Dietary Intervention

Maulishree Jhawer
Article Reviewed by Dietitian  on Apr 08, 2016
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Dietary Intervention

The basic objectives of handling gout are:

► Controlling the levels of uric acid by restricting purine rich foods and by restricting dietary factors which favor the accumulation of uric acid in blood.

► Providing the patient with symptomatic relief.

The purine rich foods can be classified into three groups:
Foods with High Purine ContentFoods with Moderate Purine ContentFoods with Negligible Purine Content
(100-1000mg purine / 100g foods)(0-100mg purine / 100g food)
Meat extractsWhite poultry meats (chicken, duck, turkey)Fruits
Minced meatDried beansMilk
Organ meat (Kidney, brain, heart)LentilsMilk products
Fishes like herring, mackerel, tuna, sardinesDried peasMost vegetables
CrustaceansMushroomsCereals
Broth and consomméSpinachNuts
BeefKidney beansCheese
PorkLima beansGreen vegetables
BaconAsparagusBreads that do not contain yeast
LambCauliflowerCoffee
Foods made with significant amount of yeast (beer, bread)MushroomsTea
Alcoholic beverages

Sweetbreads


► Purine rich foods have to be completely eliminated from the diet as soon as gout is detected.

► Around 1 serving (60 to 100g) of meat, fish or poultry, 1 serve (30g) of dried beans, lentils, dried peas, half a serving (half cup, 125g) of vegetable amongst the moderate purine containing foods are allowed daily when acute gout episodes are not experienced and the treatment is in progress.

► Foods with negligible or very less purine content can be freely consumed.

Other dietary factors:

People with gout are given a high carbohydrate, moderate protein and low fat diet.

1. Liberal carbohydrate intake prevents tissue catabolism and formation of ketone bodies. In case of carbohydrate deficit, the body breaks down more muscle and fat and greater quantities of ketone bodies are produced. Ketone bodies compete with uric acid for excretion and therefore may further increase uric acid levels. People with gout who resort to a very low calorie diet (less than 900 calories per day) in order to reduce weight, actually cause their uric acid levels to go even higher. The diet must be sufficient in carbohydrates but low in refined carbs.

2. Moderate protein intake with a major proportion of protein coming from milk, cheese, protein rich vegetables and cereals is recommended for people with gout. Vegetable protein sources like beans and lentils contain high amount of nucleo-proteins (or purines) thus increasing endogenous uric acid biosynthesis. Therefore they should be consumed only in restricted amounts.

3. Low to moderate intake of fats is recommended. Excess fatty foods may displace carbohydrate from the diet. Inadequate carbohydrate makes the body burn more fat and results in production of ketone bodies. Ketone bodies further inhibit uric acid excretion.

4. Liberal fluid intake is very essential as it assists in uric acid excretion. It also keeps the uric acid diluted to minimize the possibility of calculi formation.

5. Alcohol may precipitate attacks of gout. Alcohol dehydrates the body of water and this action increases the body''s uric acid levels. It may precipitate attacks of gout. So alcohol has to be avoided as a preventive and curative measure in case of gout. Red wine in particular is bad for gout.

6. Overall acidity or alkalinity of the body may also be responsible for gout episodes.

The foods eaten affect the body’s pH. Increasing the pH level (making it more acidic) will increase the amount of uric acid that can be dissolved in the blood. More importantly, a diet that alkalizes the body is beneficial for general health and disease prevention.

Fruits, vegetables, pulses low on purines and more alkaline foods should be opted for.

Acute attack of gout may reduce in people who eat a healthy diet which is certainly a diet rich in fiber (fruits and vegetables, whole grains), good quality proteins (low fat milk, yoghurt, nuts, soya) and low in saturated fats, cholesterol (butter, ghee, meat, shell fish). A healthy diet along with the recommended exercise plan helps to achieve steady weight loss too.

► People with gout are at a higher risk for heart disease. The diet should be low in fat and cholesterol. This diet would not only lower the risk for gout but also the risk for heart disease.

► Green leafy vegetables, carrots, beetroots, cucumber as salads or vegetable juices are said to be very effective for managing gout.

► Fruits like apple, banana, grapes, and bananas too are beneficial for the condition. It is said that they clear out the toxic acids present along with uric acid from the body.

Gout is a form of arthritis for which there is proof that certain foods worsen the symptoms. New research now suggests that a few foods may also prevent this condition. In a study published in the New England Journal of Medicine, it was found that a liberal intake of low-fat dairy products reduced the risk of gout in men by half. The reason for this protective effect, however, is not yet known.

Reference:

1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (http://www.niams.nih.gov)

2. http://www.dr-barbara-hendel.com/conscious-living/
nutrition/tables/purine-content-of-foods/

3. Choi et al. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men, The New England Journal of Medicine Volume 350:1093-1103, March 11, 2004.

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