Consuming a low purine diet significantly minimizes the risk of damaging body joints and promoting the development of gout.
Purine is a nucleotide base vital to the gene structure and operation of plants and animals. While most foods incorporate small amounts of purine, a few foods contain much higher purine levels.
Eating excessive amounts of high purine foods generates an elevated and unhealthy supply of purine, which overwhelms the kidneys and causes uric acid levels to rise. Knowing how to reduce uric acid levels will directly alleviate severe inflammation of joints and the discomfort of gouty arthritis.
What is Uric Acid?
Uric acid forms because of purine being metabolized from cellular degeneration and recycling of the cell’s genetic material. While it is normal for the production of uric acid to result from purine break down, an inordinate amount eventually proves to generate harmful medical conditions. We need certain amounts of uric acid to promote healthy blood vessel linings that properly maintain blood flow throughout the body. However, when uric acid levels exceed the beneficial limit, a substance called monosodium urate crystals accumulates in joints, tendons and kidneys, causing gout and sometimes kidney stones.
Frequently, malfunctioning kidneys are the culprit behind abnormally high uric acid levels, since they are supposed to filter and inhibit disproportionate amounts of uric acid from accumulating in the blood. However, other causes also exist that promote formation of uric acid crystals. Following a low purine diet in addition to treating these other medical conditions responsible for gout can relieve or eliminate gout attacks altogether.
Purine metabolism problems may also account for medical conditions in infants and children, which are not readily diagnosed by physicians. These conditions include cerebral palsy, anemia, epilepsy, and vulnerability to repeated infections. When conditions such as these exist and doctors can find no reason for their manifestation, screening for high uric acid levels may prove to be the answer for the cause of these issues.
What is Gout?
Gout occurs when excessive levels of uric acid amass in the body, promoting deposits of thin, sharp crystalline structures in joints and tissues. Once enough crystals impinge on joint structures, gout symptoms appear, such as pain, swelling, stiffness and redness begins to affect the area. Usually, gout is first noticed on the feet, specifically the big toe joint. This is called podagra and often leads to neighboring joints being affected, such as ankles, insteps, heels and so on.
Another type of uric acid deposit called tophi may appear as a lumpy mass beneath the skin around the joint. In addition, uric acid crystals often accumulate in kidneys, resulting in the formation of painful uric acid kidney stones. When someone begins consuming a low purine diet, these crystals quickly dissolve and discontinue inflaming joints.
Medical science recognizes four stages of gout:
- Asymptomatic stage—referred to as hyperuricemia, this stage occurs when higher than normal levels of uric acid exists but is not enough to produce symptoms. If uric acid levels stay below a certain number, treatment is usually not warranted.
- Gouty arthritis or acute gout—the asymptomatic stage develops into the acute gout stage when hyperuricemia has risen and crystalline deposits begin forming in joints. Tenderness, pain and swelling occurs, with the initial symptomatic event frequently happening at night or while the body is fighting another infection. In addition, gout attacks can be provoked by stress as well as drug and alcohol consumption.
- A typical gout attack abates over a period of three to ten days even if you do not seek treatment and immediately begin a low purine diet. Other attacks may occur at any time following the initial attack—from several months to several years. However, these subsequent gout attacks will usually increase in intensity and duration.
- Interval gout—physicians use this term to refer to the time between gout attacks. Patients will not experience symptoms during this time. They may also think they have been cured of gout, which is not the case if a treatment plan that includes eliminating high purine foods from the diet is not implemented.
- Chronic tophaceous gout—as the most debilitating phase of gout attacks, the chronic tophaceous stage develops over an extended period, sometimes lasting long as ten years. By which time, joints are permanently damaged by uric acid crystal formation. Kidneys may also have suffered irreparable harm during this time as well. This is what happens when uric acid levels increase and gout is not properly treated with a low purine diet.
How to Lower Uric Acid Levels
Once diagnosed with gout, your doctor will recommend that you begin following a uric acid diet. Consuming a well-balanced diet, containing moderate amounts of all the main food groups, means you won’t experience high uric acid levels, unless your kidneys are incapable of filtering the blood properly.
Receiving around 600 to 1000 milligrams of puric acid from foods is considered a healthy amount for most people. However, overconsumption of certain foods may produce hyperuricemia without you being aware of it.
Foods high in puric acid that you should not include in a low purine diet are:
Anchovies, baker’s and brewer’s yeast, animal organs, sardines, Boletus mushrooms and gravies—more than 800 milligrams per three ounces
Foods containing up to 200 milligrams of puric acid per 3.5 ounces:
Those who are on a doctor-prescribed diet consisting of low purine foods are generally able to eat one 3.5 ounce serving of any of the below foods each day without exceeding the limit suggested by your doctor.
- Chicken (best if you remove the skin)
- Navy and kidney beans
- Sunflower seeds
- Brown shrimp
Remember: Those who do not experience problems metabolizing uric acid or with kidney filtering functioning generally do not have to worry about the amount of high-purine foods they consume (up to a point, of course). However, those afflicted with extreme hyperuricemia need to adhere to a strict uric acid diet.
Foods containing amino acids (glycine, leucine, alanine, aspartic acid and glutamic acid) facilitate excretion of uric acid through the kidneys. Dairy foods and molasses, both part of a low purine diet, contain aspartic acid. Glutamic acid, produced by the body, assists in potassium transportation across the blood-brain barrier as well as to other parts of the body.
Low purine diet foods provide chemicals necessary in manufacturing glutamic acid within the body. Beans, nuts and whole wheat, all foods found in low purine foods, contain leucine, another essential amino acid contributing to decreased attacks of gouts by enhancing bone and muscle mass.
Low Purine Diet for Gout
All low-fat dairy products—although recent research discovered that including larger than normal amounts of low-fat dairy products in a diet decreases instances of gout by more than half, scientists are not certain why these foods produce this effect.
A list of other low-fat, low purine diet foods include:
- Peanut butter
- Low-fiber breads
- Low-fat cheese and ice cream
- Soups containing no broth or meat extract
- Sweet items in limited amounts
- Fruits and vegetables
- Red and white cabbage
- Luncheon meat
- Green olives
- Brazil and hazelnuts
Be aware that breads, cereals and crackers advertising as being “100% wheat”, “stone-ground” or “multi-grain” are generally not whole grain foods and may contain ingredients such as yeast, which increases uric acid levels and promotes formation of urate crystals.
Purchase only lean cuts of meat containing as little fillers or fat as possible when creating your low purine diet meal plan. In addition, poultry should be cooked and eaten without the skin, since the fattiest part of chicken or turkey is the skin. Instead of frying meat, bake, poach, broil or grill meat. If you prefer, meat substitutes are acceptable to include in a gout diet, such as those made with soybeans, egg substitutes, vegetable-protein tofu or legumes.
Importance of Cherries in a Low Purine Diet
Cherry juice and tart cherries (the Balaton and Montmorency kind that are grown in Michigan), contain potassium, an essential mineral necessary for optimal kidney functioning and regulating blood pressure. Because potassium is “essential”, this indicates that the body is incapable of chemically altering other substances to create potassium. Therefore, humans must then obtain potassium from other sources, such as cherries, to maintain good health.
Tart cherries and cherry juice keep urine pH at a slightly alkaline level, which inhibits accumulation of uric acid in the blood and consequential formation of uric acid crystals in joints. Cherries should definitely be a part of a low purine diet.
In addition, drinking cherry juice for gout reduces uric acid levels due to the presence of anthocyanins in the cherries. Extracted from berries and grapes, anthocyanin is an antioxidant and bioflavonoid that contains antimicrobial, anti-inflammatory properties enhancing blood vessel and platelet functioning.
Gout sufferers should eat eight ounces or more of tart cherries each day to relieve pain and swelling of gout. Drinking the same amount of cherry juice instead of eating cherries will also significantly reduce inflammation.
Mulberries should also be included in a low purine diet because they contain healthy amounts of Morin, a flavonoid attributed to relieving pain from inflammation. Although mulberries do not directly reduce the high levels of uric acid in a gout sufferer’s blood stream, they do alleviate pain as incidences of gout flare-ups are being treated.
In addition, mulberries also enhance capillary strength, which is often compromised when joints are inflamed. According to the book Vitamins and Minerals Demystified by Dr. Steven Blake “since ascorbic acid slightly increases capillary fragility, this action of the bioflavonoids offsets this tendency”. Consuming mulberries while on a low purine diet will counteract this issue precipitated by fruits being such an integral part of gout diet.
Other Flavonoid-Rich Foods
Gout sufferers who are sensitive to over the counter pain relievers such as ibuprofen or aspirin may find natural relief from flavonoid-rich, low purine diet foods such as:
- Lemons and limes
- Dark-colored beans
- Green and red vegetables
- Red and green onions
Effects of Coffee and Tea on Gout
Drinking coffee but not tea seems to correlate with a subsequent reduction of blood uric acid according to a report published in the June 2007 issue of Journal of Arthritis Care and Research. Researchers interviewed over 14,000 subjects regarding coffee and tea drinking habits and later evaluated their uric acid levels according to whether they were predominantly coffee or tea drinkers, or drank neither one.
- Those who drank four to five cups of coffee each day as part of a low purine diet indicated a decrease of 0.26 mg/dl serum uric acid in contrast to those who did not drink coffee at all.
- Those who drank six cups of coffee per day experienced uric acid level reductions of 0.43 mg/dl.
Interestingly, researchers also investigated the effects of caffeine contained in beverages other than coffee and found drinks such as soda did not influence uric acid levels one way or the other. This may indicate that coffee contains a unique ingredient or property responsible for decreasing uric acid and alleviating gout symptoms.
Fish Oil as Part of a Low Purine Diet
A substantial amount of research has been accomplished regarding the strong anti-inflammatory properties of fish oil, or omega 3 fatty acids. By facilitating the production of prostanglandins, hormones responsible for reducing inflammation and regulating calcium dispersion, fish oil is a necessary part of a successful low purine diet intended to combat the pain of gout.
In addition, prostanglandins inhibit particular pro-inflammatory hormones that are part of the prostanglandin family. While fish oil won’t relieve pain as quickly as NSAIDs (non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen), they effectively work to reduce the presence of prostanglandins over longer periods of time, eliminating the need to take NSAIDs which often cause side effects.
Frequently, insulin resistance (metabolic syndrome), heart disease and kidney stones are co-morbidly occurring diseases with gout. Fish oil supplements taken in conjunction with a low purine diet can benefit these diseases as well by decreasing bad fats (triglycerides) and preventing platelet aggregation, which is a common cause of blocked vessels and heart attacks.
A few foods other than fish contain omega 3, which are also foods that can be included in a gout diet. Walnuts, flaxseeds, flaxseed oil and eggs are all sources of omega-3 that do not contribute to uric acid levels in the body.
Folic acid effectively neutralizes an enzyme called xanthine oxidase which is directly responsible for producing uric acid. By also regulating any uric acid already present in the blood, gout attacks are usually shorter and less painful. However, the recommended daily amounts of folic acid fall short of the 80 milligrams a day that is required to decrease blood uric acid. In addition, epileptics who take medication may find that folic acid interferes with the efficacy of that medication. Little research has been done regarding the effect of high doses of folic acid so including folic acid supplements in a low purine diet should be implemented under the supervision of a doctor.
When following a low purine diet for gout, remember to increase liquids to at least ten, eight ounce servings of water or juice daily. Liquids facilitate the elimination of uric acid by assisting the kidneys in the process of filtering and disposing of wastes.
Suggested Low Purine Diet Menus for Gout Diet
Diets to reduce uric acid are not as restrictive as diabetic or even weight management diets. However, if you are accustomed to eating high purine foods or drinking alcohol on a regular basis, this diet may represent a drastic change in your eating habits. However, to avoid painful attacks of gout that could eventually result in irreversible damage to joints and lifelong impairment of movement, reducing uric acid levels should be a priority in your life.
Low Purine Diet for Gout
This type of diet should include daily servings of:
- Grain products—six to ten servings
- Fruits—two to four servings
- Vegetables—three servings
- Low-fat dairy products—two servings
- Protein-rich foods–one egg, one ounce of cheese, three ounces of cooked, low-purine meat and two tablespoons of peanut butter
When consuming foods included in a uric acid diet you may eat as much as you like, as long as this does not contribute to weight gain. This poses a problem since many low purine foods such as white breads, pasta and cereals contain high levels of sugar and carbohydrates. A good meal plan to follow to reduce uric acid in the body would be:
- Bowl of cereal such as cornflakes or crisp rice
- White bread toast, buttered with olive oil spread
- Glass of skim milk
- Cup of tea or coffee or small glass of cherry juice
Low-fat cheese and saltines or grapes
- Sliced meat sandwich (ham, chicken or turkey) on white bread or
- Peanut butter sandwich on white bread
- Fruit salad
- Coffee, tea, water or cherry juice
- Small slice of white cake or two peanut butter or sugar cookies
- Grilled chicken breast
- Pasta or rice
- Carrots, cauliflower or asparagus
- Water or cherry juice
- Pudding made with low-fat milk
- Fruit chunks
- Fresh vegetable mixture
- Fresh berries
Many variations are possible with this uric acid diet. However, even though gout symptoms decrease, you need to follow a low purine diet as closely as possible to maintain successful control over uric acid levels.
How Much Fat in a Low Purine Diet?
While eating moderate to excessive amounts of saturated fat is detrimental to everyone’s health, it is especially damaging to gout sufferers because fat is directly correlated with weight gain, heart disease and exacerbated gout symptoms. However, small quantities of fat are necessary for optimal functioning of the nervous system as myelin, a form of fat, is essential for optimal signal transduction in the brain enhancing cognition abilities.
For this reason, gout sufferers should have one serving of one of the following per day:
- 2 tablespoons of half and half cream
- 1 tablespoon of cream cheese
- 1 teaspoon of butter
- 1 tablespoon of reduced fat mayonnaise
- 1 tablespoon of whole sesame seeds
- 1 slice of bacon
- 1 tablespoon of sunflower or pumpkin seeds
- 1 teaspoon of trans fat-free margarine
Benefits of Dark Chocolate and Cocoa Powder
Research has discovered that chocolate and cocoa powder, especially dark chocolate, contains high amounts of flavonoids when compared to other foods rich in antioxidants. For this reason, an occasional small piece or two of dark chocolate or cup of cocoa should be included in a low purine diet. In fact, cocoa powder possesses the highest amount as a member of the chocolate family, containing ten times the amount of flavonoids found in cranberries and strawberries.
Chocolate is low in purines as well, but don’t eat it excessively as it is high in empty calories and promotes weight gain unless you engage in regular exercise.
Prescription Treatments for Gout and Uric Acid Conditions
While a low purine diet for gout is one of the best defensive measures which those suffering from gout can pursue, physicians provide drugs to assist in alleviating gout symptoms. The principle medication used in treating gout is colchicine, a recently FDA approved medication naturally found in plants belong to the Colchicum family.
However, colchicine is known to produce side effects such as gastrointestinal disturbances and neutropenia, which is a reduction in a vital type of white blood cell. Doses must be closely monitored, as too high of a dose can profoundly weaken bone marrow and induce anemia. Colchicine toxicity is similar to arsenic poisoning, resulting in damage and failure of internal organs within 72 hours of ingestion.
Prognosis and Summary
A gout attack or flare-up generally diminishes within five to seven days without treatment, depending on severity of the attack and amount of uric acid in the blood. More than half of these will suffer another attack within twelve months of experiencing the first attack, unless treatment is pursued and a low purine diet is adopted.
It is also important to note that developing gout also puts you at risk for diabetes mellitus, metabolic syndrome, hypertension, renal failure and cardiovascular disease. While some of these disorders may partly result from obesity or insulin resistance issues, the majority are a direct consequence of untreated hyperuricemia.
Destruction of joints is another consequence of elevated uric acid levels and continued accumulation of urate acid crystals within joints. Implementing gout prevention measures as quickly as possible is vital to eliminating uric acid from the blood and reducing the pain and swelling of gout.
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Low Purine Diet
Also visit the other great pages at this site, High Purine Foods, Symptoms of Gout – Why Low Purine Diet is so good for Gout Treatment, and Diet for Gout – Low Purine Diet.