[soc_panel color=”blue”]By: Unber Shafiq[/soc_panel]
What’s the condition that affects more than four percent of the American population and was also among the first recognized clinical entities in the history of medicine? Gout. It is a form of arthritis – an extremely painful, inflammatory condition that affects joints. Resulting from hyperuricemia – high levels of uric acid in the blood – gout was named ‘the unwalkable disease’ by Hippocrates in the fifth century BC. During a gout attack, joints can swell and cause intense pain such that one might need crutches, a cane, or a walker to perform the daily activities.
Now, what is uric acid and how it translates into medical condition gout? Uric acid is produced in our bodies as a result of purine breakdown and within a specific range uric acid makes a normal component of the blood. Purines make a large class of molecules that play different roles in the body, for example, four essential building blocks of DNA and RNA are purine. Chronic intake of purine-rich diet can lead to high uric acid in the blood which may translate into gout – a clinical condition accompanied by symptoms.
Nearly fifty percent of the cases of gout have swelling of the big toe, while other cases have affected fingers, wrists, knees, and heels. It all results due to uric acid crystal deposition in and around the joints. The symptoms of gout include the following:
- Intense pain in the affected joints (Hint: the unwalkable disease)
- Erythema (redness)
- High temperature in the affected area
Dietary Guidelines & Restrictions to Prevent Gout Attacks
Despite treatment modalities and availability of knowledge on prevention, most individuals have a poorly controlled condition and get recurrent attacks, i.e., the active periods of gout. As soon as the uric acid levels turn down to normal range, the clinical disease disappears. The symptoms arise again – usually due to low intake of gout-friendly diet and high consumption of purine-rich diet – when uric acid levels shoot high above the average range.
This article will take you through some dietary guidelines you can use to improve the recent gout attack and prevent future flare-ups.
What is a Gout-Friendly Diet?
What goes in the stomach has a lot to determine about your health and well being. Anyone living with gout would know of the importance of diet in generating or preventing a gout attack. While high levels of uric acid can be due to various factors, in most cases of gout, food is involved. Research has shown various purine-rich foods to be the causal factor behind higher than normal uric acid levels in the blood. What’s a normal uric acid level anyway?
The normal uric acid values for men are 4.0 to 8.5 mg/dL and for women 2.5-7.5 mg/dL. Anyone with gout should aim for less than 6 mg/dL. This safety mark makes sense. If someone already has 7mg/dL of uric acid in their blood, there are higher chances of this number crossing the upper limit of normal values.
Coming back to our topic of discussion, the gout-friendly diet, purine-rich foods are generally considered bad for someone with recurrent gout attacks, whereas diet low in purine content and high in some other compounds can help prevent and even lower the intensity of a gout attack.
Gout Friendly Diet: Foods to Eat
As a general principle, you are to eat foods that won’t add pounds to your waste, drink plenty of water, eat more fruits and veggies, consume whole grains to get complex carbohydrates and opt for lean meat and poultry for protein intake.
Here’s a detailed account of gout-friendly foods:
Fruits that help to lower uric acid levels include the following:
Most vegetables are safe to consume during gout and can be eaten without any restrictions. Daikon and it’s leaves with some sprinkled lemon juice are used as a home remedy to reduce uric acid.
There are only a few high-purine-content-vegetables that are to be avoided. Details are given in the “Foods to avoid” section.
While eating red meat and certain kind of sea food have been associated with gout, low-fat dairy consumption can actually help during the flare-ups. Restricting on meat, fish, and other seafood limits your protein intake. Be sure to take low-fat yogurt, milk, and cheese to compensate for the protein requirements of your body.
No debate on the quote, “Water is life,” but drinking adequate water can be helpful in preventing kidney issues and also in fighting a gout attack. The National Academies of Sciences, Engineering, and Medicine recommends about 3.7 liters of daily water intake for men and 2.7 liters for women.
5. Complex carbohydrates
Instead of refined carbs, a diet rich in complex carbohydrates is safe to consume when uric acid levels are high. In fact, researchers have discovered that individuals who follow the DASH (Dietary Approaches to Stopping Hypertension) diet have a low risk of developing gout – DAHS diet is rich in fruits, vegetables, and whole grains.
If you are a daily contributor to 400 million cups of coffee consumption in the United States, know that coffee can safely be consumed before, during, and after a gout attack.
Although high uric acid is a scary reality that can interfere with your daily routine, you can still enjoy your regular cup of coffee.
Foods to avoid during a gout:
More than the gout-friendly diet, you need to keep an eye out for foods that can cause a spike in the uric acid levels. That food is actually high in purine content. Take a look at the following list of high and moderately high purine foods to form a meal plan that’ll help you overcome gout more efficiently.
All forms of meat are either high or moderately high in purine content. High purine meat forms include:
- Organ meat (brain, heart, kidney, liver)
- Red meat
Moderately high purine meat includes:
While most websites would tell you to include lentils to your diet even if you have high uric acid, the doctors suggest otherwise. Lentils are high in purine and can cause a gout attack in a short period if the uric acid levels are already high. Once the attack phase is over, you can limit your intake, but during the active gout phase, avoid using lentils as food.
3. Certain veggies
Avoid high-purine vegetables during a gout attack and limit their use during pain-free days. Here’s a list of high-purine vegetables to avoid/limit:
- Green peas
Medical conditions are cruel not only in ways they cause suffering but also how they restrict the intake of your favorite foods. Gout does the same. Your love for fizzy drinks and soda might be intense, but that would also result in high uric acid levels. If you cannot wholly avoid these drinks, try to limit the intake.
Your present gout attack may be due to alcohol consumption. High levels of purines in alcoholic drinks interfere with the uric acid removal from the body. To prevent this situation, follow these guidelines:
- Avoid alcohol and beer during a gout attack
- Limit the intake of wine
Similar to meat, seafood is also divided into high and moderately high purine food. The high purine seafood includes:
Seafood moderately high in purine includes:
7. Refined carbohydrates
Avoiding refined carbs can be hard if you have a sweet tooth. However, these are also associated with recurrent gout attacks. Decrease your intake of candy, white pasta, cakes, white bread; in short, avoid (during attacks) or limit (during normal days) consuming any bakery products made from refined carbohydrates.
8. Fructose-rich foods
The debate on the effects of fructose on uric acid levels continues to date. What we know for sure is that a high fructose diet is associated with obesity, a risk factor for gout. A meta-analysis of cohort studies on fructose intake and risk of gout and hyperuricemia showed that a diet high in fructose and sugar is associated with a high risk of developing gout. You can opt for a healthy alternative to satisfy your sweet tooth.
Can lifestyle changes help improve uric acid levels?
In the early 19thcentury, the primary focus of scientists was on curative medicine. But the increasing global burden of disease led the researchers to look for ways to prevent diseases. This resulted in increased awareness about diet and lifestyle and their impact on human health.
A healthy lifestyle can surely help prevent gout attacks. Keep in mind that lifestyle is not a cure. If you are going through a painful episode, you will still need medications and some dietary changes to bring back the uric acid levels to normal. However, regular and appropriate lifestyle, including exercise habit can save you from pain in the future.
Risk factors for Gout
Knowing the risk factors of gout can help you tackle the problem from a correct angle. As mentioned earlier, gout is a result of high uric acid in the blood. Therefore, all factors that are related to uric acid production and excretion are also risk factors for gout. Here’s a detailed list of all things making you prone to this form of arthritis:
We have already discussed the diet factor in detail. High-purine foods cause an increase in uric acid levels.
Over the past twenty years, the prevalence of gout has significantly increased, just like the prevalence of obesity. Both are interrelated. Having a high body mass index can be a risk factor for gout even in young age.
3. Kidney issues:
Uric acid is excreted through urine. Any condition affecting the renal function can also cause an interruption in the excretion of uric acid, and hence, high uric acid levels.
4. Family history:
Individuals with a family history of gout are more likely to develop gouty arthritis. However, not having a family history does not spare the risk.
An important factor in eliminating uric acid from the body is an adequate intake of fluids. Dehydration can result in low urine output and this, in turn, leads to build up of uric acid in the blood.
What brings a cure to a particular disease can also interfere with other body functions. Medications, especially diuretics, low dose aspirin, and immunosuppressants increase the risk of gout.
Along with a gout-friendly diet, should I take over the counter drugs during an attack?
Sometimes, gout can be a highly debilitating condition affecting a person’s ability to walk. While diet can help in a speedy recovery and prevention from new attacks, it doesn’t reduce pain and swelling resulting from gout.
Getting your uric acid levels checked is the first step to recovery. Your healthcare provider – usually someone who specializes in treating arthritis (a rheumatologist) – will prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or diclofenac sodium to treat pain and swelling. Steroids, such as prednisone, and anti-inflammatory drug like colchicine are also prescribed. These drugs are for short-term treatment. You may also be prescribed a uric acid-lowering drug like Allopurinol, Pegloticase, or Probenecid for long-term treatment.
Complications of high uric acid levels
An increase in uric acid levels not only initiates a gout attack but it can also lead to the chronic condition if not treated well. The persistent presence of uric acid crystals in the vicinity of joints can lead to tissue destruction. Although this is an advanced stage taking almost a decade to develop, patients with gout need to make timely consultation with their doctor to prevent permanent joint damage.
Home remedies coupled with early treatment and lifestyle changes can significantly improve the life quality of individuals with gout. These are the excellent choice to bring back uric acid levels within a normal range.
Check out these healthy yet yummy food swaps to lower your uric acid.