Conventional dietary recommendations for gout have always been based on avoiding alcohol, coffee, tea and foods rich in compounds called purines that occur in red meat and fish.
A recent review by Martani Lombard of NICUS (Nutrition Information Centre, Stellenbosch University, published in the September edition of The Specialist Forum, summarised the latest research findings relating to the treatment and prevention of gout. This publication has come up with some new and interesting recommendations which can help to alleviate a painful and often debilitating condition.
What causes gout?
The symptoms of gout which include painful and inflamed joints particularly of the hands and feet, are primarily caused when there is a build-up in the body of a compound called uric acid.
As mentioned above, certain compounds called purines, which are breakdown products of nucleoproteins, form uric acid when they are in turn broken down by the body. The uric acid accumulates in the blood (hyperuricaemia) and is then deposited as uric acid crystals in joints causing swelling and pain and impeding movement (Mahan & Escott-Stump, 2000).
Conventional dietary treatment of gout primarily concentrated on avoidance of purine-rich foods which then inevitably led to an increased intake of highly refined carbohydrates (another undesirable dietary practice because this can lead to increased insulin levels and the development of insulin resistance and metabolic syndrome). Consequently researchers have been examining a variety of diet factors that may help to improve gout treatment and have identified a number of new risk factors associated with this condition (Lombard, 2010).
The most important research results are as follows:
- A diet that reduces insulin levels and prevent insulin resistance will also reduce uric acid levels. In other words, the low-fat, low-glycaemic index (GI) diet that can help to prevent or treat insulin resistance will also benefit patients suffering from gout.
- Intakes of red meat should still be limited both to avoid increases in uric acid levels and excessive intakes of saturated fat which can also raised insulin levels and increase the risk of heart disease.
- Legumes (canned or cooked dry beans, peas, lentils or soya) are no longer regarded as harmful to individuals with gout and researchers advise that patients can eat vegetable protein, legumes, as well as nuts, and other vegetables.
- Surprisingly drinking standard coffee or decaffeinated coffee was found to lower uric acid levels. This result was not obtained with tea or other beverages containing caffeine, so that the researchers concluded that another component of coffee and not caffeine, has this lowering effect on uric acid levels. This does not mean that gout sufferers should drink endless cups of coffee all day long, but a moderate intake of 2-3 cups of coffee is allowed.
- The use of low-fat milk and dairy products (yoghurt, cottage cheese) helped to lower uric acid levels and it is recommended that gout patients should have at least 2 servings of low-fat dairy or milk a day.
- Fruit juices and fructose (which is sometimes used instead of sugar or sucrose to sweeten foods, particularly diabetic products) raised uric acid levels significantly. The use of fruit juices and fructose-rich foods is regarded as an important risk factor for the development of gout and patients should limit their intakes of fruit juice and fructose-sweetened foods.
- In recent studies it was found that drinking sweetened cold drinks increased uric acid levels, which researchers attributed to the increased intake of the fructose such drinks contain. This finding in American subjects may not be as applicable in South Africa because sweetened cold drinks in this country are not produced from high-fructose corn syrup as is the case in the USA. However, patients with gout should limit their intake of sugar sweetened cold drinks and switch to artificially sweetened cold drinks if their gout worsens when they drink sweetened cold drinks. This will also help to prevent weight gain.
- Alcohol increases uric acid levels because it reduces the excretion of urates via the kidneys and also boosts the production of urate. Researchers did not identify any difference between the effect of alcohol in wine, beer or spirits. If you suffer from severe gout it is, therefore, a good idea to either cut out all alcohol or not to have more than one alcoholic drink a day.
- Body weight and an increased BMI were signficantly related to gout. Men with a BMI exceeding 27.5 (overweight range) were exposed to a 16-fold higher risk of gout than men with a BMI of 20 (low normal range).
- Although patients with gout may not be able to do certain exercises, the research reported by Lombard (2010) found that uric acid levels in the blood decreased when individuals did cardio exercise like running. At the moment, the role of exercise in the treatment of gout is still unsure because some scientists found that uric acid excretion is decreased in the post-exercise phase, which may worsen gout symptoms. However, the other benefits of exercise such as weight loss and reduced insulin resistance, make it an attractive option for gout patients who are able to exercise. Consider doing moderate exercise to combat gout, provided you don’t suffer from severe gout in your toes, etc.(Lombard, 2010)
Gout sufferers may, therefore, benefit for their traditional anti-gout diet combined with a reduction in the intakes of fructose from fruit juices and fructose-sweetened foods. Adding at least 2 servings of low-fat milk or dairy to your diet is also beneficial, as is losing weight and being more active. Also discuss the use of a low-fat, low-GI diet with your dietician.
(Lombard MJ, 2010. NICUS reviews the current dietary guidelines and recommendations for the prevention of gout. The Specialist Forum, September 2010, Vol 10(9):60-64; Mahan LK, Escott-Stump S (2000). Krause’s Food, Nutrition & Diet Therapy, 10th Edition. WB Saunders Co, Philadelphia)
Causes of Gout