Gout Foods: What Foods to Avoid with Gout
Gout is a common form of inflammatory arthritis that causes particularly painful symptoms in a joint or, if left untreated, multiple joints. The affected area will become red, warm to the touch, swollen, and incredibly sensitive. A gout attack will often erupt quickly and without warning, frequently waking sufferers in the middle of the night. These painful attacks are caused by high levels of uric acid accumulating into sharp, needle-like crystals in the joint.
Gout has a storied history, with rumors of famous sufferers ranging from Alexander the Great to King Henry VIII to Benjamin Franklin. Once known as the “Rich Man’s Disease” or the “Disease of Kings,” gout was thought to be an affliction of the wealthy. Modern medical research has taught us that gout is more likely caused by the frequent consumption of alcohol and red meat specifically, rather than lavish lifestyles in general. These habits caused the well-off to suffer from the disease more often than the average person who couldn’t afford those luxuries in their diet. Interestingly, this image has been flipped on its head in modern times. While the wealthy have the resources to access a variety of fresh produce, healthy alternatives, or perhaps even hired chefs to do the healthy cooking for them, it is now the less fortunate who are more likely to develop gout, due to the abundance of cheap, unhealthy food. In fact, many researchers attribute the sharp rise of gout diagnoses in recent years in part to the ever-worsening obesity epidemic.
There are a variety of factors that contribute to gout developing, and what you put into your body, unsurprisingly, affects the development of this disease. While there may not be foods that cause gout on their own, certain diets increase the likelihood of initial gout onset, as well as recurring episodes. Read on to learn what not to eat with gout.
What Triggers Gout?
Gout develops when the body cannot properly process high levels of uric acid (hyperuricemia) and it crystallizes in the synovial joint fluid. In addition to its common incidence in the big toe, gout is also found in other joints in the foot, ankles, knees, hands, and wrists. Early outbreaks tend to only affect a singular joint, however, if the disease is allowed to progress untreated, several joints will often become affected. The most severe manifestation is referred to as chronic tophaceous gout due to the development of tophi – large clumps of uric acid crystals that can break through the skin, opening the door to infections and even permanent bone damage.
So where does uric acid come from? Uric acid is a waste byproduct resulting from the breakdown of purines. Purines are organic compounds that are primarily naturally produced in the body, with about 20% of purines being derived from diet. While they may get a bad reputation from their role in gout, purines make up two of the four building blocks of DNA and RNA (adenosine and guanosine). When cells in your body die and the DNA within these cells break down, purines are released into the body. Some of those purines will be used in the formation of new cells, but a majority are sent to the liver. In the liver, they are broken down into uric acid, which is carried in the bloodstream to the kidneys in order to be processed, filtered, and ultimately excreted through urine. Purines, and more specifically their uric acid by-product, only become a problem when the body experiences an overload of the acid or loses the ability to adequately process the acid.
Excess purines are often introduced in the body through the food that you consume. Purines are abundant in:
- Alcohol, especially beer
- High fructose corn syrup, and other food and drinks high in fructose
- Red meat (beef)
- Organ meat (e.g. liver, kidneys)
- Oily fish (e.g. anchovies, mackerel, tuna, trout), as well as certain other seafoods like mussels and scallops
It is common for a gout attack to be triggered after a long weekend of indulging in an excess of alcohol. All alcoholic drinks contain purines, but the amount of purines does vary based on the type of alcohol. A study conducted by the Department of Analytical Chemistry at Teikyo University in Japan found the following breakdowns, showing beer as the worst offender:
- spirits, 0.7-26.4 micromol/L
- regular beer, 225.0-580.2 micromol/L
- low-malt beer, 193.4-267.9 micromol/L
- low-malt and low-purine beer, 13.3 micromol/L
In addition to bearing a higher purine load, your kidneys also have to focus on processing the alcohol and therefore their ability to excrete the uric acid that is created is compromised. Alcohol also causes dehydration, which further inhibits the body’s ability to process uric acid.
Sugar, specifically fructose, was first implicated with foods that cause gout in a study done by Dr. Hyon K. Choi at the Massachusetts General Hospital in Boston. This study evaluated over 45,000 men over a 12 year period, and found the consumption of soft drinks sweetened with high fructose corn syrup, as well as the consumption of fruit juice and whole fruits high in fructose, to be associated with a higher risk of gout. Diet soft drinks did not increase the risk of gout.
Red Meat, Organ Meat, and Seafood
Purine intake from animal sources – such as red meat, organ meat, and various fish and shellfish—was shown to increase the likelihood of a recurrent gout attack by up to five times. The impact of purines from animal sources persisted across designated subgroups including age, alcohol use, and use of medications (e.g. NSAIDs, allopurinol). It is unclear whether purines derived from plant sources have less of an impact, or these diets simply tend to contain less purine rich plants.
Shellfish, Glucosamine, Fish Oil, and Gout
As mentioned above, certain shellfish is high in purines and therefore should be avoided by those suffering with gout. What about medicines that are derived from shellfish, such as glucosamine? Glucosamine is a supplement that may help to slow the progression of osteoarthritis, which is unrelated to gout. It is natural to wonder if taking this supplement can increase purines in the body, ultimately worsening one form of arthritis while trying to manage pain from another. Thankfully, glucosamine is derived from the exoskeletons of shellfish, while purines are found in the meat of shellfish, meaning that glucosamine will not exacerbate gout symptoms. Similarly, purines are not found in high quality fish oil pills because they are highly purified and molecularly distilled, a process which is intended to remove heavy metals and other toxins, but also eliminates purines. Be aware that not all supplements are created equal, and it’s therefore important that the label specify that the fish oil pills are molecularly distilled.
Foods that Help Prevent Gout
In addition to cutting out foods that increase the amount of purines, and therefore uric acid, in the body, you may also be able to lower levels of the gout causing acid by adding to your diet.
Most notably, cherries and cherry juice extract have been shown to decrease the likelihood of recurrent gout attacks. This is due to anthocyanins, which are a pigment in the skin of the fruit that has powerful antioxidant and anti-inflammatory properties. Studies have also shown that ginger has anti-inflammatory properties and that taking concentrated ginger extract can provide a significant reduction in pain and stiffness in joints in some patients. Increasing your water intake is another particularly helpful diet modification that will help address hyperuricemia, as it helps the kidneys process it and excrete it as urine.
Taking a thorough medical history will be the first step that your doctor takes on the road to a diagnosis. This is important because the way the condition progressed will give clues to the diagnosis, and to which diagnostic tools should be used. For example, if your joint pain has developed and intensified gradually – perhaps over days or weeks – it is unlikely that you have gout, and you may be looking at a different type of arthritis (such as osteoarthritis or rheumatoid arthritis) or a different diagnosis altogether.
Once gout is suspected, arthrocentesis is the most effective way to confirm the diagnosis. This procedure involves extracting synovial fluid from the affected joint with a needle. While it may be painful for some patients, it is a highly effective diagnostic tool. The fluid is examined for the presence of uric acid crystals and, if present, they almost invariably signify the presence of gout. If calcium deposits are found instead, it is likely that you are suffering from pseudogout, which, as its name suggests, is a condition that is strikingly similar to gout.
Blood tests can be used to confirm whether the patient has hyperuricemia, however, hyperuricemia alone is not necessarily indicative of gout. Some individuals will have hyperuricemia and never develop gout, while some individuals do not have unusually high levels of uric acid in their blood during a gout attack. For these reasons, a blood test alone cannot confirm a gout diagnosis.
When to Contact a Doctor
It is important to consult a physician for an accurate diagnosis before starting any treatment. Depending on the severity of your condition, you may require medication in addition to the diet modifications outlined in this article. If you have gout and it is not properly treated, you have a very high risk of developing more frequent and severe gout attacks. In addition, you can develop chronic tophaceous gout which can cause irreversible damage to your joints and the surrounding bones. If you or a loved one are experiencing gout-like symptoms, you can make an appointment with your primary care physician or visit an urgent care center in order to be evaluated and diagnosed.