Gout Diet Blog

Low-Purine Diet

IntroductionWhy this diet?Foods to avoidBest betsResourcesBibliographyA low-purine diet is often prescribed for individuals with gout andLesch-Nyhan Syndrome (a rare genetic disorder that occurs in 1/100,000people). People with diabetic nephropathy need to restrict proteins, aregimen that includes, but is not limited to, the restrictions imposed by alow-purine diet.

Why do people follow this diet?In people who have gout, uric acid production in the body is increased whileits elimination is reduced. The excess uric acid builds up in thebloodstream, is deposited in the small joints or soft tissues, and causessymptoms that resemble arthritis. Purine is a compound that is mainly foundin animal protein and is metabolized to uric acid in the body. A high-purinediet, obesity, regular alcohol consumption, and diuretic therapy can allcontribute to elevated uric acid levels in individuals with gout.Preliminary research suggests that insulin resistance may also play a rolein the development of gout. A low-purine diet and medications-such asnon-steroidal anti-inflammatory drugs, corticosteroids, and allopurinol-arecommonly used to treat gout. An effective diet is important to avoid orreduce complications and lessen the expense of drug treatment. Restrictingcalorie intake and alcohol consumption, and losing weight (if overweight),can also reduce uric acid levels. It is also important to drink plenty offluids to increase uric acid excretion from the body. Alternative sources ofprotein should be included in a low-purine diet.

What do I need to avoid?To avoid purine ask about ingredients at restaurants and others’ homes, andread food labels. The following list is not complete. Consult with ahealthcare professional before making any significant changes to your diet.

The following foods have very high purine levels, and should be avoidedcompletely:

AnchoviesBouillonBrainsBrothConsommDried legumesGooseGravyHeartHerringKidneysLiverMackerelMeat extractsMincementMusselsPartridgeRoeSardinesScallopsShrimpSweetbreadsYeast (baker’s and brewer’s)Yeast extracts (e.g., Marmite, Vegemite)These foods have high purine levels

Fish (including shellfish)PoultryMeat (except those with very high purine content, noted above, or those withmoderately high purine levels, noted below)These foods have moderately high purine levels

AsparagusCauliflowerLegumesLentilsMushroomsOatmealPeas (dried)SoySpinachTripe

Best betsBeverages (carbonated)ButterCereals and cereal productsCheese (all kinds)Cocoa (however, caffeine is prohibited in Lesch-Nyhan Syndrome)CornCornbreadEggsFruit juicesFruitsGelatinIce creamMilkNoodlesNutsRefined wheat flourTapiocaVegetables (except those noted above)White bread and crackers (but not whole wheat, which is moderately high inpurines)White rice

Are there any groups or books?National Institute of Arthritis and Musculoskeletal and Skin Diseaseshttp://www.nih.gov/niams/

Arthritis Foundationhttp://www.arthritis.org

The Purine Metabolic Patient’s Associationhttp://www.pumpa.co.uk

BibliographyDessein PH, Shipton EA, Stanwix AE, et al. Beneficial effects of weight lossassociated with moderate calorie/carbohydrate restriction, and increasedproportional intake of protein and unsaturated fat on serum urate andlipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000;59:539-43.

Emmerson BT. The management of gout. N Engl J Med 1996;334:445-51.

Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy.10th ed. Philadelphia, PA: W.B. Saunders Company; 2000.

http://www.marinurology.com/articles/calculi/foods/purines.htm

Wolfram G. [Diet therapy in gout]. Ther Umsch 1995;52:524-7.

I have read that eating cherries or drinking cherry juice helps toreduce Uric acid levels. I have tried to buy cherry juice here inthe UK but with no success. Does anyone have a contact/name/addressof a supplier or stockist of cherry juice?

1. Drink water. At least a gallon extra water, over and above whatyou usually drink. The best way to regulate it is to drink at least aglass full after each time you urinate.

2. Slow down on the culchicine. It will make you sick and you willnot be able to eat or drink anything and that will only add to yourmisery. Three pills within 24 hours is right at the limit.

3. Start immediately with an NSAID, a non steroidal anti inflamitorydrug. You can buy Naprosyn, I think it is called Alleve, now over thecounter, or some stores sell the generic naproxyn. Also effective areIBProphin but stay away from Aspirin. I think you can even get motrinnow over the counter. You can get one of those over the counter antiinflamitory pills now, like in the next few hours and take abouttwice the recommended dose. Meanwhile, get your physician toperscribe a stronger anti-inflammatory like Celebrex.

4. Stay away from salty food, stop any salt intake at all while youare being attacked. I recommend a white rice diet for the first 48hours of a severe attack. You will need some flavoring with the riceso add some salid dressing but stay away from salt.

5. Clearly stay away from the known high purene foods. Too many tolist here and now byut you can find the list several places. No redmeat, especially no shrimp, lobster, clams etc. Also beans andasparagas, mushrooms— get a list.

Your attack should subside within 48 hours if you follow 1-5 abovebut you will be in an induced reprieve and not really getting welljust because the pain has subsided somewhat.

6. After the attack subsides to where you can walk comfortably, getyourself on allopurinol and stay on it.

I was wondering if anyone who has gout is thin?

Because it’s mentioned that you should lose weight, if you have gout.

Is everyone alittle overweight?

Doc wants me to take 100mg for a month and then check uric acid andkidney function levels. He is concerned because I have had elevatedcreatinine readings in the past. I am 34, 6′6″ and 280 and liftweights regularly. How many got gout as a result of startingallopurinol? How soon should I expect? Will take colchicine asprophalaxis….does this work? How long will the attack last? I knoweveryone is different just a quick synopsis please. Feeling anxiousand need reassurance….after ingesting first pill I will probablyhave an anxiety attack looking for rashes and any other horriblethings that could go wrong

What are they?

How long have you been on it and what side effectsare you, or anybody else on this list, experiencing?

I wonder if anyone out there can help me. My family doctor suspects I’ve gotgout, but says I need to get tests to be sure. The confusing thing is - I’m awoman! Feels weird to get this (provisional) diagnosis…I thought this was onefor the boys. So here’s what it feels like: swollen, red, so stretched theskin isitchy and VERY sore, although I’m still able to walk. Oh - and by ‘it’, I meanmy big toe. So what do the people who know say - is this gout?

Uric acid is an organic acid.It is a solid at room temperature, it is soluble in organic solventsand it stays mainly in the adipose tissue of your body. Adipose isthe fatty tissue-so, for all intents and purposes, uric acid isstored in the body in and around the fat in your body. If you take ajar of water and put wesson oil into the jar and shake it up, thefat, that is the wesson oil, will stay on top and the water will sinkto the bottom. In reality there is a small amount of the wesson oildissolved in the water and a small amount of the water dissolved inthe oil but the amounts are so small that it is not worth mentioninghow much. If you take a salt, like good old sodium chloride and putit into the jar and shake it up, the salt will dissolve in the waterand none of it will dissolve in the wesson oil. Similarly, if you putan organic compound, like for example cholesterol, or motor oil, ortri nitro toluene into the jar and shake it up, be careful shakingtri nitro toluene-all the organic compound will dissolve in thewesson oil and none will dissolve in the water.

OK so far so good.

The fact is that organic acids, are substances that behave like otherorganic compounds for solubility except that they are acidic, whichmeans they can be nutralized by a base, for example, by sodiumhydroxide. When that happens, the organic acid is converted into asalt.

A dramatic example of this is acetic acid. Glacial acetic acid, thatmeans pure acetic acid, is a clear srong smelling colorless liquidthat you can pour out of a bottle. However, when you nutralize aceticacid with sodium hydroxide and then remove the water that is formedby evaporation, you get sodium acetate. The sodium salt of aceticacid is a solid with a high melting point, very soluble in water andit forms crystals in water when the water gets saturated with it.

By analogy the sodium salt of uric acid, specifically the monosodiumsalt of uric acid-mono sodium acetate, is also a solid with arelatively high melting point and the properties of the salt areentirely different from the properties of uric acid. Uric acid iswhat is in trophi. Not monosodium urate crystals. Trophi are painfulbecause they are a deposit of something that the body doesn’t need orwant and they are a lump that is uncomfortable because it is a lumpbut uric acid deposited in a trophi does not cause an inflammationreaction like the crystals of mono sodium urate do.

If you shake up the contents of trophi into that jar with wesson oiland water in it, the uric acid will dissolve in the wesson oil.Virtually none of the contents of the trophi will go into the watersolution because it does not contain the crystals that kill yourfeet. Similarly if you shake up the contents of the fluid in andaround a gout inflamed toe, in that wesson oil and water, none of thecrystals will go into the wesson oil and all the crystals willdissolve in the water.

If you have so much excess uric acid in your system that you areforming trophi, you need to be on allo and get started with theprocess of removing, by way of your kidneys, more uric acid-as urate-each day than your body produces. Allo blocks the production sidewhich allows your kidneys to get rid ot what was made before youstarted allo.

My husband and I have both started suffering sever and debilitating elbow pain a few months ago. It comes and goes. I think it is Gout or something similar. He thinks he has strained his elbows. It’s both for him and only my left elbow. I think it’s a strange coincidence but stranger things have happened. We are 41 and 42. We have three grown daughters and then decided to have more kids (what were we thinking? lol) and so now we have two little boys ages 3.5 years and 8 months. We both enjoyed excellent health until this second go round of children. Now we are stressed, exhausted, we both need to lose weight, and we have this pain. Along with my elbow pain yesterday my feet really hurt. It felt like my arches were just giving out. I know losing weight would help but I can’t help to think there is more to it than that. My husband hasn’t doctored but I have. I have been tested for rheumatoid arthritis, lupus, pcos, hormone problems, thyroid, etc. The tests all came back fine except the one saying my thyroid antibodies was slightly high. All the doctors think this is in my head. Uh huh. One even had the nerve to tell me I had an extreme case of PMS! LOL!

I have referenced multiple studies that link high uricacid levels with high blood pressure, arterial detioration and withheart disease. There are even several well done studies that showthat the link is causative and not simply linked because when theyarbitrarily cause an animals (not human) uric acid to rise, thatanimal gets high blood pressure and has severe arterial deterioration.

So much we already know and therefore taking allopurinol will reducethe exposure we all experience from this risk factor.

It occurred to me that1. There are many people who have very high levels of uric acid whodo not have gout.2. High Blood Pressure is thought to be the #1 cause of, or at leastlinked to, early death from heart disease and arterial complications.3. A very large percentage of the population suffers from high bloodpressure.

Is it possible that uric acid is a much bigger problem thatn just amenace to us gout sufferers? This would be particularly true forsomeone who is overweight and would therefore have a large storeroom, so to speak, where they can store large amounts of utris acid.

For example, if there were, which there is not, a good clinicalmeasure of the total uric acid level in a person, not just the bloodlevel but the total uric acid, then it might be prudent to put a muchlarger population onto allopurinol than is now on it.

Since I am on allopurinol and will not go off it why do I care?

Why do we, or why should we care.

Well, from a purely selfish point of view, if uric acid can be shownto be participating, even mildly, in causing high blood pressure, andif those same people also have gout free but elevated levels of uricacid, there would be a significant amount of money and researchallocated toward making this elevation of uric acid not happen.

In other words, when or if the focus of medical science falls on uricacid and how to eliminate it from our systems, there will be new waysuncovered, new treatments and all of them will apply, in a totalsense, to helping gout sufferers as well.