by Y Tian

Created on: April 09, 2011   Last Updated: April 12, 2011

Gout was historically known as the “disease of kings” because it was limited to the upper class of society who had access to expensive food such as meat and seafood. It is an inflammatory arthritic condition that affects approximately 1-2% of the Western population. The incidence of gout has increased in recent decades and it is believed to be due to risk factors like changes in diet.

The underlying cause of gout is hyperuricemia – elevated levels of uric acid in the blood. When humans consume food containing purine, the purine is metabolized through a metabolic pathway to uric acid. Since humans lack functional uricase, an enzyme that breaks down uric acid, the uric acid is usually excreted out of the body by the kidneys. However, when there is an elevated level of uric acid in the blood and the kidneys cannot excreted all the uric acid, the excess uric acid crystallize and are deposited in joint spaces and/or surrounding connective tissues – most commonly in the metatarsal-phalangeal joint at the base of the big toe. The crystallization and deposition of uric acid in the joint leads to inflammation, causing swelling, redness, heat and pain, which are characterized clinically by a swollen joint that is sensitive to the touch.

Uric acid accumulates in the bloodstream when there is an imbalance between the intake and excretion of uric acid. Therefore, high intakes of purine-rich food and/or under-excretion by the kidneys could both increase the risk of gout. So what foods should gout patients avoid?

It seems quite straight-forward that gout patients should avoid purine-rich food. However, not all purine-rich food is associated with an increased risk of gout. Large consumptions of certain food such as fructose-sweetened drinks, meat and seafood should be avoided because studies have found associations between these dietary factors and gout. However, interestingly, purine-rich vegetables such as spinach and mushrooms have found to be not associated with gout.

Alcohol is another big cause of hyperuricemia. This is because when the body metabolizes the alcohol, adenosine monophosphate is produced and it is converted to uric acid for excretion by the kidney. In addition, lactate generated by the alcohol increases uric acid re-absorption by the kidneys. Therefore, not only does alcohol increase the uric acid level in the blood, it also increases the retention of uric acid by the body.

So to summarize, gout patients should avoid the following food (list not exhaustive):

- Herring & sardines

- Mussels & other shelled seafood

- Bacon

- Veal

- Salmon & trout

- Animal livers, kidneys & hearts

- Turkey & pheasant

- Alcohol

However, it is not all bad news. Certain foods have been found to be beneficial to gout patients. Consumption of fruits containing vitamin C and dairy products appear to decrease the risk of gout. This is believed to be partly due to their effect in reducing insulin resistance.

Through a few changes in the diet, gout patients can reduce their risk of gout. With the help of gout medication, patients can really control their gout and prevent another inflammatory flare-up. 

Resources:

Reginato, AJ. (2005) Gout and other crystal arthropathies. Harrison’s Principles of Internal Medicine 16th Edition. USA: McGraw-Hill Companies, Inc.

http://arthritis.about.com/od/gout/ss/informationgou t.htm

http://en.wikipedia.org/wiki/Gout#Lifestyle

http://www.medscape.com/viewarticle/524766_5

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