What to Eat and What to Avoid If You Have Gout?

Jef L'Ecuyer April 1, 2019 Arthritis, Health

This article was originally written on April 1, 2019 and fully updated on September 21, 2020.

Gout is a disease related to arthritis that has been known for hundreds of years. Indeed, gout is sometimes called the disease of the kings, since it is associated with a diet high in fat, animal protein and alcohol. Dietary recommendations and diets for gout found on the internet may seem drastic. In addition, the scientific evidence is not always there to support these recommendations. So what’s true? Is there something that can be done to help from the point of view of diet and lifestyle? 

What is gout?

As mentioned above, gout is a form of arthritis that is characterized by a problem with the metabolism and elimination of uric acid. Gout attacks are periodic episodes in which the immune system attacks the accumulations of uric acid in the joints. The joints most commonly affected are those of the toes, ankles and knees.

The development of gout is multifactorial. Genetics, being overweight, taking certain medications (ex diuretics), diminished kidney function, and bad lifestyle habits can all contribute to the development of this disease.

Gout is often associated with other related diseases (comorbidities) such as diabetes, obesity, dyslipidemia, hypertension and hypertriglyceridemia. Nutritional management of gout should, therefore, also include the management of these other diseases. 

Nutritional recommendations

Although diet alone cannot cause or treat gout, some foods and lifestyle habits can vary the risks for developing gout. Taking specialized medication combined with good eating habits may be the best way to treat gout.

Here are some recommendations to follow:

1- Limit alcohol consumption, especially beer, to a maximum of one daily consumption. During a gout attack, it is best to avoid all consumption of alcohol because it increases the level of uric acid in the body.

2- Limit the consumption of foods rich in purines. First and foremost, pay attention to the size and frequency of your animal protein portions and consider including vegetable proteins (edamame, tofu, chickpeas, lentils…).

In effect, plant sources of purines such as legumes and certain vegetables (such as asparagus, cauliflower, spinach and mushrooms) although rich in purines, will have a protective effect because they reduce the level of uric acid in the body.

Among the foods that are very rich in purines, to be consumed in moderation, we find:

• Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, cod, scallops, trout and haddock;
• Some meats, such as bacon, turkey, veal, deer and offal.

3- Limit foods and meals rich in saturated fats (such as fast food, fried food, rich dairy products…) as they reduce the ability to eliminate uric acid.

4- Eat fruits and vegetables rich in vitamin C such as red pepper, broccoli, orange, kiwi, mango and strawberry. They will help to reduce the level of uric acid.

5- Eat foods rich in omega 3. These fatty acids can be found in some fish, such as salmon and tuna, which are recommended to be consumed in 2 servings of 100g per week.
You can also meet your needs by eating ground flaxseed, chia seeds or walnuts on a daily basis.
These fatty acids help reduce inflammation and reduce the risks of developing gout. There is no evidence that taking supplements has a similar effect.

6- Limit the consumption of sugary drinks, fruit juices and processed foods in order to reduce your intake of added fructose.

7- Maintain good hydration by drinking 1.5 to 2L of water per day. This prevents urine from being too concentrated.

8- Achieve and/or maintain a healthy weight. A person suffering from gout who also has excess weight may see the recurrence of their gout episodes decrease as a result of their weight loss.

9- Adopt an active lifestyle: adults should participate in at least 150 minutes of moderate to high intensity aerobic physical activity each week, in sessions of at least 10 minutes.

A few precisions:

It is often said that cherries may help reduce the risk of recurrence. At present there is no scientific evidence to validate this.

According to the latest clinical guidelines for 2020, vitamin C supplementation should no longer be recommended. It should be noted that people at risk or with a history of kidney stones should avoid taking supplementation.

References

• FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello‐Petersen, R., Guyatt, G., Abeles, A. M., … & Levy, G. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis care & research.
• Beyl Jr, RN, Hughes, L et Morgan, S. (November 2016). Update on Importance of Diet in Gout. The American Journal of Medecine, 129, 11, pp.1153-1158. DOI: 10.1016/j.amjmed.2016.06.040
• MacFalane, LA, Kim, SC. (November 2015). Gout: a review of non-modifiable and modifiable risk factors. Rheum Dis Clin North Am, 40(4), pp.581-604. DOI: 10.1016/j.rdc.2014.07.002
• Nickolai, B, Kiss, C. (2016). Nutritional therapy for gout. Therapeutische Umschau, 73, pp.153-158. DOI: 10.1024/0040-5930/a000772
• Nielsen, Sabrina M et al. (2017). Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Annals of the rheumatic diseases vol. 76,11 (2017): 1870-1882. DOI: 10.1136/annrheumdis-2017-211472
• Nuki, G, Doherty, M et Richette, P. (April 2017). Current management of gout: practical messages from 2016 EULAR guidelines. Polish Archives of Internal Medicine, 127(4), pp.267-277. DOI: 10.20452/pamw.4001
• Ordre professionnel des diététistes du Québec. (2007). Goutte – Classification de divers aliments selon leur contenu en purines. Manuel de nutrition clinique en ligne.
• Robinson, P. (December 2018). Gout – An update of aetiology, genetics, co-morbidities and management. Maturitas, vol 118, pp.67-73. DOI: 10.1016/j.maturitas.2018.10.012
• Terkeltaub, R. (2017). What makes gouty inflammation so variable? BMC Medicine, 15(1). DOI: 10.1186/s12616-017-0922-5
• Université de Sherbrooke. (2018). L’alimentation et la goutte. Prepared by Cora Loomis, Dt.P.
• Arthritis foundation. Gout. Accessed September 16th 2020.
• UnlockFood. Pour en savoir plus sur la goutte. Accessed September 16th 2020.
• Canadian Society For Exercise. Directives canadiennes en matière d’activité physique. Accessed September 16th 2020.

Author

Jef L'Ecuyer

Member of the Quebec College of Dietitians (ODNQ) and Dietitians of Canada,Jef graduated from McGill University in December 2014. Recently graduated and passionate about culinary arts, Jef poses a simple, effective and practical look at daily meal planning. With this in mind, she works in conjunction with the mission of SOSCuisine...