Diet for gout: Simple tips for a symptom-free life

Everything was fine in the evening - but in the middle of the night you suddenly wake up with a start: your big toe or another joint hurts terribly, is red and maybe even swollen. "Oh dear, a gout attack ," you might sigh.

How often the attacks occur is also a question of the diet. Here you can find out which diet is good for you if you have gout and why you don't have to worry about giving up everything. We also give you a food table to print out: for a symptom-free life.

What is gout and how does it arise?

Gout is a metabolic disease that is associated with elevated levels of uric acid in the blood (“hyperuricemia”). If left untreated, uric crystals (“urates”) accumulate in the joints and cause painful inflammation . Tendons and internal organs – especially the kidneys – can also be affected.

Because gout is associated with a lavish lifestyle, it has long been considered a disease of kings and wealth. And indeed, diet plays a crucial role - some foods increase uric acid levels , while others have no effect on them or even reduce them.

Nevertheless, the actual cause lies elsewhere. Due to genetics or illness, the body either produces too much uric acid - or it excretes too little in the urine. A rich diet alone does not trigger gout. However, if there is a predisposition to this, the attack is often preceded by a large meal.

Preventing gout attacks: The 5 most important principles

Some sufferers stumble from one attack to the next, while others experience long periods without pain. This is because what you eat determines how often your attacks occur. The following five principles will help prevent outbreaks and prevent long-term damage.

1. Prefer low-purine foods

Purines are found in every cell as a building block of the genetic material. Here they are involved in the formation of enzymes and energy metabolism - they are therefore vital substances that are found in almost all foods. In addition, purines are produced by our own bodies.

The problem: During cell renewal or digestion, the body breaks down these purines - a process that produces uric acid . That's why a diet rich in purines can increase your uric acid level by 1-2 mg/dl.

If the value exceeds 6 mg/dl (in women) or 7 mg/dl (in men), hyperuricemia is present. Meat and fish in particular contain a lot of purine - so much that every additional portion of meat increases your risk of gout by 21%. (1)

2. Enjoy fat in moderation

When fat is broken down, metabolic products are created that have a negative effect on the excretion of uric acid . (4) Therefore, try not to cover more than 30% of your daily energy needs with fats - that corresponds to around 600 calories, for example five tablespoons of oil.

3. Reduce your alcohol consumption

Alcohol increases the production of uric acid and simultaneously inhibits its excretion. It also increases the appetite for fatty foods.

The combination of alcohol and rich, hearty food is particularly conducive to the next attack. Therefore, try to reduce your consumption as much as possible - this is especially true for beer , because brewer's yeast is one of the foods richest in purines.

4. Avoid fructose

On the one hand, fructose stimulates the body's own purine production and on the other hand, it inhibits the excretion of uric acid . (2) However, this applies primarily to drinks that are sweetened with fructose, such as corn starch syrup - fresh fruit can still be on the plate. According to recent findings, fruit juice could also be harmless . (3) You can therefore have no worries about fruit juice concentrates that you only consume in small quantities.

5. Aim for your normal weight

If your body mass index is over 25, your risk of gout increases. (5) If you lose excess weight, the likelihood of another attack decreases. As the pounds melt away, your uric acid levels also decrease. Your kidney function may also improve. (6)

But be careful: crash diets and fasting cures put your metabolism into ketosis. If the body is deprived of carbohydrates for a longer period of time, it must obtain energy from fats and proteins. At the same time, urine excretion can decrease . (7)

Radical starvation therefore provokes exactly what you want to prevent: the next attack. So lose weight slowly – a maximum of 2-3 kilos per month is optimal.

What does a low-purine diet look like?

A diet rich in purines causes the uric acid level to skyrocket, while a diet low in purines lowers it - that's the theory. But what can gout patients eat and what should they avoid? In short: nothing. It's not about completely eliminating certain foods - it's about enjoying them in moderation.

Experts recommend consuming a maximum of 500 milligrams of purines per day . During and after a gout attack, you should temporarily consume only 200 milligrams. (8) If you have these numbers in mind, you can put together your meal plan based on the purine content of your favorite foods.

Below you will find a detailed gout nutrition table with the purine content of various foods, which you can also download as a PDF and print out and hang in your kitchen if necessary. Important: These are only approximate figures. The purine content varies depending on the method of preparation - for example, some of it passes into the water when cooking.

>>Download table<<

Which foods lower uric acid levels?

Studies have shown that at least three foods increase urine excretion. Curtain up for:

• Low-fat dairy products: A study of 10 subjects revealed that casein significantly reduced uric acid concentration. (9)
• Coffee: The effect was strongest with regular coffee, but decaffeinated varieties also have a positive effect. Tea, on the other hand, does not seem to have any influence. (10)
• Cherries: Various scientific studies have concluded that cherries – unlike other fruits – reduce the risk of gout attacks. (11)

Possibly because they contain anthocyanins : secondary plant substances with anti-inflammatory and antioxidant effects . Incidentally, the content is particularly high in the Montmorency sour cherry , which boasts an impressive range of nutrients.

DASH diet: Modern approach to gout nutritional therapy

If you don't feel like counting purines, you can try the DASH diet instead. This is based on the Mediterranean diet and was actually developed to treat high blood pressure . However, studies show that it also lowers uric acid levels . (12)

The DASH diet focuses on natural and plant-based foods . The menu focuses on:

• Whole grain products: 7 to 8 portions spread throughout the day, for example whole grain bread, pasta or rice.
• Vegetables: At least 3 portions a day. Try varieties such as spinach, asparagus, salsify or mushrooms, which are actually considered to be high in purines. According to recent studies, plant-based purines do not seem to have any influence on uric acid levels. (13)
• Fruit: At least 2 portions a day. Again, there are no restrictions on the type. It should just be fresh – enjoy candied dried fruit or sugared preserves only as a sweet treat.
• Nuts, seeds and legumes: 4 to 5 servings per week.
• Lean meat and fish: 1 to 2 portions per week, for example salmon or chicken breast.

You should largely avoid processed, red and fatty meat, fast food, sweets, convenience foods and salty snacks. In addition, the way you prepare the food plays an important role here: add flavor to meals with herbs and use salt sparingly.

Conclusion: With the right diet you can finally live pain-free again

Even if it seems complicated at first, it is worth it to prevent further gout attacks with the right diet - otherwise there is a risk of long-term damage. This article has shown you that some foods are more advisable than others:

FAQ

What should you not eat if you have gout?

Alcohol, fatty foods, fructose and foods that are very high in purines – especially meat and fish – increase the risk of another gout attack. Therefore, they should only be included in the diet in moderation.

Which foods do not contain purines?

Low-fat dairy products, eggs and many vegetables contain very little or no purine. These include:
• Cucumbers
• Carrots
• Kohlrabi
• Peppers
• Salads
• Pumpkin

Which vegetables should you eat if you have gout?

Some varieties such as spinach, salsify, Brussels sprouts or asparagus are rich in purines and were therefore banned for gout patients for a long time. However, recent studies indicate that plant-based purines have no effect on uric acid levels.

Can you eat cheese if you have gout?

Cheese is almost purine-free. You can eat Edam, Emmental, cream cheese, Gouda, cottage cheese, mozzarella or processed cheese almost without worry. Prefer varieties with up to 45% fat in dry matter and eat a maximum of three portions (including other dairy products) per day - because a high-fat diet promotes obesity and is itself considered a gout risk factor.

Which meat can you eat if you have gout?

Poultry, turkey and lean beef or game are fine in moderation. Choose meat without skin or remove it - this will drastically reduce the purine content.

Which bread can you eat if you have gout?

Wholemeal bread is ideal. Bread made from white flour or with added sugar should only be eaten in exceptional cases. Because these are less filling, they promote obesity, which in turn is considered a risk factor for gout.

Can I eat pizza if I have gout?

There is nothing wrong with enjoying a pizza every now and then. Vegetable-rich varieties contain fewer purines than pizzas with salami and tuna. But you shouldn't overindulge, as obesity and gout are linked.

Which beer can I drink if I have gout?

No matter what kind, beer should be an absolute exception - alcohol increases the production of uric acid and at the same time inhibits its excretion. In direct comparison, Kölsch has less purine than Hefeweissbier or Weizenbier. Nevertheless, it is better to only enjoy it on special occasions! This also applies to non-alcoholic beer due to the purine content.

Which drinks are forbidden if you have gout?

Alcohol, soft drinks and other sweetened drinks (eg cocoa) encourage attacks. Better: Drink lots of water and tea. Vegetable juices and acidic fruit juices are also OK. Coffee and milk can even lower the uric acid level.

Are bananas okay for gout?

Bananas have a low purine content and can therefore be eaten without any concerns. Fructose is only a problem if it is consumed via industrial products - for example, sweetened fruit juices or cereal bars.

Sources:

1. Beate Nicolai, Caroline Kiss (2016): Nutritional therapy for gout, https://econtent.hogrefe.com/doi/10.1024/0040-5930/a000772

2. Pharmaceutical Journal: Be careful during celebrations and fasting, https://www.pharmazeutische-zeitung.de/ausgabe-502009/gicht-vorsicht-bei-festen-und-beim-fasten/

3. Sugar in orange juice: New studies give the all-clear. Juice reduces the risk of gout, https://www.uni-kiel.de/de/universitaet/detailansicht/news/zucker-im-orangensaft-neue-studien-geben-entwarnung-saft-senkt-gicht-risiko

4. Hyon K. Choi, Walter Willett, Gary Curhan (2010): Fructose-Rich Beverages and Risk of Gout in Women, https://jamanetwork.com/journals/jama/article-abstract/186958

5. Hyon K. Choi, Karen Atkinson, Elizabeth W. Karten (2005): Obesity, Weight Change, Hypertension, Diuretic Use, and Risk of Gout in Men, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/486491

6. Monika Reuss-Borst (2020): Gout – also a question of lifestyle, https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-1243-1145.pdf

7. Margaret J. Maclachlan, Gerald P. Rodnan: Effects of food, fast and alcohol on serum uric acid and acute attacks of gout, https://www.sciencedirect.com/science/article/abs/pii/0002934367900058

8. Institute of Nutritional Medicine: Nutritional recommendations for hyperuricemia and gout: https://www.mri.tum.de/sites/default/files/seiten/ernaehrungsempfehlung_gicht_2016.pdf

9. Dominique R. garrel, M. Verdy, C. Petit Clerc, C. Martin (1991): Milk- and soy-protein ingestion: Acute effect on serum uric acid concentration, https://www.researchgate.net/publication/21154830_Milk-_and_soy-protein_ingestion_Acute_effect_on_serum_uric_acid_concentration

10. Hyon K. Choi, Gary Curhan (2007): Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey, https://pubmed.ncbi.nlm.nih.gov/17530681/

11. Yuqing Thang, Tuhina Neogi, Clara Chen, Christine Chaisson, David J. Hunter, Hyon K. Choi (2012): Cherry consumption and decreased risk of recurrent taste attacks, https://pubmed.ncbi.nlm.nih.gov/23023818/

12. Sharan K. Rai, Teresa T. Fung, Na Lu, Sarah F. Keller, Gary C. Curhan, Hyon K. Choi: The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men : prospective cohort study, https://pubmed.ncbi.nlm.nih.gov/28487277/

13. Hyon K. Choi, Karen Atkinson, Elizabeth W. Karlson, Walter Willett, Gary Curhan (2004): Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men, https://www.nejm. org/doi/full/10.1056/nejmoa035700