Foods To Avoid With Gout
'It's All Just A Case Of Balancing Your Uric Acid Account'
The Short Answer…
There are 4 key types of food to avoid with gout –
- Purine-rich foods such as liver, kidney or some seafood
- Alcohol, especially Beer.
- Fizzy drinks that contain high levels of fructose corn syrup
- Processed foods and refined carbohydrates
‘Purines’ are the most often cited substance for the development of gout. However, gout is never as simple as that and purines themselves have many good qualities too, vital for our own health.
In this article we look at each of the four sections in more detail and take a realistic view of which foods to avoid with gout – because if you cut out everything you’ll end up with a very dull diet! (Which in itself will bring other health problems).
Foods To Avoid With Gout – Purines.
Purines are very natural, organic molecules found in all foods, to some extent.
Not all purines are bad.
While they are most often discussed in relation to causing gout, purines themselves are not something that should be avoided at all costs. Even if you suffer with gout, purines are still essential in providing vital antioxidants and protecting blood vessels.
In actual fact, it is the natural bi-product of purines – ‘uric acid’ (often demonised in articles about gout) that is vital to your health as a human being.
It is also true that (as noted by Kaneko et al in the Biological and Pharmaceutical Bulletin), many purine-rich foods are also energy-rich foods that are again essential to our diet.
It is only when we consume too many purine rich foods that our bodies’ healthy balance of uric acid is tipped, resulting in a condition known as ‘hyperuricemia’ (a build up of uric acid).
In some people (not all) the excess uric acid turns into urate crystals which travel around the body until they start attacking one of your joints (gout).
Purines are actually made up of 4 ‘nucleotides’ (adenine, guanine, hypoxanthine, xanthine). This is relevant because in the same study as referenced above (Kaneko et al), they found hypoxanthine to have a disproportionately bad effect on gout.
So when the food eaten contained a particular purine base (a higher than normal content of hypoxanthine), then they noted a significantly higher incidence of gout.
Knowing the exact purine content of most foods is therefore still very important in determining which foods to avoid with gout, albeit more for comparison purposes than to rule out a whole class of foods.
Unfortunately, there is no recommended daily quantity of purines for gout sufferers or otherwise.
Below I have put together as fuller list as possible of common foods with their approximate purine levels below.
It is not easy to pinpoint precise levels of purines – because there are so many other factors at play as well. A ‘7 day matured’ beef steak will have different purine levels to a ‘21 day matured steak’ for example.
Even within identical foods, the levels will vary to some extent.
A free range chicken from a local farm will have different purine levels to battery-reared chicken from the same farm.
This will also be different to a battery-reared chicken from a foreign country that’s been transported to the supermarket and may therefore be older.
As a result, the figures listed are ‘accurate approximations’ based on 3 key sources as listed below in the references.
Providing The Most Accurate Data Possible
Where some foods had 3 different purine levels listed from each source, I have taken an average across the three.
As only one source listed the individual breakdown between purine, we have taken the % of hypoxanthine vs the total and then applied it as a % of the total.
To represent the increased importance of hypoxanthine, I then doubled the amount in mg/100g and provided a ‘gout-inducing score’. This should provide some consideration of where foods contain the highest uric acid-creating purines.
The 3 sources used were –
A full data set can be requested by emailing [email protected]
Foods To Avoid With Gout – Alcohol.
This is always a difficult one. Alcohol gets blamed for almost all of the bodies’ pains. Much like smoking, it sits like a devil on the shoulder of healthy choices.
However, in the case of joint pain, as specifically here with gout pain, alcohol is one of the most important foods to try and avoid if you suffer with gout.
I did not include alcohol (or any drinks for that matter) in the table above.
There were three main reasons for this –
- Firstly it’s measured differently – in mg/100ml. This creates a figure that looks smaller than for most of the foodstuffs above. This gives a poor comparison and becomes more misleading than helpful.
- Secondly, as well as containing high levels of purines, there is also fairly large quantities of fructose present, so a purine score again would not be truly representative.
- Thirdly (and perhaps most relevant), is the fact the so many different beers/ lagers/ bitters/ spirits etc have different brewing processes.
Each brand will have a different purine/ fructose content and data simply does not exist to cover the thousands of brands available globally.
Furthermore, by the time such a table was tested and created, new brands would come out – not to mention the trend of ‘home brewing’ creating further very different variants.
This is true to some extent with purines in foods too – but the variance between chicken breasts or cod fillets is nowhere near as wide.
Beer has long been thought of as the real risk for gout sufferers, but a substantial study in The American Journal Of Medicine measured 724 participants and actually concluded that
“Episodic alcohol consumption, regardless of type of alcoholic beverage, was associated with an increased risk of recurrent gout attacks, including potentially with moderate amounts.”
These findings have two important implications –
- It’s not just beer that affects gout, all alcohol does.
- Even just ‘moderate’ amounts of alcohol will increase the frequency of gout attacks.
This also contradicts a study published ten years earlier (2004) in The Lancet that ranked beer as the worst for gout, with spirits in a close 2nd and wine having no impact.
What is clear however, is there is a direct dose response to alcohol. In other words, the more you drink the more frequently you will suffer with gout (and the worse the attacks may be).
Similarly, the less you drink, the better things will get. A meta-analysis in ‘Clinical Rheumatology’ by Wang et al on 17 studies with 42,924 participants confirmed this.
Foods To Avoid With Gout – Fizzy Drinks.
Fizzy drinks are another huge source of gout. Choi et al reporting in the BMJ carried out a study on over 46,000 men over 12 years and came to the strong conclusion that
“consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.”
This was pretty conclusive evidence given the size and breadth of the study. What was really interesting was that it was not the carbonated nature of fizzy drinks, but the fructose corn syrup that caused the issue.
This was also present in fruit juices, although not in diet drinks.
So the evidence is fairly clear without saying too much more – fructose corn syrup found in drinks in particular should live permanently on your foods to avoid with gout list!
Foods To Avoid With Gout – Processed Foods/ Refined Carbohydrates.
Examples of this type of food includes breakfast cereals, savoury snacks such as pasties or sausage rolls, white bread and processed meats such as bacon, salami or ham.
These are dangerous for two key reasons – they have a high percentage of fructose corn syrup and a high content of purines (as listed above under purine content).
Processed foods, which typically contain highly refined carbohydrates are often secretly filled with sweeteners.
The manufacturers are much more interested in making their product marginally tastier than someone else’s, and adding fructose is a perfect way to achieve this.
In cakes this may be obvious, but the same sweeteners are often added in bread, pastries and even processed meats or ready meals.
For this reason, gout sufferers need to consider eating as many fresh home-made meals as possible.
The Final Word –
Changing your diet is perhaps the single most effective treatment for preventing future gout attacks there is.
It wont help you at the onset of an attack (it’s too late by then) – but sensible choices beforehand will put back future attacks and most likely, make them less severe.
Some people advise a complete diet change if you have gout, but the reality is you are not going to live a happy life on lettuce leaves alone!
Rather, your selection of what to eat/ what not to eat, should be based around moderation and a REDUCTION of certain foods.
Trying to completely cut out certain foods is only likely to lead to failure In the same way that very restrictive diets for weight loss have a very small chance of success.
Beer for example, is not good for gout. Some of you may be able to give it up completely, others may not.
In reality, every food has some purine content, so perhaps cutting down to two pints a week and eating less of other purine-rich foods is better than trying to cut it out altogether.
Similarly, striking a sensible balance on fizzy drinks and processed foods is more realistic. The more you can reduce, the better controlled your hyperuricemia will be – and ultimately the less gout attacks you’ll suffer.
However, at the end of the day, it also has to be balanced against the enjoyment of life as well.
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1. Kaneko K, Aoyagi Y, Fukuuchi T, Inazawa K, Yamaoka N. (Feb 2014). Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biological & Pharmaceutical Bulletin.
4. Tuhina Neogi MD PhD, Clara Chen MHS, Jingbo Niu DSc, Christine Chaisson MPH, David J. Hunter MD, Yuqing Zhang DSc. (Jan 2014). Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study. The American Journal Of Medicine.
5. Dr Hyon K Choi MD, Karen Atkinson MD, Elizabeth W Karlson MD, Walter Willett MD and Gary Curhan MD. (April 2004). Alcohol intake and risk of incident gout in men: a prospective study. The Lancet.
6. Wang M, Jiang X, Wu W, Zhang D. (July 2013). A meta-analysis of alcohol consumption and the risk of gout. Clinical Rheumatology.
7. Hyon K Choi and Gary Curhan. (Jan 2008). Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. The British Medical Journal.