Gout Low Purine Diet

Overview

What is the gout diet?

Gout is caused by high uric acid levels in your blood. Extra uric acid forms sharp crystals that settle in your joints, causing swelling and pain. But you can help reduce the amount of uric acid in your body by maintaining a low-purine diet. Reducing uric acid levels can help prevent new crystals from forming, reducing gout attacks.

What is a low purine diet?

Purines are chemicals that are naturally found in certain foods and drinks. When your body breaks down these chemicals, uric acid is the byproduct. A low-purine diet reduces the foods and drinks with the highest purine content to reduce uric acid. It also encourages some select foods that may reduce uric acid levels in your body.

Who can benefit from a low purine diet?

Anyone with high uric acid levels in their blood (hyperuricemia) can benefit from reducing high-purine foods. This may help to prevent gout in people with hyperuricemia who haven’t yet developed the disease. It may also help prevent existing gout from progressing and prevent other complications of hyperuricemia, such as kidney stones.

Procedure Details

What foods make gout worse?

The top 10 foods and drinks that trigger gout are:

  • Sugary drinks and sweets. Standard table sugar is half fructose, which breaks down into uric acid. Any food or drink with higher sugar content can trigger gout.
  • High fructose corn syrup. This is a concentrated form of fructose. If you start looking at labels, you’ll find high fructose corn syrup in all kinds of packaged food products that you wouldn’t necessarily expect.
  • Alcohol. Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.
  • Organ meats. These include liver, tripe sweetbreads, brains and kidneys.
  • Game meats. Specialties such as goose, veal and venison are among the reasons why gout was known in the Middle Ages as the “rich man’s disease."
  • Certain seafood, including herring, scallops, mussels, codfish, tuna, trout and haddock.
  • Red meats, including beef, lamb pork and bacon.
  • Turkey. This leaner meat is nonetheless high in purines. Especially avoid processed deli turkey.
  • Gravy and meat sauces.
  • Yeast and yeast extract.

What are the best foods to eat when you have gout?

While eating particular foods won’t be enough to make gout go away, studies suggest that certain foods and drinks may help reduce uric acid in your body. For example:

  • Milk. Some early research suggests that drinking skim milk may help reduce uric acid and gout flare-ups. It speeds up the excretion of uric acid in your urine and also reduces your body’s inflammatory response to uric acid crystals in your joints.
  • Cherries. Scientists are currently researching the benefits of cherries and cherry juice for managing gout symptoms, and early results are promising. Cherries have known anti-inflammatory properties, and they may also help reduce uric acid in your body.
  • Coffee. You may have heard that coffee is acidic, but the type of acid in coffee is very different from uric acid. In fact, drinking coffee daily can reduce your uric acid levels by several means. It slows the breakdown of purine into uric acid and speeds the rate of excretion.
  • Water. People who drink five to eight glasses of water a day are less likely to experience gout symptoms. This makes sense since your kidneys use water to excrete uric acid in your urine. Water is also good for kidney health. Impaired kidney function is one factor that can contribute to gout.

However, many healthcare providers prefer to focus on general dietary guidelines rather than particular foods. They suggest that you:

  • Vary your protein sources. Certain meats and seafood are higher in uric acid, but if you eat a wide range and stay away from the worst offenders listed above, you’ll do all right.
  • Enjoy fruits and vegetables. Most are low in purines, but even the ones that are higher have not been shown to affect gout symptoms. And the benefits are worthwhile.
  • Enjoy grains (except oats). Rice, pasta, bread and cereals are all gout-friendly (except oats). Beware of added high fructose corn syrup in packaged products, and choose whole grains (at least half of the time) to help control blood sugar.

Risks / Benefits

What are the advantages of a low-purine diet?

  • Reducing uric acid. People who are disposed to hyperuricemia may be able to manage their condition with diet to prevent complications such as gout and kidney stones from developing. People who have already been diagnosed with gout or kidney stones may be able to prevent new uric acid crystals from forming in their joints or kidneys or at least slow the process down.
  • Reducing weight. Avoiding high-purine foods such as red meats and sweets may help you reduce weight as a secondary benefit. Gout is highly associated with excess weight gain and related metabolic syndromes such as obesity, diabetes and cardiovascular disease. Weight loss statistically lowers your risk of developing gout, and it helps relieve symptoms of gout by taking stress off your joints.
  • Reducing medication. Diet is not as effective as medication for managing gout, and it’s not supposed to replace it. But paying attention to your diet may help minimize your need for medications.

What are the disadvantages of a low-purine diet?

  • It’s limiting. For people with hyperuricemia, a low-purine diet is a long-term lifestyle change. It also happens to target many favorite indulgences, including sugar, sweets and alcohol. For some people, giving these up indefinitely may seem unrealistic, especially when it’s only a complementary therapy. Like most diets, you do have to stick to it to reap the benefits.
  • It limits omega-3 sources. Seafood is among the most important dietary sources of omega-3 fatty acids, and the low-purine diet limits many of these. Omega-3s have many known health benefits — in particular, alleviating inflammation and joint pain from arthritis. Many Americans don’t get enough omega-3s, and limiting seafood can make it even harder. However, fish-oil supplements are ok on this diet. Salmon, sardines and mackerel are also good sources and relatively low in purines.
  • It’s not a cure. Diet may move the needle a little on uric acid levels in your blood, but not as much as medications do. The best approach is to combine them. Some people argue that the benefits of the diet aren’t proven to be worth the trouble when compared with medication. But medication alone is often not enough to manage gout effectively. In these cases, many people appreciate having something they can do proactively to reduce their symptoms.

A note from Cleveland Clinic

A low-purine diet is designed to help manage hyperuricemia and its complications, such as gout. But the diet is also a reasonable lifestyle to adopt for general health. It reduces sugar, alcohol and meat and emphasizes plants and alternative sources of protein. This has plenty of benefits outside of reducing uric acid, and it won’t deprive you of any important nutrition. If you’re at risk of developing gout, or of living through another gout attack, a low-purine diet may be worth a try. Ask your healthcare provider if it’s a good option for you.

Last reviewed by a Cleveland Clinic medical professional on 03/14/2022.

References

  • Arthritis Foundation. Fructose and Gout: What’s the Link? (http://blog.arthritis.org/gout/fructose-sugar-gout/#:~:text=High%252520fructose%252520corn%252520syrup%252520is,made%252520sweetener%252520produced%252520from%252520corn.&text=As%252520the%252520body%252520breaks%252520down,the%252520joints%252520and%252520causes%252520gout.) Accessed 03/14/2022.
  • Collins MW, Saag KG, Singh JA. Is there a role for cherries in the management of gout?. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535740/#:~:text=In%252520a%252520large%252520case%25252Dcrossover,lowered%252520the%252520risk%252520by%25252045%252525.&text=In%252520combination%252520with%252520allopurinol%25252C%252520cherry,risk%252520reduction%252520in%252520gout%252520flares.) Ther Adv Musculoskelet Dis. 2019;11:1759720X19847018. Published 2019 May 17. doi:10.1177/1759720X19847018. Accessed 03/14/2022.
  • Creakyjoints.org. The Connection Between Alcohol and Gout: How Does Drinking Alcohol Affect Gout? (https://creakyjoints.org/about-arthritis/gout/gout-diet/alcohol-and-gout/) Accessed 03/14/2022.

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