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Severe joint pain, which occurs after a very sumptuous meal or an alcohol-rich celebration, especially in the area of the toe joints, often gives a first indication that the metabolic disorder gout is present in those affected.
If this suspicion of a medical diagnosis has been confirmed, a change in diet will inevitably become the focus of everyday life. Because only those who value adequate nutrition in gout can avoid long-term unpleasant accompanying symptoms and prevent severe episodes of illness. Our guide on the subject is therefore intended to provide an overview of possible nutritional measures for gout and to provide help with the implementation of important basics in the field of nutrition.
What is gout?
Gout (uricopathy) is referred to in medical jargon as arthritis urica because the disease causes inflammation of the joints, which is caused by urinary crystals or salt crystals from the urine.
Uricopathy is therefore a disturbance in the urea metabolism, more precisely a disturbed metabolism of purine. A body substance that serves as a building block for so-called nucleic acids, which in turn control important body functions. For example, the macromolecules are on the
- Storage of genetic information,
- Signal line for the body's own functional processes
- and emergence of biochemical reaction processes involved in the body.
Because their task is so essential for the body, nucleic acids are sometimes referred to as "key molecules of life". As building blocks for these key molecules, purines are of course also of particular importance for the body. However, the organism is not dependent on an external purine supply, since it can produce the substance itself. A permanently purine-rich diet can therefore quickly mean too much purines.
And this is exactly where the most important aspect that people with gout have to take care of in their daily diet can be found. Because foods rich in purine leave a particularly large number of nitrogen compounds in the body when they are broken down. In order to make them excreted, purines are converted into uric acid in the kidneys using a special reaction cascade and then excreted in the urine.
However, if the balance between the formation and excretion of uric acid is disturbed, the uric acid accumulates more in the blood. At some point the uric acid level becomes so high that there is an increased precipitation of uric acid crystals. These are deposited in the joints, which leads to various complaints. In addition to general symptoms of illness such as fever or fatigue are here above all
- and pain
characteristic of one or more joints - often the big toe joint, but also knee, ankle and finger joints are affected.
The joint complaints usually occur suddenly in gout and, if left untreated, lead to serious complications, including:
- chronic joint arthritis,
- Bone deformities,
- Kidney stone disease,
- Renal failure to kidney failure.
Causes of disturbed purine metabolism
In the case of an increased uric acid level in the blood, medicine also speaks of the so-called hyperuricaemia. It forms the physiological basis for gout and can come about through two different mechanisms:
- Too much purine is ingested through food.
- Too little purine is excreted through the kidney.
If the excretion rate of purine in the form of uric acid is too low, there is usually a congenital renal dysfunction. This primary hyperuricaemia is present in over 90 percent of all gout diseases. Typically, genetically determined kidney diseases that affect uric acid metabolism can be identified in those affected. Occasionally there is a congenital overproduction of purine, which is the exception.
Secondary hyperuricaemia, which consequently affects ten percent of all gout patients, is an acquired form of the disease. A high level of purines occurs, for example, with increased cell disintegration (for example, with leukemia), but also with chemotherapy and radiation from tumor disorders. Previous triggers such as diabetes mellitus and persistently high blood pressure are also possible triggers, which are particularly stressful for the kidneys and therefore increase the risk of renal insufficiency. On the other hand, secondary hyperuricaemia can of course also be attributed to a diet rich in purine.
Important: Regardless of the cause, care should be taken to keep the diet free of purines as far as possible for both primary and secondary hyperuricaemia!
No therapy without a change in diet
A disorder in uric acid metabolism is not always noticeable by the symptoms described above, but often simply runs silently in the body at the beginning. In addition to patients in the advanced stage of gout, who come to the doctor the next day after a alcohol and food-rich celebration with the most severe joint complaints, there are also many cases in which the diagnosis of gout is diagnosed accidentally by routine laboratory checks. A crucial piece of information that arouses suspicion of gout in the doctor is nevertheless always the information of those affected that they somehow do not feel so good after eating foods rich in purine.
Once a positive finding has been made, the subsequent therapy pursues several sub-goals, many of which can only be achieved with medication. These include:
- Reduction of uric acid production by uricostatic drugs such as allopurinol,
- Promotion of uric acid excretion by uricosurics such as benzbromarone,
- Inhibition of joint inflammation through active ingredients such as colchicine.
Despite the variety of drug therapy options, there is no alternative to permanently changing gout nutrition. Because only by reducing purines in the diet can the uric acid metabolism be regulated in the long term. The positive influence of appropriate nutritional measures on the metabolism is sometimes so great that after successful conversion, drug therapy can be dispensed with entirely. This has the advantage that there is no risk of undesirable side effects from the medication in the treatment.
Proper nutrition for gout
In ancient times, gout was considered a disease of the kings and the nobility. It was already known at the time that the disease developed primarily in people with an excessive lifestyle, which involved the lavish consumption of fat and protein-rich dishes such as meat or cheese and a lively alcohol consumption.
Food that ordinary people at the time could not afford in such dimensions. However, since in the past the details of the relationship between diet and elevated uric acid levels were not known in detail, many of the dietary recommendations for gout patients at the time were extremely hard. In addition to a regulation on more piety and penance for the decadent lifestyle, court doctors usually recommended a strict diet of self-mortification, the avoidance of all meat and sausage products and the avoidance of all types of alcohol. In addition, bloodletting for the removal of "bad blood" was common.
Fortunately, we no longer live in the old days, so bloodletting and religion are no longer part of medical treatment strategies. In addition, modern medicine is currently undergoing a rethinking process when it comes to nutritional recommendations. Because it is now known that strictly avoiding certain foods can generally improve gout, but at the same time puts the body and mind of the person concerned in a permanent stress phase, which reduces the body's defense function, promotes emotional stress and this favors the development of other diseases.
Even diabetics are therefore no longer recommended to avoid chocolate or cakes altogether. There's nothing wrong with a piece of cake at the family celebration or ice cream on warm summer days, as long as it stays that way and it doesn't happen regularly. And even gout patients are no longer advised to avoid purines. Nevertheless, it is important to prefer low-purine variants of foods rich in purine.
Foods rich in purine
Purines are present in all cell nuclei in the body. They are an important part of DNA and therefore necessary for the construction of new cells. Cell types that renew themselves relatively frequently through cell division therefore contain a particularly large number of purines. For this reason, the cells of the skin, internal organs and muscle tissue are particularly rich in purine. Of course, this also applies to animal foods. The cells of plants that reproduce very well also contain many purines.
With the exception of dairy products, which despite their high protein content are generally considered to be rather low in purine, the purine content in many other foods is closely linked to the protein content. For this reason, it can be said in a very simplified way that very protein-rich foods usually also contain many purines. The hit list of purine carriers are animal foods such as offal, sausage, meat extract, muscle meat and high-fat fish such as mackerel, tuna or sardines. Some plant-based foods such as soy products, raisins and lentils are also at the top of the list of purine-rich foods. Overall, the following foods can be defined as very pure:
- alcohol (especially beer),
- Meat and poultry,
- Fish and seafood,
- certain types of cereals (e.g. book whitening and green core),
- legumes (e.g. peas, beans or lentils),
- cabbage (especially sauerkraut),
- Soy products,
- Animal innards (e.g. heart, liver or kidney),
- Sausages (especially liver sausage and smoked ham).
Some of these foods can still be enjoyed in moderation under certain conditions. With other types of food, such as animal innards, the purine content is so high that it is advisable to do without it entirely. Even foods with meat extract, as is often used in the preparation of ready meals, should no longer be eaten by patients with gout.
In addition to the purine content, it also depends on how much uric acid the respective foods produce. For example, a skinned trout produces only 148 mg uric acid per 100 g, while trout with skin produces a full 297 mg uric acid per 100 g. It is therefore worth comparing, if you consider that if the uric acid value in the blood is outside the normal range, the daily amount of uric acid should not exceed 500 mg in order to improve the diet.
Alcohol and gout
An acute gout attack is never triggered by alcohol alone. If the uric acid level in the blood is already elevated, an excessive intake of alcoholic beverages can provoke a gout attack. Since the body classifies alcohol as a toxin, it is highly motivated to metabolize it as quickly as possible and to excrete it through the kidneys. For this, he throttles other metabolic processes in favor of alcohol degradation. As a result, less uric acid is excreted through the kidneys and the level of uric acid in the blood increases.
This negative effect of alcohol is particularly stimulated when the alcoholic beverage is beer. With beer, you not only add alcohol to your body, but also a large amount of purines through the beer’s own yeast. Drinking beer therefore reduces uric acid excretion through the alcohol it contains and increases the formation of uric acid through the purines it contains.
One of the most promising measures to prevent and treat gout is therefore the controlled consumption of alcohol. As outlined above, the dose makes the poison. Gout patients are therefore advised to limit alcohol consumption to special occasions and, if possible, to wine or sparkling wine - and never to consume large quantities.
More tips on gout nutrition
Apart from absolute taboo foods such as meat extract or beer, the diet is relatively simple, low in purine, but still varied and tasty. If you like to eat lentil dishes, for example, you can try the low-purine alternative bulgur. And if you don't want to do without meat on Sundays, you can put skin-free game dishes on the menu instead of purine-rich meat variants such as poultry. Here is an overview of some examples of low-purine alternatives:
|Purine-rich food||Low purine variant|
|Mackerel, tuna, sardine||Cod, plaice, pikeperch|
|Pork, poultry||Venison, beef|
|Limburg cheese||Edam, feta, mozzarella|
|Peas, lentils, beans||bulgur|
|Buckwheat, green seeds||Wheat, rye|
|milk chocolate||Dark chocolate|
It should also be mentioned that there are now numerous nutrition tables on the Internet that list the mathematically and experimentally determined purine and uric acid content of various foods. In addition, there are now also purine calculators that calculate the actual purine content after specifying the amount of the respective food. These tools can be very helpful as a guide in the beginning of the changeover phase.
The choice of food has a decisive influence on the level of uric acid in the blood. But there are a number of other nutritional and everyday measures that can have a positive effect on uric acid metabolism in gout:
- Drink a lot: Gout patients should drink at least two to three liters of water, unsweetened tea or heavily diluted juice spritzer every day. The hydration helps to flush out the kidneys and to maintain and improve their function.
- A lot of movement: As is well known, movement keeps the metabolism busy. Especially people with existing metabolic disorders should therefore encourage their bodies to improve their metabolism's turnover rate through regular exercise units.
- Avoid sugar: Although gout patients should also eat a lot of fruit and vegetables every day, as much as possible on larger amounts of the fruit sugar contained in the fruit (Fructose) to renounce. Numerous studies have shown that fructose increases the risk of gout and can worsen the course of the disease if the disease is already present. Since fruit sugar cannot be conjured up from fruit, at least highly concentrated fruit sugar extracts, such as those found in juices and sweets, should be avoided.
- Proper preparation: It also makes sense to boil food in water instead of steaming or frying it. Because the cooking process in water causes additional purines to pass into the cooking water, making the food less purine.
- Correct storage: Whenever possible, choose fresh stored foods. Smoked goods should also be avoided. During the storage and smoking process, the purine content in the food increases even further.
- Regular weight and blood checks: Overweight should be prevented if possible. Those who already have obesity are required to reduce their weight. In addition, the uric acid level in the blood must be tested regularly and the medication dose and diet adjusted.
- Beyeler, Christine: "Joint Pain Clinical Guide to Differential Diagnostics", in: Switzerland Med Forum, No. 49, 2003, medicalforum.ch
- Müller, Sven-David; Weissenberger, Christiane: Gout nutrition guide: enjoyment allowed, Schlütersche Verlagsgesellschaft mbH & Company KG, 2011
- Kämmerer, Hugo: Allergic Diathesis and Allergic Diseases, Springer, 2013
- Hettenkofer, Hans-Jürgen; Schneider, Matthias; Braun, Jürgen: Rheumatology: Diagnostics - Clinic - Therapy; 155 tables, Thieme, 2003
- Elmadfa, Ibrahim; Meyer, Alexa Leonie: Proper nutrition for gout, Grafe and Unzer, 2017
- Choi, Hyon K. et al .: "Purine-rich foods, dairy and protein intake, and the risk of gout in men", in: The New England Journal of Medicine, 350, 2004, NEJM
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Barbara Schindewolf-Lensch