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Diet in gout
contents
- What is gout?
- Causes of disturbed purine metabolism
- No therapy without diet change
- Proper diet for gout
- Purine rich foods
- Alcohol and gout
- More tips on diet for gout
If this suspicion has been confirmed by a medical diagnosis, then a change in diet inevitably becomes the focus of everyday life. Only those who attach importance to adequate nutrition in gout can avoid long-term unpleasant concomitant symptoms and prevent severe relapses of the disease. Our guidebook on this topic is therefore intended to provide an overview of possible nutritional measures for gout and to provide assistance in the implementation of important nutrition basics.
Gout causes significant pain in the joints. (Picture: staras / fotolia.com) What is gout?
The gout (uricopathy) is referred to in the medical jargon as arthritis urica, because it comes in the course of the disease to an inflammation of the joints, which comes from deposits of urea crystals or salt crystals from the urine.
Thus, uricopathy is a disorder in urea metabolism, more specifically a disturbed metabolism of purine. A body substance that serves as a building block for so-called nucleic acids, which in turn control important body functions. For example, the macromolecules are attached to the
- Storage of genetic information,
- Signal line in the body's own functional sequences
- and development of biochemical reaction processes in the body involved.
Because their job is so essential to the body, nucleic acids are sometimes referred to as "key molecules of life." Naturally, purines are also of particular importance to the body as building blocks for these key molecules. However, the organism does not depend on an external purine supply because it can produce the substance itself. A permanently purine-rich diet can therefore quickly mean an excess of purines.
And this is exactly the most important aspect that people with gout need to watch out for in their daily diet. Because purine-rich foods leave behind in their degradation in the body particularly many nitrogen compounds. To make them excreted, purines are converted into uric acid in the kidneys using a special cascade of reactions and then excreted through the urine.
However, if the balance between formation and excretion of uric acid is disturbed, the uric acid accumulates more and more in the blood. At some point the uric acid level is so high that it leads to an increased precipitation of uric acid crystals. These are deposited in the joints, resulting in various complaints. Besides general illness symptoms like fever or exhaustion are here above all
- redness,
- swelling
- and pain
characteristic of one or more joints - often affected are the metatarsophalangeal but also knee, ankle and finger joints.
Typical of gout are pain on the finger, knee and metatarsophalangeal joint. (Image: EVGENIY / fotolia.com) The joint complaints usually occur abruptly in gout and lead, if left untreated, to serious complications, including:
- chronic arthritis,
- Bone deformities,
- Bursitis,
- Kidney stone disease,
- Renal insufficiency to kidney failure.
Causes of disturbed purine metabolism
The medicine speaks at an elevated uric acid level in the blood of the so-called hyperuricemia. It forms the physiological basis for gout and can come about through two different mechanisms:
- There is too much purine in the diet.
- There is too little purine excreted via the kidney.
If the urinary excretion rate of purine is too low, there is usually a congenital renal impairment. This primary hyperuricemia is present in more than 90 percent of all gout diseases. Typically, affected individuals can detect genetically-related kidney diseases that affect uric acid metabolism. Occasionally there is also a congenital overproduction of purine, which is the exception.
Secondary hyperuricemia, which consequently affects ten percent of all gout patients, is an acquired form of the disease. As a trigger here on the one hand, pre-existing conditions such as diabetes mellitus or leukemia in question, which represent a special burden on the kidneys and therefore increase the risk of renal insufficiency. On the other hand, a secondary hyperuricemia can of course also be attributed to a strong purine-rich diet.
Gout is caused by too much purine and the subsequent formation of uric acid crystals in the body. (Image: Gerhard Seybert / fotolia.com) Important: Regardless of the cause, care should be taken to keep the diet purine-free as much as possible in both primary and secondary hyperuricemia!
No therapy without diet change
A disorder in the uric acid metabolism is not always conspicuous by the symptoms described above, but at the beginning often just silently in the body. In addition to patients in the advanced stage of gout, who after a high-alcohol and food-rich celebration the next day with the strongest joint complaints to the doctor, there are therefore many cases in which the diagnosis gout is accidentally diagnosed incidental by routine laboratory tests. However, a crucial clue that arouses the suspicion of gout in the doctor is, however, always the information of those affected, somehow not feel so good after eating purine-rich foods.
Once a positive finding has been made, the subsequent therapy pursues several subgoals, many of which can only be achieved through medical intervention. These include:
- Reduction of uric acid production by uricostatic drugs such as allopurinol,
- Promotion of uric acid excretion by uricosuric drugs such as benzbromaron,
- Inhibition of joint inflammation by drugs such as colchicine.
Despite the variety of drug therapies, a permanent change of diet for gout is without alternative. Only by reducing purines in the nutritional plan can the uric acid metabolism be regulated in the long term. The positive influence of appropriate nutritional measures on the metabolism is sometimes even so great that after a successful conversion can be completely dispensed with a drug therapy. This has the advantage that the risk of unwanted side effects caused by the drugs in the treatment is eliminated.
Proper diet for gout
In ancient times, gout was regarded as the disease of kings and nobility. For even then it was known that the disease was mainly caused by people with a dissolute lifestyle, the lush consumption of fat and protein-rich foods such as meat or cheese and a brisk consumption of alcohol brought with it.
Foods that ordinary people could not afford at that time. However, as it was not yet known in detail about the relationship between diet and elevated uric acid levels, many of the dietary recommendations for gout patients of his time extremely hard. In addition to prescribing more piety and repentance for the decadent lifestyle, court doctors often recommended a strict diet of self-mortification, the avoidance of any meat and sausage products, and the renunciation of all kinds of alcohol. In addition, Aderlässe to the discharge of "bad blood" aisle and Gäbe.
In ancient times, gout prescribed a strict diet and bloodletting. (Image: kulkann / fotolia.com) Fortunately, we no longer live in the old days, so that bloodletting and religion no longer form part of medical treatment strategies. In addition, modern medicine is currently undergoing a process of rethinking nutritional recommendations. Because one knows meanwhile that by the strict renouncement of certain foods can be achieved as a rule an amelioration of the gout, body and spirit of the concerning at the same time however also in a permanent stress phase are shifted, which reduces the physical defensive function, psychological stress promotes and favors the development of other diseases in this way.
Even diabetics are therefore no longer recommended to abstain completely from chocolate or cake. There is nothing wrong with a piece of cake at a family celebration or an ice cream on warm summer days, as long as it stays that way and does not happen with regularity. And gout patients will no longer be forced to give up purines. Nevertheless, it is important to prefer purine variants to purine-rich foods.
Purine rich foods
Purines are present in all cell nuclei of the body. They are an important part of DNA and therefore necessary for the construction of new cells. Cell types that regenerate relatively frequently by cell division therefore contain a particularly large number of purines. For this reason, especially the cells of the skin, the internal organs and the muscle tissue are very rich in purine. Of course, this also applies to animal foods. Similarly, the cells of highly proliferating plants contain many purines.
Skinned trout contains only half as much purine as trout with skin. (Image: Maksim Shebeko / fotolia.com) With the exception of dairy products, which, despite their protein wealth, are generally considered to be more purine-poor, the purine content of many other foods is closely linked to the protein content. For this reason, it can be said very simply that very protein-rich foods generally also contain many purines. The hit list of purine carriers lead to animal foods such as offal, sausages, meat extract, muscle meat and high-fat fish species such as mackerel, tuna or sardines. Some herbal foods such as soy products, raisins and lentils also top the list of purine-rich foods. Overall, the following foods can be defined as very pure:
- alcohol (mainly beer),
- Meat and poultry,
- fish and seafood,
- certain cereals (e.g., white and green kernels),
- yeast,
- legumes (e.g., peas, beans or lentils),
- cabbage (especially sauerkraut),
- raisins,
- soy products,
- asparagus,
- animal offal (e.g., heart, liver or kidney),
- sausages (especially liver sausage and smoked ham).
Some of these foods can still be enjoyed in moderation under certain conditions. In other food variants, such as animal innards, the purine content is so high that a complete abandonment is advised. Even food with meat extract, as it is often used in the preparation of ready meals should not be eaten by patients with gout.
In addition to the purine content, it also depends on how much uric acid the respective foods produce. For example, a skinned trout produces only 148 mg of uric acid per 100 g while trout with skin produces a total of 297 mg of uric acid per 100 g. It is therefore worth comparing, if one considers that with a uric acid value in the blood outside of the standard range the daily uric acid amount of maximally 500 mg should not be exceeded, in order to achieve an improvement by change of the nutrition.
Alcohol and gout
An acute gout attack is never triggered by alcohol alone. However, if the level of uric acid in the blood is already elevated, an excessive intake of alcoholic beverages may provoke a gout attack. Since the body classifies alcohol as a toxin, it is highly motivated to metabolize it as quickly as possible and to excrete it via the kidneys. For this he throttles other metabolic processes in favor of alcohol degradation. As a result, less uric acid is excreted through the kidneys and uric acid levels in the blood increase.
This negative effect of the alcohol is particularly stimulated when the alcoholic beverage is beer. With beer, the body is not only supplied with alcohol, but also with its own yeast, a larger amount of purines. On the one hand, the beer enjoyment throttles the excretion of uric acid by the alcohol contained therein and at the same time increases the formation of uric acid by the purines it contains.
The German national drink is poison at Gicht. (Image: Wolfilser / fotolia.com) One of the most promising measures for the prevention and treatment of gout is therefore the controlled consumption of alcohol. As already outlined above, but makes the dose the poison. Gout patients are therefore advised to restrict their use of alcohol to special occasions and, if possible, to wine or sparkling wine - and not to consume larger amounts.
More tips on diet for gout
Apart from absolute taboo foods such as meat extract or beer, the diet can be relatively simple purinarm, but still varied and tasty. For example, those who like to eat lentil dishes can try the purinar alternative Bulgur. And if you do not want to give up meat on Sundays, you can put skin-free venison dishes on the menu instead of purine-rich meats like poultry. Below are some examples of purinary alternatives at a glance:
| Purine rich food | Purinary variant |
|---|---|
| Mackerel, tuna, sardine | Cod, plaice, zander |
| Pork, poultry | Game meat, beef |
| Limburger cheese | Edam, feta, mozzarella |
| Peas, lentils, beans | bulgur |
| Buckwheat, green kernel | Wheat, rye |
| Vegetarian lard | margarine |
| milk chocolate | dark chocolate |
It should also be mentioned that there are now numerous nutrition tables on the Internet listing the computationally and experimentally determined purine and uric acid content of various foods. In addition, there are now Purinrechner that calculate the actual purine content after specifying the amount of each food. These tools can be very helpful in the early days of the transition phase as a guide.
The choice of food has a decisive influence on the uric acid level in the blood. But there are a number of other nutritional and everyday measures that can have a positive effect on the uric acid metabolism in gout:
- Drink a lot: Gout patients should drink at least two to three liters of water, unsweetened tea or heavily diluted juice spritzers every day. Hydration helps flush the kidneys to maintain and improve their function.
- Lots of exercise: Exercise is known to keep metabolism busy. Especially people with existing metabolic disorders should therefore encourage their body through regular exercise units to a better conversion rate of their metabolism.
- Avoid sugar: Although gout patients should eat a lot of fruits and vegetables every day, it is advisable to use larger amounts of fruit sugar in the fruit (Fructose) to renounce. Many studies have shown that fructose causes an increased risk of gout and in the presence of this disease can worsen the disease even further. Since you can not dissipate fructose from fruit, should at least highly concentrated fructose extracts, such as those found in juices and sweets, be avoided.
- Proper preparation: It also makes sense to cook food in water instead of steaming or frying it. Because by the boiling process in water once again go in addition purines in the cooking water, making the food purine poorer.
- Proper storage: Whenever possible, store fresh stored food. Smoked goods should also be avoided. During the storage and smoking process, namely, the purine content in the food increases even further.
- Regular weight and blood checks: Obesity should be avoided if possible. Those who already suffer from obesity are required to reduce their weight. In addition, the uric acid level in the blood must be regularly tested and the drug dose and diet adjusted.
(Ma)