No magic diet will curb gout
Wednesday, October 2, 2019
Q: I recently developed gout. An old friend of mine dug a piece of well-worn paper from his wallet. It was a list of foods someone told him to avoid a long time ago. He said it pretty much works for him. Is this an old wives’ tale or are there scientific recommendations on how to prevent/treat gout with food? RK, Greenville
A: Yes, lifestyle changes can help with preventing and treating gout and its symptoms. However, there is not a clear-cut list of foods to eat or avoid. Chloe Opper, a Brody medical student will explain.
Gout is a disease that has been steadily increasing in the United States and currently affects around four in 100 adults. It is a condition in which the body forms sharp crystals if a person has too much uric acid in their blood. These can cause a form of painful arthritis as these crystals deposit in joints, referred to as “gout flares."
The reason some people think you can prevent gout with food is because uric acid, in part, comes from the breakdown of certain foods, such as purines and proteins. Purines are compounds found in alcoholic beverages, some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock. They also are in some meats such as bacon, turkey, veal, venison and organ meats like liver.
It would make sense that restricting these foods entirely could decrease gout flares. And that’s what people were told to do for a long time. However, this turns out not to be an effective treatment for gout. First, it’s hard for people to follow restricted diets. The diets proposed for gout prevention are usually not appetizing or appealing as they eliminate foods people really like. So, they are not easy to follow for life. Second, and more importantly, researchers surprisingly found that restricting protein and/or purines in the diet does not decrease the amount of uric acid in the blood by enough to make a large difference. While it makes sense to limit these foods, especially during a flare, there isn’t a compelling reason to eliminate them. Unless, like your friend says, it “works for him”.
While there is a lot of disagreement about how diet can help to prevent gout, experts all agree that obesity is a main risk factor. Those who are overweight my benefit from a healthy, calorie restricted eating approach to manage gout and recurrent gout attacks. Following the Dietary Approaches to Stop Hypertension, or DASH, diet has recently been shown to be a good way to manage gout.
As Dr. K has written in this column many times, DASH is an evidenced based approach to eating that can be followed for a lifetime and has been proven to help manage blood pressure, heart disease, weight and other chronic conditions. The main components of the diet involve decreasing the amount of meat, including dairy, replacing simple sugars with complex carbohydrates, and decreasing saturated fats and sodium. DASH has been promoted by the experts as a healthy way for adults and children to eat. See https://www.nhlbi.nih.gov/health-topics/dash-eating-plan or ask your doctor for a handout about DASH.
Let’s break down what this means. Simple carbohydrates tend to be processed, such as candy and sugary drinks like sodas, sweet tea and juice. These simple sugars can make gout symptoms worse. On the other hand, complex carbohydrates can reduce the risk of chronic health conditions such as diabetes and hypertension and tend to be highly nutritious. Examples of these foods include brown rice, oats, beans and whole wheat products. Additionally, when you think of saturated fats, think of foods that come from animals, including several different types of meats, butter and cheeses. Although butter, cheeses and other animal byproducts are not necessarily directly linked to gout, decreasing these foods in the diet can lead to excess weight loss which is closely tied with reducing gout symptoms.
Additionally, alcohol use is associated with increased risk of gout flares. In moderation it is unlikely to cause a flare, however, and excess or chronic intake of alcoholic beverages can worsen symptoms. There are claims that some vitamins, cherries and cherry juice and coffee reduce gout symptoms. Although they are unlikely to cause harm, the claims lack scientific proof and there are other strategies that should be tried first.
In summary, even though you can go on the web and find a list of foods to avoid, there is no evidence based “gout diet.” Following the DASH or Mediterranean eating pattern may help especially along with achieving and maintaining a healthy weight. There are things to do only in moderation, like drinking alcohol and sugar sweetened beverages. Consult with your doctor on medications that can help also help control your symptoms.