Gout, Purines and Uric Acid
Purines are substances found in foods that are high in protein content. When one consumes a lot of protein-rich foods like organ meats, pork, beef, lamb and seafood, purine accumulates in the blood. Purines are metabolized and excreted as uric acid by the kidneys. However, when the blood uric levels are elevated due to a protein rich diet or a decrease in the ability to excrete the substance, urate crystals form and are deposited in joints.
Deposition of uric acid crystals in the joints of the large toe, ankle, foot, knees and fingers causes severe pain and inflammation which is known as gout. Gout is a type of arthritis characterized by intense redness, swelling, pain and may be accompanied by fever and chills. Gout attacks usually occur at night or early morning and may be triggered by a purine-rich diet. Controlling gout attacks may be done by adapting a low purine gout diet.
Low Purine Diet for Gout
A low purine diet involves avoiding foods that are good protein sources such as:
- Red meat of pork, beef and lamb
- Organ meats from animal kidneys, heart, liver, brain and sweetbreads
- Seafoods like herring, mackerel, scallops, anchovies and sardines
- Meat gravy, meat broths and mincemeat
- Other substances that should be avoided are beer and high fructose beverages which may also increase uric acid levels and decrease its excretion.
Instead, one must plan a diet that is low in purines with foods such as:
- Breads, cereals, rice, potato and pasta – carbohydrates help get rid of uric acid; however, one must limit the intake of whole-grain breads and cereals, wheat germ, bran and oatmeal to two servings per week because these are moderately rich sources of purine
- Fruits and vegetables – purines from fruits and vegetables do not appear to trigger gout and may be safely taken; however, mushrooms, dried peas and beans, spinach, asparagus and cauliflower must be taken in moderation
- Milk and dairy products like eggs, yogurt and cheese – low fat dairy products may help in reducing the risk for gout
One must also drink 8-12 glasses of water and fluids a day to help in proper excretion and avoid kidney stone and urate crystal formation.
Meats and other high protein sources are not absolutely contraindicated in gout. They may raise one’s uric acid levels in the blood but do not necessarily result in gout attacks if taken in moderation. Limiting meat intake to three ounces per meal is recommended. Therefore, avoiding binge eating and regular consumption of large amounts of purine-rich foods are important to prevent gout attacks.
Another point to remember is that there are other risk factors that can cause the symptoms of gout such as obesity and joint injury. Improving one’s lifestyle in terms of diet and exercise to maintain a healthy weight can help prevent stress on the weight-bearing joints, thus reducing the risk for arthritis. To maintain a healthy weight that is proportional to one’s height and age one must avoid foods that are high in fat and sugar such as fried foods, rich sauces and dressings, whole milk, cream, sour cream and high-fat breads like pancakes and cakes.
In people who are obese, gradual, rather than rapid weight loss is recommended. Rapid reduction in weight may exacerbate the increase in uric acid levels due to breakdown of proteins.
UMMC, “Gout – Lifestyle Changes”, https://www.umm.edu/patiented/articles/what_specific_drugs_used_gout_000093_8.htm
UPMC, “Low Purine Diet”, https://www.upmc.com/HealthAtoZ/patienteducation/Documents/LowPurineDiet.PDF