A Low Purine Diet Can Help Those with Gout or Kidney Stones

Podcast Transcript

Dr. Scott Steele: Butt and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi again, everyone. Welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. Today, I always like welcoming back our guests, and we're super pleased to have Julia Zumpano, who's a Dietitian in Cleveland Clinic's Digestive Disease and Surgery Institute. I encourage all of our listeners out there to look at the back episodes, especially the one around the holiday, for some tips in terms of staying healthy during those holidays. But today, we're going to talk a little bit about how a low-purine diet can help those with gout and kidney stones. Julia, welcome back to Butts and Guts.

Julia Zumpano: Thanks for having me.

Dr. Scott Steele: For those who have not listened to the old episodes, can you tell us a little bit about your background?

Julia Zumpano: Yes, I completed my Bachelor of Science and focused on nutrition at the University of Akron. Then I completed my dietetic internship at the Cleveland Clinic and have been at the Cleveland Clinic ever since.

Dr. Scott Steele: That's fantastic. Today, we're going to talk a little bit about low-purine diet. Again, for many people they're like, "Wait a second. What is a purine?" Let's just start there. What are purines, and what types of foods are they found in?

Julia Zumpano: Purines are chemicals that are naturally found in certain foods and drinks. When our body breaks down these chemicals, uric acid is the byproduct. High levels of uric acid can form sharp crystals and then settle in your joints causing some swelling and pain, which is known as gout.

Dr. Scott Steele: When you talk about typical types of foods that they're in, what types of common foods would maybe somebody find them in? What about pizza, is that high in purine? Apples, bananas? What's a purine food?

Julia Zumpano: They are found in high-sugary foods. So, sweetened beverages, high-fructose corn syrup, game meats, organ meats, turkey, meat sauces or gravy, certain seafoods, and then yeast and yeast extract. There are some purines in some vegetables, but those are less likely to cause the negative effects that we see in the body when you formulate gout.

Dr. Scott Steele: We're obviously talking about a low-purine diet in the context of gout or kidney stones. But is this low-purine diet for everybody, or is it just for patients with those disorders?

Julia Zumpano: It's really anyone who has a high level of uric acid. Anyone who has a history of gout or kidney stones, like you said, is really who we're targeting here.

Dr. Scott Steele: How does this diet differ from some of the other ones that are out on the market?

Julia Zumpano: This diet specifically limits purine-rich foods to prevent gout attacks and kidney stones. Most diets that are out on the market now are followed to accomplish a certain goal. It may be weight loss, reducing inflammation, or improving gut health. The goal of this diet is specifically for that reason. You just want to follow a plan that is according to your goal or what you want as an outcome.

Dr. Scott Steele: I read an article not too long ago that talked about how the number one diet in the US, the Mediterranean Diet is. So, truth or myth: The popular Mediterranean Diet is a type of low-purine diet.

Julia Zumpano: It is somewhat true. The Mediterranean Diet in general is low in red meats, game meats, organ meats. It does discourage intake of sweets and high-fructose corn syrup, although you do have seafood on the Mediterranean Diet. As long as you're choosing the sources of seafood that are low in purine, it can very well be a low-purine diet.

Dr. Scott Steele: I'm a listener out there, and I'm like, "Okay. I'll give this a try." Diets are something that many people struggle with in different fashions. What might someone struggle with being on a low-purine diet?

Julia Zumpano: I think limiting the meats can be challenging. People who tend to have gout tend to have a higher meat intake, which is what I've found in my practice. I think that may be difficult for some people. The other one is sugar. As we know, sugar is extremely addictive, and it's very difficult to remove from any diet plan. I think I'm just struggling by really eliminating and preventing high sugar intake.

Dr. Scott Steele: Let's just say that the low-purine diet isn't for a listener out there. Are there any alternative diets that somebody could try?

Julia Zumpano: Well, we already mentioned the Mediterranean Diet, and I'm a huge fan. I do specialize in cardiology in my practice. I'm a huge fan of the Mediterranean Diet. It does incorporate so many benefits when it comes to lowering cardiovascular disease risk, decreasing inflammation. It's not overly restrictive. It has a wide variety of foods. It can be adjusted based on individualized eating habits. That's one of my favorites. Secondary, I like, generally, a whole-foods diet, where you're eating primarily whole foods, really minimizing any processed foods.

Dr. Scott Steele: Is this low purine diet a diet that can be done in the short-term, or is it meant to be more of a long-term commitment?

Julia Zumpano: Typically, it's done short-term. Let's say you have a gout attack. You want to really cut down purines in your diet until that attack suppresses and eventually resolves. But if you are one that consistently has gout attacks or kidney stones, this general eating plan is something you want to consistently follow. Maybe a little bit stricter when you're in a flare up or having a stone, and then maybe a little bit more lenient in-between. But you still want to keep a general reduction in purines in your diet if you consistently see gout and kidney stones as a historical occurrence for you.

Dr. Scott Steele: It seems like, just in general, the more you try to take something away, the more that you want it. No more is that in fashion than in diets. What's the best way to offset any extra indulgence? For example, while on a low-purine diet, or for the matter of fact, any diet in general.

Julia Zumpano: I would say just really keeping portions down. Portion and frequency. Instead of fighting it constantly and saying, "I can't. I can't. I can't. "No one likes to be told that you can't have something. That just makes them want it more. Just changing your mindset around it and saying, "I can have this, but in moderation. I can have small amounts of this." Whatever the food may be, just allow yourself. Maybe you set a goal of what that small amount may be. Like, "Maybe I can have organ meat once a week," if that's one of your favorites that you have struggled giving up. "I only will take it in into half portion of what I normally would be taking in." That way you don't feel deprived, but you just have more control over the amount and frequency that you're eating the foods.

Dr. Scott Steele: Great advice. Now it's time for our quick hitters. Since you're a return guest, we got slightly different questions to get to know you a little bit better. First of all, salt or sweet?

Julia Zumpano: Oh, definitely sweet.

Dr. Scott Steele: Do you have a favorite sweet at that?

Julia Zumpano: I love chocolates. I like things like brownies and chocolate chip cookies, a really nice rich chocolate, like some Belgian chocolates.

Dr. Scott Steele: What was your first car?

Julia Zumpano: My first car was a Ford Escort, and it did not have any power steering. I passed maneuverability on the first try. I was very proud of myself.

Dr. Scott Steele: Fantastic, fantastic. I think I remember right on your prior episode you said you're a world traveler. What is a place that you would like to go on your bucket list?

Julia Zumpano: Oh, gosh. Picking one is very hard. I would love to go to Thailand. I would love to go to the Philippines because I have family that's Filipino. And Australia. I have to do all three.

Dr. Scott Steele: That section of the world. That's fantastic.

Julia Zumpano: Yep.

Dr. Scott Steele: What's a final take home message for our listeners regarding the low-purine diet, especially for those with gout and kidney stones?

Julia Zumpano: I think it's great if you can keep a food diary. If you have constant gout attacks or kidney stones, I think it's nice to write down what you're eating, especially around an attack. See if you notice a trend of certain foods, you're eating more of that could be leading to some of these attacks if they're high in purines. That I think is really key to help you pinpoint what could be triggering some of these events, then also could help you find a threshold of how much you can have if it's something you enjoy. One thing I forgot to mention, too, is that alcohol can lead to some gout attacks, too. That's another purine-rich beverage that we want to limit.

Dr. Scott Steele: Well, thanks so much for spending the time with us here. To learn more about nutrition therapy at Cleveland Clinic, please visit clevelandclinic.org/nutrition. That's clevelandclinic.org/nutrition. You can also call 216-444-3046. That's 216-444-3046. Julia, thanks so much for joining us again on Butts and Guts.

Julia Zumpano: Thank you so much for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.