Here I look at the foods that cause gout and how you can treat/prevent it
What is gout?
Gout is a common and painful form of arthritis that tends to occur more frequently in men than women, and is more likely to occur as we age. Gout causes swollen, hot and stiff joints, and ensues when uric acid builds up in the body. Under normal conditions, uric acid dissolves in the blood, passes through the kidneys and out the body in urine. However, under the right (or wrong) conditions, excess uric acid leads to crystal formation in and around the joints (termed monosodium urate crystal deposition). This process sets off an inflammatory reaction, and causes great pain and discomfort.
Sources of uric acid
Sources of uric acid include the breakdown of substances called Purines. Purines occur in naturally in the body’s tissues, and are crucial for normal physiological function (they’re not inherently ‘bad’). Purines also occur in foods we eat. (Purine rich foods include: liver, meat, fish, beans and peas, and anchovies, which have also traditionally been viewed as the foods that cause gout). However, the traditional dietary approach to treating Gout – restricting (purine containing) foods that cause gout for instance, as well as adopting a low protein diet with unlimited carbohydrate consumption – may not be the most beneficial approach in alleviating the debilitating effects of gout. Foods that cause gout have typically been seen as alcohol, meat and fish, and other purine containing foods like spinach, beans and peas. Current guidelines for treating gout, therefore, may need revising. Here’s why…
A research study (Dessein et al. 2000) concluded that general weight reduction, along with a change in proportional macronutrient intake (i.e. the ratio of carbohydrates to fat to protein in ones diet) is potentially very beneficial in reducing the symptoms and markers of ill-health in people with gout. The idea that these changes may be beneficial in people with gout came about as similar dietary/nutritional changes appear to alleviate issues in people with other metabolic disorders, including: insulin resistance, obesity, hypertension or coronary artery disease. Moreover, the presence of another metabolic disorder – as listed above – in people with gout is common; where people have gout, they tend to have another disorder.
What were the changes in macronutrient ratios?
Participants of the study were encouraged to: switch refined carbohydrates for complex carbohydrates (without the specific details given, one would assume a switch from processed/refined carbohydrates to whole/fresh/natural sources e.g. white rice, potato & vegetables); increase their consumption of monounsaturated fat e.g. macadamia nuts and almonds, olive oil and avocado; and consume oily fish at least 4 times per week. In actuality, carbohydrates were slightly reduced, protein was slightly increased (previously a controversial piece of advice), and fat was modified (with an increase in unsaturated fat and a decrease in saturated fat). Interestingly, foods high in purines (previously thought to cause gout) were NOT restricted.
Result: participants in the study who adopted the dietary recommendations given appeared to significantly improve their condition. Specifically, the number of gouty attacks reduced, whilst their serum urate levels also declined. This occurred along with a reduction in triglyceride and Low-density-Lipoprotein levels (i.e. beneficial changes to cholesterol numbers).
Caveat: participants were also on a calorie restricted diet. As such, participants lost weight, improved their insulin sensitivity, and reduced blood glucose levels. These changes would be seen as beneficial in most individuals, regardless of whether or not they have/had gout. It is therefore likely that a combination of caloric restriction AND dietary manipulation (e.g. food swaps) have benefits on individuals with gout; whether beneficial changes on an individual’s gout condition would occur purely from food swaps – without caloric restriction – remains to be seen (especially in long-term controlled study trials).
Gout appears to be an inflammatory disease that can be contained, and improved, largely through medication and/or dietary intervention. Individuals with gout should reduce overall caloric/food consumption, in order to promote weight loss and improve insulin sensitivity. In addition, reducing the consumption of alcohol appears an effective method by which to control and treat gout. Beyond that, reducing overall carbohydrate consumption (from bread, pasta, cereal), restricting refined/processed foods (sweets, confectionary, fast food & fried food, baked goods & pastries), and eating foods good for gout like unsaturated fat (from oily fish, nuts, avocado and olive oil), high quality protein from meat & fish, and whole grains, such as quinoa and rice would be positive steps in reducing the symptoms of gout.
*the typical low purine diet may NOT be the most beneficial for treating gout