A diet for gout and high uric acid is necessary to treat and prevent worsening of the disease. The expert told us which products should be included in the daily menu, and which should be completely excluded.
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 joints and various tissues and occurs in connection with chronic hyperuricemia (increased levels of uric acid in the blood).
Uric acid is usually broken down and excreted from the body by the kidneys. However, if the body produces too much of it or the kidneys cannot adequately remove it from the body, uric acid builds up in the joints.
Gout is more common in men than women because estrogens increase the excretion of uric acid by the kidneys.
The main causative factors of gout appear to be diet and genetic predisposition.
Throughout history, gout has been commonly associated with the diet of the wealthy (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 moderate food intake 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 is distributed in the blood, filtered by the kidneys, and then excreted from the body in the urine. When this process is interrupted, excess uric acid can accumulate in the joints to form sharp crystals, which can cause severe joint discomfort and also cause kidney stones to form.
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.
Uric acid, which comes from high-purine foods, however, 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 a large role in determining how much uric acid is synthesized in the body.
According to a Boston University study of more than 600 people, those on a high-purine diet had a five times higher risk of developing gout than people on a low-purine diet. Taking purine bases was associated with an increase in gout attacks, regardless of whether they drank alcohol or took medication.
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 irritations, the level of uric acid in the blood plasma and body weight.
The basic principles of dietary therapy for gout are the complete provision of the body's physiological needs for energy, macro and microelements, dietary fiber, vitamins and minerals. We are usually talking 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 fat from animals (the ratio of animal and vegetable fat is 1. 2: 1) with an adequate content of unsaturated fatty acids ofω. -6 and ω-3 families, as well as a reduction in the carbohydrate portion of the diet by reducing the amount of easily digestible and refined sugars.
During the period of exacerbation of gout, it is recommended to exclude meat and fish products from the diet, using mainly liquid foods (jelly, compote, milk, lactic acid products, vegetable and fruit juices, liquid cereals) and drinking up to2 liters. liquid per day.
It is recommended to limit the consumption of table salt, as well as to ensure that the body receives a sufficient amount of vitamins, especially antioxidant vitamins (vitamins C, A, B-carotene).
The main goal of a diet for gout in men and women is to reduce purine bases in the body, which is achieved in several ways:
- Restriction of foods rich in purine bases (meat, fish).
- Including foods in your diet that can control uric acid levels (cereals, milk).
- Drinking enough fluids.
- Losing weight, achieving 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 offal (brains, kidneys, liver), meat extracts, sardines, anchovies, small shrimps, mackerel, fried legumes.
Limit the consumption of foods containing 50-150 mg of purines per 100 g - meat products (beef, lamb), poultry, fish, crustaceans, vegetables (peas, beans, lentils).
Given that 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 meat rich in purine. A typical portion of meat is 85 grams, and fish is 110-115 grams.
When cooking meat, up to half of the amount of purines enters the broth, so it is advisable to eat boiled meat. In any case, meat and fish dishes, if it is impossible to refuse them altogether, 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 as cholesterol levels in the blood increase, the secretion of uric acid by the kidneys worsens. It is believed that the daily diet should contain no more than 200 mg of purine bases.
Purine foods to avoid if you have gout:
- derivatives
It is recommended to avoid dishes such as chopped liver, as well as other offal such as kidneys, hearts, as they contain a lot of purines.
Alternative: You can eat other types of meat, such as poultry and beef, which contain fewer purines. For example, you could try a vegetarian recipe for mushroom and walnut pate, which mimics the taste of liver but contains ingredients that won't worsen 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 is 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 gout than those who drank less than one serving per month.
Alternative: You can drink diet sodas, which don't cause gout and can help you give up sweets. For example, you can try water with slices of lemon and lime. - Seafood
Some types of seafood—anchovies, mussels, crab, shrimp, sardines, herring, trout, mackerel, and others—contain moderate to high levels of purines. Men who ate more seafood were more than 50 percent more likely to have high uric acid levels compared to those who ate less 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 high-purine fish balanced with large portions of vegetables, such as roasted zucchini or broccoli in lemon juice, as lemon juice helps neutralize acid. urine. - alcohol
According to a 2014 study from Boston University School of Medicine, drinking wine, beer or spirits was associated with an increased risk of a gout attack. The more alcohol a person drank, the greater 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 a day.
Foods to avoid:
- smoked meat, canned food, frozen meat, fish;
- meat extracts, meat juices;
- dried beans (lima beans), lentils, peas, asparagus, frozen and canned vegetables;
- alcoholic drink;
- dry cereals, excluding husked rice, hulled wheat and milled wheat;
- dried fruits, except prunes;
- biscuits, confectionery products prepared with salt and powdered sugar;
- salt, hot sauces, gravy, mustard, marinades, spices, olives, ketchup and pickles.
Patients are advised to use foods and dishes with low or no purine content. The gout diet during an exacerbation should be particularly strict.
The general principles of the gout diet correspond to the typical recommendations for a healthy diet.
Weight loss
Being overweight increases the risk of developing gout and losing weight reduces the risk of gout. Research shows that cutting calories and losing weight—even without a purine-restricted diet—lowers uric acid levels and reduces the number of gout attacks. Losing weight also reduces the overall stress on your joints and also reduces the risk of diabetes.
Eating complex carbohydrates
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and drinks with high fructose corn syrup and limit your intake of naturally sweet fruit juices.
Drinking regime
Maintaining an adequate water regime. To accelerate the elimination of purine bases from the body in the diet, the total amount of fluids is increased to 2. 5 l/day (if there are no contraindications from the cardiovascular system). You can drink weak tea, fruits, berries, vegetable juices, milk, alkaline mineral water. It is advisable to avoid strong tea and strong coffee: frequent use can lead to deterioration.
Fat reduction
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 sources of protein.
Specific product recommendations
Underwear. Avoid meats such as liver, kidneys, which have high levels of purines and contribute to increased levels of uric acid in the blood.Red meat. Average serving size 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 high in purines. Research has shown that vegetables with high purine content, such as asparagus and spinach, do not increase the risk of gout or repeated 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 consumption of natural sweet fruit juices.Vitamin C. Vitamin C can help lower 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.
Recommended foods and drinks 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 also reducing the amount of saturated fat found in high-purine animal proteins.
Thus, a vegetarian diet is recommended for gout. In countries where the traditional way of life involves eating mainly plant foods, gout is rare.
It is important to understand that diet for gout is not the only treatment. Rather, it's 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.