.
High-purine foods to avoid if you have gout:
- Byproducts
It is recommended to avoid dishes such as chopped liver, as well as other offal such as kidneys, heart, as they contain a large amount of purines.
Alternative:You can eat other types of meat, such as poultry and beef, which contain less purines. For example, you can try a vegetarian mushroom and walnut pâté recipe, which mimics the flavor of liver but contains ingredients that won't aggravate gout symptoms.
- Cold drinks
Although fructose and sugar-based soft drinks do not contain high levels of purines, they have been shown to increase the risk of developing gout. This occurs because uric acid is one of the byproducts of fructose metabolism.
Evidence has shown that consuming large amounts of fructose can increase uric acid levels in the blood.
Drinking soda with high fructose corn syrup has been 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 developing gout than those who drank less than one serving per month.
Alternative:You can drink diet sodas, which do not cause gout and can help you give up sweets. For example, you can try water with lemon and lime slices.
- Seafood
Some types of seafood (anchovies, mussels, crabs, shrimp, sardines, herring, trout, mackerel, and others) contain moderate to high levels of purines. Men who ate the most seafood were more than 50 percent more likely to have high uric acid levels compared to those who ate the least in a study conducted at Vanderbilt University Medical Center in Nashville.
Alternative:Since fish is good for the heart and blood vessels, it makes sense to keep it in the diet. One option is low-purine cod. You can also eat small, palm-sized portions of purine-rich fish, balanced with large portions of vegetables, such as roasted zucchini or broccoli in lemon juice, as lemon juice helps neutralize uric acid. .
- Alcohol
According to a 2014 study from Boston University School of Medicine, drinking wine, beer, or liquor was associated with an increased risk of a gout attack. The more alcohol a person drank, the higher 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, preserves, frozen meats, fish;
- meat extracts, broths;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic beverages;
- dry cereals, except husked rice, husked wheat and milled wheat;
- dried fruits, except for prunes;
- biscuits, confectionery prepared with salt and powdered sugar;
- salt, hot sauces, juices, mustard, marinades, condiments, olives, ketchup and pickles.
Patients are recommended to use foods and dishes that are low or do not contain purines. The diet for gout during an exacerbation should be especially strict.
The general principles of the gout diet correspond to typical recommendations for a healthy diet.
Weightloss
Being overweight increases your risk of developing gout, and losing weight reduces your risk of developing gout. Research shows that cutting calories and losing weight, even without a purine-restricted diet, reduces uric acid levels and reduces the number of gout attacks. Losing weight also reduces overall stress on the joints and also reduces the risk of diabetes.
Eat complex carbohydrates
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and drinks with high fructose corn syrup and limit intake of naturally sweet fruit juices.
Drinking regimen
Maintain an adequate water regime. To accelerate the elimination of purine bases from the body through the diet, the total amount of fluid is increased to 2. 5 l/day (if there are no contraindications on the part of the cardiovascular system). You can drink weak tea, fruits, berries, vegetable juices, milk and alkaline mineral water. It is advisable to avoid strong tea and coffee: frequent use can cause aggravation.
Reduce fat
Reduce your intake of saturated fat from red meat, fatty poultry and full-fat dairy products.
Choose lean meats and poultry, low-fat dairy products, and lentils as protein sources.
Product Specific Recommendations
- Offal.Avoid meats such as liver, kidneys, which have high levels of purines and contribute to increased uric acid levels in the blood.
- Red meat.Medium portions for beef, lamb and pork.
- Seafood.Some types of seafood, such as anchovies, clams, sardines, and tuna, contain more purines than other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish are an integral part of the gout diet.
- Vegetables rich in purines.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 foods and drinks.Limit or avoid foods that contain sugar, such as sweetened cereals, baked goods, and candy. Limit your consumption of naturally sweet fruit juices.
- Vitamin C.Vitamin C can help reduce uric acid levels.
- Coffee.Some studies suggest that drinking coffee in moderation may be associated with a reduced risk of gout. However, it is necessary to take into account the presence of concomitant diseases.
- Cherry.There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Foods 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 reducing the amount of saturated fat found in high-purine animal proteins.
Therefore, a vegetarian diet is recommended for gout. In countries where the traditional way of life involves eating predominantly plant foods, gout is rare.
It is important to understand that the gout diet is not the only treatment. Rather, it is a lifestyle change that can help reduce or eliminate gout symptoms.
Following a diet, along with calorie restriction and regular exercise, can also improve your overall health and quality of life.