This article explains, among other things:
- What gout is and how it comes about
- Which foods are permitted and prohibited
- Why beer is a particularly sensitive issue with gout
- How to lower uric acid immediately
Let's start with the definition to have the same basic understanding of gout and the causes...
What is gout and what does diet have to do with it?
Gout describes a disorder of purine metabolism that causes uric acid crystals to form in the joints and tissues. A doctor can use the blood count to determine whether the uric acid level is too high and whether there is a risk of gout.
Men over the age of 40 are particularly frequently affected, which is due to the combination of beer and meat that is predominantly found in men.2
Women, on the other hand, are less likely to develop gout and if they do, it tends to be at an older age.3
A basic distinction is made between two different symptoms through which the disease manifests itself:
- Acute attacks of gout
In addition to sudden severe pain, an acute attack of gout is also characterized by swelling of the affected joints and fever - which is triggered by the inflammation in the joints.4
In rare cases, headaches and vomiting may also occur. If the acute gout attack is not treated with medication, it can take one to two weeks for the swelling to subside. - Chronic gout
After the first acute attacks, gout becomes chronic. The joints are destroyed over the long term and without much pain. This can be seen on an X-ray. In addition to the deformation of the joints, uric acid crystals are deposited in the kidneys, which can lead to kidney stones and, in the worst case, kidney failure.
As gout is often the result of a poor and unbalanced diet, it falls into the category of "diseases of affluence". Like most diseases of affluence, gout can be brought under control to a certain extent in the long term with the right diet.5
To a large extent, however, gout is genetic, which unfortunately cannot be influenced.6
A study from 2017 shows that losing excess weight is beneficial for lowering uric acid levels and thus reducing the risk of gout.7
Gout can be prevented through an appropriate diet. However, if you already have the disease, it can no longer be cured. In this case, the progression can be mitigated by a low-purine diet and the disease can be brought under control.
In order to understand how gout and diet are linked, we clarify the connection between the three crucial elements.
The connection between gout, purines and uric acid
The cause of gout is so-called hyperuricemia, which stands for an excessively high uric acid level in the blood. An excessively high uric acid level is in turn caused by a purine-rich diet.
Purines: what they do in the body
With purines8Purines, in the form of adenine and guanine, are an integral part of every human cell and are used to build DNA.
The purines contained in food and drink are converted to uric acid in the body after ingestion.
The intake of more than 500 mg of uric acid (approx. 450 g of chicken breast) per day should be avoided in order not to increase the risk of gout.9
Uric acid - degradation product of purine metabolism
Uric acid is formed at the end of the purine metabolism as a breakdown product of the purine bases. Uric acid forms crystals, which are white and odorless. If too many of these crystals form in the joints and tissues, the aforementioned disease gout occurs.
A purine-rich diet leads to increased uric acid levels, which in turn greatly increases the risk of gout.
If uric acid levels are too high, this is known as hyperuricemia. This is reached as soon as the uric acid level in the blood exceeds the limit of 7.4 mg/dl in men and 6.7 mg/dl in women.
Above this limit, the uric acid crystals can no longer be dissolved naturally in the body and they begin to form unhindered.
Doctors prescribe medication with allopurinol, benzbromarone and febuxostat to treat high levels of uric acid in the blood.
These foods are prohibited for gout
- Offal (e.g. sweetbreads, liver, kidneys)
- trout
- Sprat
- Canned fish (e.g. oil sardines)
- Seafood (e.g. shrimps)
- Beer
- Sugary drinks (e.g. cola)
- peanuts
The list of prohibited foods shows those foods that are at the top of every table of purine-containing foods (purine table) that can be found on authoritative websites such as the ÖGK. The higher up a food is on the list, the more likely it is to be avoided. The purine content is too high for people who suffer from gout.
In particular, foods with a purine or uric acid content of more than 300 mg per 100 g should be avoided.10
Purine-rich vegetables are also often included in banned lists for gout. However, a 12-year study has shown that consuming moderate amounts of vegetables with a high purine content does not lead to an increased risk of gout.11
Black tea or coffee can be drunk with a clear conscience.
Drinks table for gout sufferers
The table below lists various drinks and how dangerous their consumption is for gout sufferers:
Beer (also non-alcoholic): very harmful
High-proof alcohol: very dangerous
Sugary soft drinks: questionable
Sweetened fruit juices: questionable
freshly squeezed juices: harmless
Milk: safe
Coffee: desirable
Tea: desired
Water: desired
In general, still water, preferably with a dash of lemon juice (because of the vitamin C it contains), or tea should be drunk, as plenty of water helps to dissolve the uric acid better. Sugary soft drinks should be avoided if possible.12
The purines contained in foods and drinks are converted to uric acid in the body after ingestion.
Smoothies containing vegetables such as carrots or spinach are also very suitable. These contain very little fructose, but lots of valuable nutrients and vitamins.
Fructose and the diet for gout
Fructose describes nothing other than the fruit sugar contained in fruit. As fructose is contained in pineapples, bananas and other fruits, it is not a problem because the concentration is far too low.
It becomes problematic when foods with industrially isolated fructose are consumed.13 This artificial form of fructose is often used in processed food and ready meals because it is the most economically profitable for companies.
Apart from the fact that this increased intake of isolated fructose drives up insulin levels - which increases the risk of diabetes - the consumption of fructose also causes the body's own production of purines.
Anyone who has to watch their diet due to gout should avoid foods with added fructose as far as possible.
Beer and gout don't mix!
Beer is a double vice when it comes to gout. On the one hand, brewer's yeast contains too many purines, which drastically increases the uric acid level in the blood. On the other hand, the alcohol it contains prevents the body from breaking down uric acid optimally.
In the summer months at barbecues, beer is often consumed together with meat and sausages, which is doubly bad for gout patients.
In contrast to beer, the moderate consumption of wine is not a problem, as a study from 2004 found out.14 However, the exact components in wine that are harmless to uric acid levels have not yet been clarified.
Are chocolate and bananas okay for gout?
Don't worry, you don't have to give up chocolate if you have gout or are at increased risk.
Neither in the form of a bar nor as drinking chocolate do you need to have any concerns here. With chocolate, the added sugar is more of a problem if it is consumed in excessive quantities.
With a purine content of just 11 mg per 100 g, bananas are a safe food. Their vitamin C content also ensures that uric acid is reduced - more on this shortly.
What foods should you definitely eat if you have gout?
Several cups of coffee a day and vegetables containing vitamin C (e.g. peppers) can lower uric acid levels in the blood.15
A long-term study with over 45,000 participants suggests that more than 4 cups of coffee a day keeps the risk of gout low.16 It does not matter whether it is caffeinated or decaffeinated coffee. The researchers assume that the chlorogenic acid contained in coffee counteracts uric acid.
In general, with the exception of offal and the foods mentioned above, nothing needs to be completely avoided. Legumes and asparagus are also often in the line of fire of many critics. However, it is actually the dose or the combination with other purine-rich foods that has an unfavorable effect on uric acid in the blood.
A plate of lentils would still be okay as long as it is not consumed together with a lot of sausage and a beer.
Lowering uric acid naturally and plant-based with vitamin C
A high consumption of vitamin C has been shown to reduce the risk of developing gout.17
Fortunately, vitamin C occurs naturally in many varieties of herbs, vegetables, leafy greens and fruits. The following table lists foods with outstanding vitamin C content:
Foods: Vitamin C content per 100 g
Acerola: 1790 mg
Sea buckthorn: 450 mg
Rosehip: 426 mg
Nettle: 330 mg
Blackcurrants: 189 mg
Parsley: 159 mg
Wild garlic: 150 mg
Paprika: 140 mg
Broccoli: 115 mg
Brussels sprouts: 110 mg
Kiwi: 100 mg
Lemons: 53 mg
The higher the daily dose of vitamin C, the lower the risk of developing gout - especially acerola18 stands out here with its immensely high vitamin C content.
In a study conducted over 20 years, fewer people who consumed more than 1,500 mg of vitamin C per day developed gout than those who consumed less than 500 mg per day.
Cherries against gout
Cherries help against gout. This is proven by a study in which 633 people suffering from gout were followed for a year.19
People who ate cherries over a period of 2 days had a 35% lower risk of a gout attack - compared to people who did not consume cherries.
Another study investigated these results further and was also able to establish a positive correlation between the consumption of tart cherry juice and the reduction of uric acid levels in the blood.20
The DASH diet helps against gout
The DASH diet is often mentioned in combination with gout. DASH stands for "Dietary Approaches to Stop Hypertension". A diet that aims to sustainably reduce high blood pressure.
The reason why this form of nutrition - the DASH diet has less to do with classic diets - helps against gout is that it focuses primarily on fruit and vegetables. These are precisely the foods that do not raise uric acid levels too much.
The DASH diet is a huge topic in itself, which is beyond the scope of this article.
High-calorie food: an option for gout?
While a low-purine diet is crucial to controlling the symptoms of gout, there are situations where patients may also need a high-calorie diet. High calorie diet is particularly useful for people who are underweight or need extra calories to meet their energy needs without having to consume large amounts of food.
However, when choosing high-calorie foods, it is important to choose foods that are rich in healthy fats, complex carbohydrates and high-quality proteins, but remain low in purines.
High calorie diets such as the drinkable meals from Saturo can offer an ideal solution here. The specially developed drinks from Saturo not only provide a high calorie count, but are also designed to provide the body with all essential nutrients - from proteins and carbohydrates to lipids and fiber, as well as a full spectrum of vitamins and minerals. This makes them a practical option for anyone who wants to supplement their diet without unnecessarily increasing their purine levels.
