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Ask Dr. Leavitt--I have gout. What foods should I avoid?
Gout is an extremely painful form of arthritis. This condition is chronic in nature with severe, brutal acute attacks. Gout has long been associated with diet, particularly eating too much meat, seafood (shellfish) and alcohol. Because of this, treatment for gout used to involve severe dietary restrictions, which made the gout diet hard to stick with. Now that newer medications are available to treat gout, the need for a strict gout diet has been reduced, although following the guidelines is highly recommended.
The gout diet resembles the healthy eating plan recommended for most people in many ways. Besides helping maintain a healthy weight and avoiding many chronic diseases, this diet may contribute to better overall management of your gout.
How does gout occur?
Gout occurs when high levels of uric acid in your blood cause crystals to form and accumulate around a joint. Your body produces uric acid when it breaks down purines. Patients with gout either under excrete or over produce uric acid. Which one you are will determine the type of medicine needed to resolve the attack. Purines occur naturally in your body, but you also get them from eating certain foods, such as organ meats (processed lunch meat such as bologna, hot dogs, ham), anchovies, herring, shellfish such as crab and lobster, asparagus and mushrooms.
How does it help?
A gout diet helps to control the production and elimination of uric acid, which may help prevent gout attacks or reduce their severity. If you look at uric acid crystals under a microscope, they look like tiny round balls with spikes all around them. Many patients say gout flare ups feel like hot needles stabbing them. Most cannot even tolerate the weight or touch of a bedsheet on the affected area. The diet is not a treatment for gout, but may help you control the number and severity of attacks. Obesity also is a risk factor for gout, so losing weight can help you lower your risk of attacks.
How does it work?
The gout diet reduces your intake of foods that are high in purines, which helps reduce your body's production of uric acid. If you are overweight or obese, it is important to lose weight. However, avoid fasting and rapid weight loss because these can bring on a gout attack. Drink plenty of liquids to help flush uric acid from your body. Avoid high-protein diets, which can cause you to produce too much uric acid (hyperuricemia).
To follow the diet:
- Avoid or severely limit high-purine foods, such as organ meats, herring, anchovies and mackerel. Red meat (beef, pork and lamb) that has been cured or processed, and seafood (shrimp, lobster and scallops) are associated with increased risk of gout. Because all meat, poultry and fish contain purines, limit your intake.
- Eat more plant-based proteins. Increase protein by including more plant-based sources, such as beans and legumes. Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid from your body. Drinking beer, in particular, has been linked to gout attacks. If you're having an attack, avoid alcohol. When you're not having an attack, drinking one 5-ounce serving a day of wine is not likely to increase your risk.
- Drink plenty of water. Fluids can help remove uric acid from your body. Aim for 8-16 eight-ounce glasses of water a day.
- Choose low-fat or fat-free dairy products. Some studies have shown that drinking skim or low-fat milk and eating foods made with them, such as cheese or yogurt, help reduce the risk of gout.
- Choose complex carbohydrates. Eat more whole grains and fruits and vegetables and fewer simple, refined carbohydrates, such as white bread, cakes and candy.
- Limit or avoid sugar. Too many sweets can leave you with no room for plant-based proteins and low-fat or fat-free dairy products — the foods you need to avoid gout. Sugary foods also tend to be high in calories, so they make it easier to eat more than you're likely to burn off. Although there's debate about whether sugar has a direct effect on uric acid levels, sweets are definitely linked to overweight and obesity.
- There's also some evidence that drinking four to six cups of coffee a day lowers gout risk in men.
Following a gout diet can help you limit your body's uric acid production and increase its elimination. It's not likely to lower the uric acid concentration in your blood enough to treat your gout without medication, but it may help decrease the number of attacks and limit their severity. Following the gout diet and limiting your calories — particularly if you also add in moderate daily exercise, such as brisk walking — also can improve your overall health by helping you achieve and maintain a healthy weight.
Be sure to call your family doctor and discuss your gout symptoms. By working with your primary care physician you can create a plan to minimize the frequency and severity of your gout attacks.
At Leavitt Family Medicine, we are here for you, for all of your health care needs. We appreciate your questions and comments; Please let us know how we can help you today!