Gout and diet

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The information below has been written for people with gout. It provides general information about reducing the risk of gout attacks through changes in your diet and where to go for further information and advice. This sheet does not provide specific advice for people with other medical conditions or food intolerances.

How is gout affected by diet?
Gout is a type of arthritis that is associated with elevated levels of uric acid in the blood. High levels of uric acid can cause crystals to form in the joints, causing pain and swelling. Uric acid is a normal waste product formed from the breakdown of food, particularly compounds called purines. It is believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks.

Can losing weight help gout?
If you are overweight, gradual weight loss may help lower uric acid levels and reduce the risk of gout attacks. However it is important to avoid fasting or ‘crash’ dieting, where you go without adequate food for long periods and lose weight rapidly. This type of dieting can actually increase uric acid levels and trigger a gout attack. A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely. Talk to your doctor or see a dietitian for advice.

Do certain foods cause gout?
There are many misconceptions about diet and gout. For example it is commonly thought that foods such as citrus foods cause gout. There is no evidence that this is true. However it is known that some foods appear to trigger attacks of gout. These foods tend to contain high levels of purines, a substance that can be made into uric acid in the body. Purine-rich foods include:

• meat – particularly red meat and offal, such as liver, kidneys and heart
• seafood – particularly shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
• foods containing yeast – such as Vegemite and beer.

Another food source that can increase uric acid levels in the blood and lead to gout attacks is a type of sugar called fructose. It is found in high levels in soft drinks sweetened with corn syrup (not used in soft drinks manufactured in Australia) and fruit juices.

What should I eat to avoid attacks of gout?
There is very little scientific proof that avoiding the purine-rich foods listed above can successfully reduce gout attacks. You may miss out on important nutrients and vitamins by completely cutting these foods from your diet. If you notice certain foods trigger your gout attacks, you may benefit from cutting down the amounts of those foods in your diet. However not all purine-rich foods are thought to cause gout. For example, a number of vegetables (asparagus, mushrooms, cauliflower and spinach) are also rich in purines but appear less likely to cause gout than diets containing meat and shellfish. Vitamin C and low fat dairy foods, such as skim milk, can reduce your risk of gout attacks. You should get individualised advice from your doctor or a dietitian before starting a special diet for gout.

Should I avoid soft drinks and fruit juices?
A recent American study found drinking five to six servings of sugar-sweetened soft drinks per week was linked to an increased risk of gout in men. However the high-fructose corn syrup used to sweeten soft drinks in this study is not used in Australian soft drinks. If you are trying to control your weight, then it may be helpful to reduce the amount of sugar based soft drinks you consume or trial diet soft drinks instead. Diet soft drinks do not appear to increase the risk of gout and may be a better option if you have gout. Fruit juice and fructose rich fruits (such as apples and oranges) are also associated with a higher risk of gout. If you are trying to control your weight, then it may be also helpful to limit the amount for fruit juice you drink. However naturally occurring fructose in fruit and vegetables also provides general health benefits and should not be completely avoided without advice from your doctor or dietitian.

Can I drink alcohol?
Drinking alcohol can increase your risk of a gout attack as it can raise the level of uric acid in your blood. While it is possible to control gout attacks without completely cutting out alcohol, try to reduce the amount of alcohol you drink and avoid binge drinking (drinking a lot of alcohol at one time). Talk to your doctor or see www.alcohol.gov.au for Australian government guidelines on recommended alcohol intake.

Are some types of alcohol better than others?
It seems that gout attacks are more common in beer and spirits drinkers than in people who drink wine. Many beers contain large amounts of purines, which can lead to elevated uric acid levels in the blood. However there is no scientific proof that only certain types of alcoholic drinks can lead to gout attacks.

Should I drink lots of water?
Dehydration (not drinking enough water) is thought to be a risk factor for gout. Drinking 1 – 1.5 litres of fluids a day is recommended for general health benefits. However if you are taking diuretics (also known as ‘water pills’ or tablets which help the body get rid of water) or have heart or kidney problems, talk to your doctor about the right amount of fluids for you to drink.

Where can I get advice about my diet?
Look no further than an Accredited Practising Dietitian (APD). An APD can provide you with personalised advice to give you the confidence to eat in a way that is best for you. APDs are university-qualified experts in nutrition and dietetics and are committed to the Dietitians Association of Australia’s (DAA) Code of Professional Conduct, continuing professional development and providing quality services. To find an APD, search the ‘Find an APD’ feature of the DAA website www.daa.asn.au or call 1800 812 942.

A healthy balanced diet may help reduce the risk of gout attacks. See an Accredited Practising Dietitian for individualised dietary advice.

For more information

To find an Accredited Practising Dietitian near you, use the ‘Find an APD’ service at www.daa.asn.au or contact the Dietitians Association of Australia on 1800 812 942.
Read the Australian Government’s Food for health booklet at www.nhmrc.gov.au/publications to learn about general healthy eating guidelines.

Books:
Emmerson, Bryan 2003, Getting rid of gout: A guide to management and prevention, Oxford University Press, Melbourne.
Schneiter, Jodi 2001, Gout haters cookbook: Recipes lower in purines and lower in fat, Reachment Publications, Palm Coast