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 is a chemical created when the body breaks down substances called purines. Purines are found in some foods and drinks including liver, anchovies,…. 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 Proteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of…. 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 Source||Purine Content|
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 is a simple sugar that occurs naturally in fruits, vegetables and their juices, as well as in honey…., 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 is short for low density lipoprotein. It is the “bad cholesterol” which collects in the walls of blood vessels, causing blockages. High LDL levels…, and then put into storage as There are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to….
Normally fruit in nature is supplied with lots of Fibre is an important part of a balanced diet. There are two type of fibre; soluble and insoluble. Insoluble fibre helps your bowel to pass…, 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 is a completely natural sweetener that looks and tastes like sugar. It is naturally occurring in many fruits and vegetables…. 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 or sour cherries, which are believed to be more effective.
The use of cherries for treating gout goes back a long time. In 1950, a scientific review promoted daily cherry consumption as a means of alleviating gout attacks7. More recently, a 2003 study by the US Department of Agriculture (USDA), University of California at Davis, looked at the plasma urate levels, Antioxidants are substances that protect cells within the body from damage caused by free radicals. They help to strengthen the body’s ability to fight infection… and inflammatory markers of ten women consuming two servings (280g) of sweet cherries following an overnight fast. The results were striking. The USDA team demonstrated clearly that uric acid excretion increased significantly and blood uric acid levels declined. In the author’s words: “The decrease in plasma urate after cherry consumption supports the reputed anti-gout efficacy of cherries.”8
Generally it is now recognised that cherries are a genuine remedy for gout9. Animal studies confirm that cherries are potent anti-inflammatory agents and suggest that it is powerful antioxidant compounds called anthocyanidins that are likely to be the key components within cherry juice that yield the benefits for gout sufferers 10. Especially high in these antioxidants are the Montmorency variety of cherries, which provide 280mg of anthocyanidins in a 30ml shot of cherry concentrate, known as Cherry Active. Cherry Active is also sold in capsules. I recommend a shot a day, or three capsules, if you have gout.
Eat a low GL diet
My low-GL diet is the most rapid way to stabilise blood sugar levels and will, naturally, reduce the amount of both fructose and uric acid in your system. Eating a low-GL diet also improves your resistance to Insulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. – which is the hormone you produce to process sugar – and this helps to support healthy kidney function. The reason this is important is because it is the kidneys that need to excrete uric acid. I have had many people with gout who have reported instant relief when switching to a low-GL diet, even when eating previous high-purine trigger foods. If you follow my low-GL diet you will almost certainly find that your gout goes away, along with unwanted fat.
Improve kidney function
In the majority of gout sufferers, uric acid levels are high in the blood due to under-excretion of uric acid by the kidneys, rather than over-production11. Nine out of ten people with high blood uric acid levels and gout have some level of kidney dysfunction12.
Both high blood glucose levels and high insulin levels, the hallmarks of metabolic syndrome (a precursor to diabetes), stress the kidneys. So as above, eating a low-GL diet is the solution.
Also, many people with kidney problems have very high levels of Homocysteine is an amino acid found in the blood. Elevated levels of homocysteine have been associated with narrowing and hardening of the arteries, an increased…. This is worth getting checked, which you can do with a home-test kit. If your level is high then you are going to need certain supplemental B vitamins to normalise your level, as well as eating a better diet, with more beans and greens and less alcohol. See my Special Report on How to Lower Your Homocysteine Level.
Vitamin C myths
A common myth is that supplementing large amounts of What it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against… raises uric acid levels and might increase the risk for gout. In fact, the opposite is true, according to a 2009 study published in the Archives of Internal Medicine. This 20-year trial involved 47,000 men and found that compared with those who did not take vitamin C supplements, men taking 1000-1499mg per day had a 34% lower risk of gout – and those taking 1500mg per day had a 45% lower risk. This was irrespective of other gout risk factors such as diet and alcohol use.
Another common myth with vitamin C relates to the formation of oxalic acid, which is implicated in gout and especially kidney stones. Again, this is not true and turns out to be due to poor experimental methods, in which subjects were given vitamin C, their urine collected and not immediately analysed. Components in the urine oxidised and formed oxalic acid. However, in properly conducted trials, those taking several grams of vitamin C show no increase whatsoever in uric acid or oxalic acid.
In the words of Professor Allen Rodgers from the Kidney Stone Research Laboratory of the University of Cape Town: “We conducted a controlled trial in which ten volunteer subjects were required to ingest 4g of vitamin C per day for five days. Urines (24h) were collected before, during and after the ingestion period. These were rigorously analysed for a host of independent physicochemical risk factors, all of which are regarded as powerful indicators of the risk of kidney stone formation. The results showed that these risk factors were not significantly altered. We concluded that ingestion of large doses of Vit C does not increase the risk of forming kidney stones. The results of this study were published internationally.” 13
Another study gave very high dose of intravenous vitamin C and again did not result in increases in oxalic acid associated with kidney stone formation.14
However, it is possible that high doses of niacin (above 1,000mg a day) taken to lower cholesterol, may exacerbate gout. So, if you are taking this, monitor carefully what happens.
Supplements for Gout
There are many nutrients involved in protein Metabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it… – B vitamins and especially B6, What it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous… and What it does: Component of over 200 enzymes in the body, essential for growth, important for healing, controls hormones, aids ability to cope with stress… – which are also an essential part of a nutritional programme for preventing gout. Also, essential fats (both Gamma Linolenic Acid (GLA) is an essential fatty acid within the omega-6 family. It is found primarily in plant based oils such as evening primrose… and EPA is short for Eicosapentaenoic Acid. It is an essential omega-3 fatty acid found in fish such as salmon, mackerel and herring, and is often…) help prevent the excessive production of urate crystals15. I recommend the following:
- 2 x high-potency multivitamin and multi-mineral complexes.
- 2 x vitamin C 1000mg.
- 2 x essential omegas (both 3 & 6)
Make sure these are giving you 20mg of vitamin B6, 200mg of magnesium and 10mg of zinc.
See www.holfordirect.com for a Daily Essentials Programme.
- HK Choi et al, Alcohol intake and risk of incident gout in men: a prospective study, The Lancet (2004), vol 363(9417), pp. 1277-81.
- HK Choi & G Curhan G, Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study, BMJ (2008), vol 336(7639), pp 309-12. Epub 31 January 2008.
- S Nguyen, HK Choi, RH Lustig, CY Hsu, Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents, Journal of Pediatrics (2009), vol 154(6), pp 807-13. Epub 17 April 2009.
- HK Choi & G Curhan G, Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study, BMJ (2008), vol 336 (7639), pp 309-12. Epub 31 January 2008.
- HK Choi et al, Fructose-Rich Beverages and Risk of Gout in Women, JAMA (2010), vol 304(20), pp 2270-2278.
- AT Eggebeen AT, Gout: an update, American Family Physician (2007) vol 76(6), pp 801-8.
- LW Blau, Cherry diet control for gout and arthritis, Texas Reports on Biology & Medicine (1950), vol 8(3), pp 309-11.
- RA Jacob et al, Consumption of cherries lowers plasma urate in healthy women, Journal of Nutrition (2003), vol 133(6), pp 1826-9.
- N Schlesinger, Dietary factors and hyperuricaemia, Current Pharmaceutical Design (2005), vol 11(32), pp 4133-8.
- JM Tall et al, Tart cherry anthocyanins suppress inflammation-induced pain behavior in rat, Behavioural Brain Research (2004), vol 153(1), pp 181-8.
- WN Kelley & HR Schumacher Jr, Crystal-associated synovitis, Textbook of Rheumatology (1993), 4th ed. Philadelphia: Saunders, pp 1291-1336.
- RL Wortman, Gout and other disorders of purine metabolism, Harrison’s Principles of Internal Medicine (1998), edited by AS Fauci, 14th ed. New York: McGraw-Hill, pp 2158-65.
- B Auer, D Auer, A Rodgers, Clinical Chemistry and Laboratory Medicine (1998), vol 36(3), pp 143-148.
- L. Robitaille L et al., ‘Oxalic acid excretion after intravenous ascorbic acid administration.’ Metabolism. 2009 Feb;58(2):263-9
- G. A. Tate et al., ‘Suppression of monosodium urate crystal-induced acute inflammation by diets enriched with gamma-linolenic acid and eicosapentaenoic acid’, Arthritis and Rheumatism, vol. 31 (12), 1988, pp. 1543–51.