Goodbye to Gout

  • 1 Oct 2010
  • Reading time 11 mins
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Gout is actually a form of arthritis, sometimes called gouty arthritis. The cause of gout is thought to be a build-up of uric acid, a substance in the blood that should be excreted from the body via the kidneys.

If you are unfortunate enough to suffer from the painful symptoms of gout, you will probably be prescribed NSAIDs (in the absence of kidney or digestive problems) or another form of drug to lower urate levels. Other measures include a low purine diet, weight loss in the case of obesity and lowering alcohol intake.

Reduce intake of purines and protein

Certain foods are rich in naturally occurring substances called purines, which are metabolised into uric acid. Purines are not bad for you as such – in fact they are essential, but excessive consumption is associated with increased risk for gout. The same is true with excessive consumption of protein. The most concentrated sources of purines are red meat, organ meat and oily fish (such as salmon, sardines, and herring), as well as lentils, peas and beans.

The table below shows you the richest foods:

Food SourcePurine Content
Anchovies 411
Sardines (tinned) 399
Herrings (tinned) 378
Sardines (fresh) 345
Pork liver 289
Salmon 250
Mackerel (tinned) 246
Chicken liver 243
Blackeye beans 230
Lentils 222

If you are actively suffering from gout, it is best to limit your intake of these until the gout has gone away. Your ability to tolerate purine-rich foods, in moderation, will probably return once you are following a low GL diet.

Cut back on alcohol

The more alcohol you drink, the greater becomes your risk. Port and also red wines have been associated with gout for many years, however, a more recent study finds that beer is worse. Published in The Lancet, this study involved 50,000 men and found that while drinking alcohol is linked with an increased risk of developing gout, the consumption of beer had the strongest association, followed by spirits, then wine.1

Also, make sure you drink plenty of water which helps to flush out excess uric acid and improve kidney clearance. Exercise also helps.

Avoid high-fructose drinks and foods

Fructose, the sugar in many fruits, cannot be directly used for energy and thus has to be converted into glucose by the liver. This process creates uric acid, which then promotes gout.2

Also, the uric acid impedes the production of a substance called nitric oxide which keeps your blood pressure low. So too much fructose is also associated with high blood pressure. But most fructose is turned into LDL, making LDL cholesterol, and then put into storage as fat.

Normally fruit in nature is supplied with lots of fibre, so you feel fuller and don’t eat too much. But mankind, in his infinite wisdom, has learnt how to extract only the juice, or the fructose, and add it into foods. So, drinking any juice, including apple or orange juice, gives you quite high levels of fructose. Most fizzy drinks are absolutely loaded with ‘high-fructose corn syrup’ which is the worst sugar of all.

That’s the theory but where’s the evidence? Three recent trials have confirmed this link. The first, published in the Journal of Pediatrics, studied almost 5000 adolescents and found that the more sweetened drinks they drank, the higher their uric acid level and their blood pressure 3. The second in the British Medical Journal studied 46,393 men without gout over 12 years, during which time 755 developed the condition. The more sweetened soft drinks these men drank, the greater was their risk of developing gout, with almost double the risk if drinking two or more sweetened drinks a day. Their total intake of fruit juices or fructose-rich fruits such as apples and oranges was also associated with increasing risk4. The third trial studied gout in women, which is becoming more common. Out of almost 79,000 women studied over 22 years, 778 developed gout. Once again, the study found that increasing intake of sugar-sweetened drinks was associated with increasing risk of gout. Compared with women who consumed less than one serving per month, those who consumed one serving per day had a 74% increased risk of gout; and those with two or more servings per day had a 2.4 times higher risk 5.

Orange juice intake was also associated with risk of gout. Compared with women who consumed less than a glass (6 oz) of orange juice per month, women who consumed one serving per day had a 41% higher risk of gout, and there was a 2.4 times higher risk with two or more servings per day. Also, compared with women in the lowest quintile (fifth) of fructose intake, women in the highest quintile had a 62% higher risk of gout. In the words of the researchers: "Our data provides prospective evidence that fructose poses an increased risk of gout among women, thus supporting the importance of reducing fructose intake." So, you want to stay away from high-fructose drinks, fruit juices and also eating too much high-fructose fruit.

Eat cherries, berries and plums and drink cherry juice

The good news is that not all fruit is high in fructose. The principal sugar in berries, cherries and plums is xylose which is not metabolised in the same way, so these are much better for you. Nine teaspoons of xylose (called xylitol when crystallized) has the same blood-glucose-raising effect as one teaspoon of sugar. There also seems to be something special about cherries in relation to gout. One study in particular points to the importance of cherries as a treatment regimen6. However, this study was conducted on sweet rather than tart ......

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