For most of history, gout has been associated with those living a prosperous life full of indulgence. Gout was prevalent among aristocrats living off a surplus of fine wine, fruits, cake and other sweet treats dripping with honey.
However, gout is present in individuals of all socioeconomic classes and ages. This suggests that the condition is less likely associated with meat consumption, which has been on a sharp decline for the last 60 years, but more likely related to metabolic syndrome, high fructose intake, eating a highly processed diet full of grains, sugar, industrial seed oils, and alcohol consumption – all of which makes up most of our typical standard Western diet.
It is interesting to note that while there is limited clinical research to link gout flares to any specific foods, we can conclude from the limited data we have from large-scale trials that gout is rarely, if ever, reported as a side effect of following a low carbohydrate or ketogenic diet.
Gout patients can see immense relief from their symptoms when they follow a low purine diet and lower or eliminate inflammatory foods known to aggravate gout and raise uric acid levels.
What causes gout?
Gout is caused by having high levels of uric acid in your blood. Excess uric acid forms sharp crystals in your joints, causing swelling, redness and pain.
But by lowering the uric acid in your blood to more normal levels, you can help prevent more crystals from forming, therefore reducing gout attacks.
What are purines?
Purines are natural chemicals commonly found in food and drink. They are vital building blocks of DNA cells, and neither humans, animals or plants can do without them. Purines are essential to life and fantastic at the proper levels, but in excess can become an issue. When your body breaks down purines, uric acid is the byproduct.
The problem for anyone suffering from gout is that purines are found in so many foods, with a few exceptions such as milk and yoghurt, that it becomes difficult to avoid overeating them. The best you can do is to reduce or eliminate the foods that contain the most purines.
What is a low-purine diet?
A low-purine diet is an eating plan that reduces the foods and drinks with the highest purine content to help lower uric acid levels in your blood. It also encourages consuming foods that may further reduce uric acid levels in your body.
Oxalates and gout
Most gout patients would do well also to avoid high oxalate foods and follow a low-purine and low-oxalate diet to get the most effective relief. Gout sufferers in the high-risk group for calcium-oxalate kidney stones would do well to avoid oxalate-rich foods.
Oxalate is an organic compound found in many plant foods and is also produced as a waste product by the body. When we eat oxalate-rich foods, the oxalate molecules pass through the digestive system, where some will bind with calcium molecules to form tiny crystal-like structures. Nearly 80% of kidney stones are created this way.
The foods with the highest oxalate content, according to WebMD:
- Almonds and cashews
- Baked potatoes with skin
- Bran cereals and shredded wheat cereals
- Cocoa powder
- French fries
- Miso soup
- Stevia sweeteners
- Sweet potatoes
This list includes nut butter, nuts like cashews and peanuts, almonds, tofu, Swiss chard, legumes, oranges, cranberries, gooseberries, soybeans, soy milk, and more. But what has oxalate got to do with gout?
Gout is a form of inflammatory arthritis caused by higher than normal levels of serum uric acid. Monosodium urate crystals from uric acid settle in the joints and connective tissue, and our own inflammatory response against these sharp crystals presents as exceedingly painful gout attacks.
Uric acid is a natural byproduct of purine metabolism, and gout patients are advised to follow a low-purine diet to lower uric acid to healthy levels. But many low-purine foods include many plant-based foods high in oxalates – where gout and oxalate issues collide.
While many gout patients will be fine following a low-purine diet alone, others will need to replace those high-oxalate foods with low-oxalate, low-purine foods, especially if they are at more risk of kidney stones.
What are low-purine and low-oxalate foods?
For those who choose to be extra careful about following a diet low in both purines and oxalates, here is a breakdown of foods that contain the lowest levels of both compounds.
- Vegetables: artichokes, kale, broccoli, Brussels sprouts, cabbage, lettuce, corn, onions, and bell peppers. Although low in oxalate, Cauliflower has moderate amounts of purines, so it has to be consumed in moderation.
- Fruit: apples, apricots, avocados, bananas, grapefruit, dark-coloured grapes, melons, nectarines, peaches, strawberries, and pineapples. And, of course, they are low in purines too.
- Dairy: whole milk, butter, yoghurt, cheese, and eggs are low in purines and oxalate. Natural dairy products are also generally high in calcium. There is some evidence that increasing dairy foods containing natural dietary calcium can help lower the risk of kidney stones, mainly caused by plant oxalates.
Adding these low-oxalate, low-purine foods into your gout diet can lower the risk of gout and oxalate kidney stones.
What foods to avoid on a low-purine diet
These foods are known to worsen gout and should be reduced or eliminated to help reduce uric acid levels and improve your symptoms.
- Alcohol: Alcohol prevents your kidneys from eliminating uric acid, cycling it back into your body, where it continues to accumulate and form uric acid crystals in your joints.
- Certain fish and seafood: herring, scallops, mussels, codfish, tuna, trout, and haddock, are all high in purines.
- High fructose corn syrup: Fructose is known as a primary trigger for gout, and this is a concentrated form of fructose. Check food labels as this is an often-used cheap additive for many foods – even savoury ones where you wouldn’t expect it.
- Organ meats: Including liver, tripe sweetbreads, brains and kidneys. While extremely nutrient-rich, they should be limited for anyone suffering from gout.
- Sugary drinks and sweets: One of the main culprits for uric acid formation. Avoid standard table sugar, which is half fructose and breaks down into uric acid. Any food or drink with a high sugar content can trigger gout.
- Yeast and yeast extract: Bread, pastries, other yeast-containing foods, and yeast extracts such as Bovril should be reduced or completely eliminated. Many people take brewers yeast tablets or powder for extra Vitamin B, but anyone with gout should avoid this.
What about gout and red meat?
Red meat is often labelled as a high-purine food but, in fact, only has medium levels of purines. You shouldn’t cut out red meat because it offers too many health benefits to discount.
Red meat is a fantastic source of many bioavailable nutrients, including vitamins, minerals, and healthy fats. Because of insulin’s effects on uric acid retention in the body, those suffering from gout can benefit from eating a low-carb or ketogenic diet rich in red meat and low on high-purine and high-oxalate foods.
Contrary to conventional advice for gout, there’s no need to avoid animal protein. If anything, modern research indicates that increasing animal protein intake could benefit gout as long as they reduce or eliminate carbohydrates.
Long-term followers of keto and animal-based diets report complete elimination of gout flares, lower inflammation, improved insulin resistance, blood pressure etc.
Those switching to a keto or ketogenic diet prone to gout flares may initially experience increased symptoms. This is because uric acid competes with ketones for excretion, but this is only temporary. Once through adaptation, people see gout attacks decrease over time as uric acid levels lower and are excreted normally.
What are the best foods to eat when you have gout?
Studies suggest that consuming food and drinks that help reduce uric acid in your body can help lower your risk of gout flares. These include:
- Whole milk: Some research indicates that drinking milk may lower uric acid levels and gout flare-ups. Drinking milk can help speed up uric acid’s excretion in your urine and reduce the body’s inflammatory response to uric acid crystals lodged in the joints.
- Cherries: Ongoing research into the benefits of consuming cherries and cherry juice is promising for managing gout symptoms.
- Groud coffee: Drinking coffee daily can help to reduce uric acid levels in the blood. It slows the breakdown of purine into uric acid and speeds up the rate at which it is excreted from the body.
- Water: Staying hydrated with water is essential for gout patients. Your kidneys use water to excrete uric acid in your urine, so drinking water is good for flushing out uric acid and boosts your kidney function. Impaired kidney function is a factor that contributes to gout.
You can get relief for your gout symptoms with proper medical treatments from a qualified specialist, such as Dr Bhadauria, in one of his London-based clinics.
Gout can be treated and the pain relieved by using Non-Steroidal Anti-Inflammatory Drugs such as ibuprofen. But if the symptoms worsen or last longer than 3-4 days, you might be prescribed steroids in the form of tablets or injections.
You may also be prescribed a medicine such as allopurinol or febuxostat. These are used to reduce the amount of Uric acid in the body, which might need to be taken over a long period.