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Is gout caused by overindulgence?

Posted June 04, 2012, at 11:15 p.m.

Gout is the most common form of inflammatory arthritis in men. It affects as many as 3.4 million men in the U.S. each year. It is first noticed as what appears to be an attack on your big toe. It causes swollen, red, hot and stiff joints. Gout also can attack heels, ankles, knees, wrists, fingers and elbows. Consider yourself at an increased risk of developing gout if you are male, have a family member who has gout and you drink alcohol. Postmenopausal women also are at an increased risk of developing gout. Anecdotal evidence suggests that purine-rich foods can trigger gout attacks, but it hasn’t been clear whether they cause immediate attacks

Famous sufferers of gout include Thomas Jefferson, King Henry VIII of England and Benjamin Franklin.

Gout occurs when high levels of uric acid in your blood cause crystals to form and accumulate around a joint. This can happen if your body produces extra acid or does not eliminate enough, or if you eat too many foods with purines. The first few attacks of gout usually get better in days. Eventually attacks last longer and occur more often. Untreated, gout can cause permanent joint and kidney damage.

Diet can help control gout. Drinking adequate water along with a diet low in alcohol and purine-rich foods and high in vitamin C can lower blood uric acid levels and lessen the frequency and severity of attacks. Obesity is also a risk factor for developing gout, so weight loss can help to lower your risk.

Gout treatment used to be strictly severe dietary restrictions, but now there are newer medications that also help treat the problem and have reduced the need for a strict gout diet. Still, gout long has been associated with diet, particularly overindulgence. Animal sources of purines — such as meat and seafood – are associated with a much higher risk of a gout attack than plant sources, such as beans, peas, lentils, oatmeal, spinach, asparagus and mushrooms. A gout diet can help to control the production of uric acid and may help prevent gout attacks or reduce their severity.

What to eat and avoid when it comes to managing gout

Managing gout means making lifestyle changes, such as eating fewer foods high in purines. Limiting those with the highest amounts may help control gout attacks. Here’s a list — from highest to lowest — of foods and their purine content.

Group A

Foods with a high purine concentration, about 150 to 1,000 milligrams of purine per 100 grams of food. Your doctor may recommend not eating these foods.

• Liver

• Sweetbreads

• Brains

• Fish roe/eggs

• Beer

• Kidney

• Sardines

• Gravies

• Broths

• Mussels

• Wine

• Anchovies

• Heart

• Herring

Group B

Foods with moderate amounts of purine, 50 to 150 milligrams per 100 grams of food. Your doctor may recommend that you not eat more than one serving of any of these foods each day.

• Meats

• Peas

• Cauliflower

• Lentils

• Yeast

• Beans

• Asparagus

• Mushrooms

• Spinach

• Whole-grain cereals

• Fowl (chicken or duck)

• Fish (except for those listed above)

• Other seafood

Group C

Foods with very few purines. You do not need to limit these foods to avoid purines.

• Vegetables (except for those listed above)

• Fruits

• Milk

• Eggs

• Spices and condiments, including salt and vinegar

• Refined cereals and cereal products

• Butter and fats (in moderation)

• Sugar and sweets (in moderation)

• Vegetable soups (clear broth)

• Nuts

A recent study looked at more than 600 men with gout. The patients were followed for about a year. During this time they experienced a total of 1,250 gout attacks, most in the toe joints. The average amount of dietary purines consumed during a two-day period without gout attacks was 1.66 grams, compared with 2.03 grams in the two days before an attack, according to a journal news release. Patients in the top 20 percent of purine consumption were nearly five times more likely to have a gout flare-up than those in the bottom 20 percent.

To follow a gout prevention diet:

Limit meat, poultry and fish. Animal proteins are high in purine

Eat more plant-based proteins. You can increase your protein by including more plant-based sources, such as beans and legumes.

Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid from your body. Drinking beer, in particular, has been linked to gout attacks

Drink plenty of fluids, particularly water. Fluids can help remove uric acid from your body.

Choose low-fat or fat-free dairy products. Some studies have shown that drinking skim or low-fat milk and eating foods made with them, such as yogurt, helps reduce the risk of gout.

Choose complex carbohydrates. Eat more whole grains and fruits and vegetables and fewer refined carbohydrates, such as white bread, cakes and candy.

Following a gout diet can help you limit your body’s uric acid production and increase its elimination. It’s not likely to lower the uric acid concentration in your blood enough to treat your gout without medication, but it may help decrease the number of attacks and limit their severity. By following the gout diet and limiting your calories — particularly if you participate in moderate daily exercise — you can improve your overall health by helping to achieve and maintain a healthy weight.

Gout itself may not be preventable, but you may be able to avoid things that trigger your symptoms.

 

Georgia Clark-Albert is a registered dietitian and adjunct nutrition instructor at Eastern Maine Community College who lives in Athens. Read more of her columns and post questions at bangordailynews.com or email her at GeorgiaMaineMSRDCDE@gmail.com.

 

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