For centuries, gout was called the “disease of kings” because it was associated with eating rich foods like meat and fish and consuming lots of alcohol. Gout is no longer a disease only affecting aristocrats, but impacts average adults who suffer from unbearable pain and joint swelling caused by the disease.
Gout, or sometimes referred to as gouty arthritis, is the most common form of inflammatory arthritis. It’s a serious disease that affects the joints and surrounding tissues, and it’s characterized by recurrent attacks, called flares, that can last days or even weeks and is extremely painful for sufferers.
An estimated 9.2 million Americans suffer from gout, according to the Gout Education Society. The incidence of gout has more than doubled over the past few decades and is the most common cause of acute joint inflammation in men over age 40.
“The number of people suffering from gout has also increased due to living with other conditions like high blood pressure, heart disease, kidney disease and diabetes. Any weight loss occurring from following a healthy eating plan not only helps reduce the risk of gout but also can have a positive effect on other comorbidities,” says Dr. Brian Mandell, chairman of academic medicine in rheumatology and immunologic diseases at the Cleveland Clinic and board member with the Gout Education Society. “Permanent joint damage may occur over time, but taking medications and following a common sense, healthy diet may help alleviate symptoms.”
[READ: A Patient’s Guide to Gout]
What Is Gout?
Gout is caused by excess levels of uric acid in the blood — known as hyperuricemia. Deposits of needle-like crystals settle in and around joints and tendons that lead to flares of severe joint pain and inflammation, swelling and redness often starting in the big toe, but it can occur in any joint.
Uric acid is created when the body breaks down purines, which are substances both produced naturally in the body and found in food. Normally uric acid is cleared efficiently from the body mainly by the kidneys, but if not enough of it is excreted through urine and stool, you can develop gout.
Purines come in two forms: endogenous and exogenous.
— Endogenous purines are made by the body and recycled from our RNA and DNA.
— Exogenous purines come from foods that are metabolized by the body as part of the digestive process.
What Not to Eat With Gout
Many foods can raise the level of uric acid in the blood. Chief among these are beer, beef, pork, shellfish and foods or beverages containing high-fructose corn syrup. High-fructose corn syrup is found in sodas and juices, certain cereals and pastries, ice cream and candy and other processed foods. In some people with gout, eating these foods can trigger flares.
“While certain foods have been known to trigger gout flares there is no regimented ‘gout diet,'” Mandell says. “Doctors advise patients to avoid drinking beer and extremely high purine foods. Low-fat dairy products can be beneficial in reducing urate levels slightly and reducing flares. At present, the major dietary message to patients includes limiting beer and mineral spirits and focusing on a heart-healthy, common sense, calorie-limited diet.”
Examples of high-purine foods include:
— Certain animal proteins such as fish (like sardines, anchovies, herring, codfish, scallops, trout and haddock), shellfish, pork, chicken, turkey, mutton, organ meats, bacon, venison and veal.
— Alcohol, beer (including non-alcoholic).
— Certain vegetables such as cauliflower, green peas, dried beans, mushrooms and asparagus.
— Processed and sugary foods such as what is found in a bakery, sodas, certain fruit juices, candy, ice cream.
What to Eat With Gout
Food choices are important as they can influence gout flares, but there is no substitute for the right medication and coming up with a treatment plan with your rheumatologist. When exploring what dietary choices are right for you, keep in mind that certain foods do not affect all people in the same manner, and paying close attention to how some foods impact any gout flares is critical for long-term success. When managing food and gout, become familiar with what are high-purine foods and low-purine foods to help guide your choices.
Examples of low-purine foods include:
— Coffee and tea.
— Whole-grain breads, cereals and pasta.
— Limited animal proteins such as low-fat milk, yogurt and cheese; eggs.
— Most fruits and vegetables, although be mindful of the sugar content in fruit and limit accordingly.
Tart cherry juice and cherries in general have a reputation as being helpful in managing uric acid levels. Some sufferers recommend adding certain spices and herbs to food that may help decrease inflammation. These include ginger, turmeric, apple cider vinegar or dandelion. Before trying anything in large doses double check with your doctor to be sure it isn’t going to interact with any medications you are taking.
Mainstream Diets for Gout
There are a number of different diet plans that can help limit uric acid production and increase its elimination. Diet alone, in most patients, is not likely to lower the uric acid concentration in the blood enough to treat gout without medication; however, it may aide in decreasing the number of flares and limit the severity.
Plant-based diets with or without limited animal proteins (think the low-purine kind) are easy to find these days. “Diets like vegan, vegetarian and Mediterranean have been shown to be helpful for those with gout. The DASH diet could also be another option. Within those dietary patterns, you will still need to pay attention to foods that are high in purines and avoid or limit them,” says Ginger Hultin, a nutrition expert advisor with the Arthritis Foundation and author of “Anti-Inflammatory Diet Meal Prep.”
The Mediterranean diet typically encourages nutrient-dense fresh fruits, vegetables, whole grains, legumes, herbs, spices, nuts, seeds and heart-healthy fats as found in the traditional foods eaten in countries bordering the Mediterranean Sea. It discourages added sugars, refined grains, sugar-sweetened drinks, processed meats and other highly processed foods. This eating plan has been shown to have many health benefits ranging from heart health to brain health. It is recommended frequently for those looking to lose weight and protect themselves from diseases like gout.
The DASH diet, which stands for dietary approaches to stop hypertension, was designed for those looking to support their heart health by concentrating first on foods rich in potassium, calcium, magnesium, fiber and protein such as fruits and vegetables, whole grains, fish, beans, nuts, low-fat dairy and poultry. It limits foods high in added sugars, saturated fats and sodium. As with the Mediterranean diet, many like it because it’s both flexible and balanced with foods easily found in a supermarket. This diet emphasizes portion size and provides nutritional goals both daily and weekly.
A different dietary approach is to look for one-on-one support. “Think about getting a referral to a registered dietitian or nutritionist who can help personalize your diet. Many people go to extremes when they first get diagnosed, but that can be unrealistic to stick to over the long term,” Hultin says.
Drink Lots of Water
Adequate hydration is a simple yet critical necessity for your body to process uric acid effectively and prevent unnecessary flares. A report from the U.S. National Academies of Sciences, Engineering, and Medicine set general recommendations for adequate daily fluid intake as:
— About 15.5 cups (3.7 liters) of fluids a day for men.
— About 11.5 cups (2.7 liters) of fluids a day for women.
These recommendations cover fluids from water, other beverages and food. “It is important to be mindful of your daily fluid intake. Drinking enough water with a gout diagnosis is one way of keeping your body healthy,” Hultin says.
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