Gout diet: What to eat and what not to eat to reduce uric acid levels in the body

Gout is a type of inflammatory arthritis that causes swelling, redness and pain in the affected joint. Most commonly, gout affects the big toe. However, it can affect any joint of the body and is usually progressive if not treated on time. The condition shows up in flares: the symptoms worsen and get better for a while (remission). With progression, the flare-ups become worse too.

Fortunately, gout can be easily managed with a combination of medications and dietary modifications. The idea is to control inflammation, prevent or delay flare-ups and reduce the levels of uric acid in the body, the underlying cause of gout.

Uric acid is a product of the breakdown of purines in the body. Purines are organic compounds that are present in certain foods such as beer, certain kinds of meat, peas and seafood like sardines and mussels. If you are a male, are overweight or an alcoholic, you are at higher risk of developing high uric acid levels in the blood and hence gout.

A typical diet for gout patient focuses on reducing purine intake and increasing the intake of liquids to flush out the extra uric acid from the body. This diet should also be followed by people who have high uric acid levels but do not have any symptoms of gout yet.

Good foods for gout
Uric acid foods to avoid or reduce

Doctors for Gout diet: What to eat and what not to eat to reduce uric acid levels in the body

Good foods for gout

A gout diet is restrictive: it focuses on reducing the intake of purines and proteins (a high protein diet usually has a lot of purines). However, cutting out nutrients from the diet may cause more harm than good. There are certain foods that you can substitute in your diet to make sure that you get the required amount of nutrition. Here are some foods that you can take if you have gout:

Drink lemon water to reduce gout

If you have gout, make sure you take plenty of water to keep yourself hydrated. Dehydration increases the risk of hyperuricemia and formation of uric acid crystals in joints. On the other hand, if you take ample fluids, it will help flush out the extra uric acid from your body and would hence aid in controlling gout. Try to drink at least eight to 10 glasses of water (two litres) per day.

You can also add the juice of two lemons to the water and drink this daily to reduce uric acid levels in the body. Research shows that lemon juice becomes alkaline once it is digested by the body. The calcium carbonate released binds with the uric acid and reduces uric acid levels over time.

Daily intake of lemon water is recommended for people with high uric acid levels (even when they don't have gout symptoms) for at least six weeks.

Which vegetables to eat in gout

If you have gout, then you should opt for vegetables such as cabbage, carrots and cucumber in your diet. Cabbage is an anti-inflammatory agent, carrots reduce pain and inflammation and cucumbers contain many antioxidants.

For protein, substitute animal protein with soy, lentils, peas and unsalted seeds and nuts. Though all of these sources do contain purines, this kind of purine does not harm as much as the one obtained from animal protein.

Add up to five 80g servings of vegetables and fruits in your diet.

Research shows that though vegetables like spinach, mushrooms, cauliflower and asparagus contain higher amounts of purine, the benefits of eating them in moderation outweigh the harm. They should be consumed in moderation.

Low-fat dairy for gout

Some studies show that taking low-fat dairy products can reduce your uric acid levels. Low-fat dairy has anti-inflammatory properties which would help to control gout symptoms.

You can take two to three glasses of low fat or skimmed milk per week and about two cups of low-fat yoghurt per week.

Losing weight can also help to reduce the symptoms of gout. Switching to low-fat foods may, therefore, help patients in the long run.

Coffee benefits for gout patients

Yes, you read that right. Coffee can not only help you control your serum (blood) uric acid levels but also helps to prevent gout.

Studies have shown that people who drink four cups of coffee a day are at a much lower risk of developing gout than those who do not. A review study published in the journal Seminars in Arthritis and Rheumatism concluded that moderate coffee consumption should be added as a dietary suggestion for preventing hyperuricemia.

However, since drinking a lot of coffee may lead to chronic kidney disease, it is best to check in with your doctor to know more about the benefits of coffee for you.

Complex carbohydrates and whole grains for gout patients

The benefits of carbohydrates for gout patients depend on the type and quantity of carbs consumed. While eating a lot of carbohydrate foods may worsen your gout, taking complex carbohydrates which have a low glycemic index (meaning, they don’t increase your blood sugar levels much) can help reduce your uric acid levels.

However, the key here is consuming low glycemic index foods. This can include:

Legumes like beans and peas
Dairy products like cottage cheese (avoid processed cheese, as it has higher amounts of purine)
Fruits rich in fibre and vitamin C
Whole grains contain ample amount of complex carbs, minerals like iron and fibre, but they are also rich in proteins. So you should eat these in moderation.

Talk to your dietician to know more about foods with a low glycemic index.

Eggs for gout patients

Eggs are one of the best sources of proteins. For this reason, they are often thought to be bad for gout patients. However, eggs are low in purines and can be taken in moderation.

There aren’t many studies that say for sure that gout patients can consume eggs or how many eggs they can consume. So, if you have gout, it is better that you ask your doctor before eating eggs.

Vitamin C for gout

When it comes to the benefits of vitamin C for gout patients, the evidence is not very clear. Some scientists say that vitamin C promotes the elimination of uric acid from the body and is hence an excellent way to reduce gout symptoms.

Various studies have linked vitamin C uptake with a reduction in serum uric acid levels. In 2009, a research paper published in Jama Internal Medicine, a peer-reviewed journal published by the American Medical Association, explained that taking up to 1500 mg of vitamin C per day can reduce the uric acid levels to about 45% and is helpful in preventing gout.

The exact mechanism of how vitamin C helps reduce uric acid is unknown. However, it is speculated that it may do so by increasing the filtration rate in kidneys and by selectively stopping the resorption of uric acid from kidneys. The antioxidant action of vitamin C is also thought to play a role in controlling inflammation in gout patients. According to the Arthritis Foundation, US, if you have gout, increase your intake of vitamin C rich foods, especially fruits like cherries.

However, a 2013 study published in the peer-reviewed journal Arthritis and Rheumatology indicated that even though vitamin C reduces uric acid levels in the body, the reduction is not clinically significant.

Uric acid foods to avoid or reduce

Gout can be worsened by some foods. If you have gout, it is best you avoid the below-mentioned foods:

Meats: If you love red meat or organ meat, you might have to part with them for a while since both these types of meat are particularly high in purines and may cause your gout to flare up. It has been scientifically proven that people who take a meat-based diet have much higher levels of uric acids in their blood than those who took a vegetable-based diet.
However, you don’t have to completely cut off red meat from your diet as they are a rich source of iron among other nutrients. Experts suggest you can just reduce your portion size to about 75g and don’t consume meat more than twice a week.
Seafood: Just like red meats, some types of seafood are also known to be rich in purines and hence cause a rise in blood uric acid levels. These include mussels, lobsters, shrimps, crabs and oysters.
A three-year follow-up study done on more than 400 Japanese adults showed that those who consumed roasted or raw fish were at much higher risk of hyperuricemia than those who consume fried or boiled fish. However, more studies are needed to confirm this.
According to the Ministry of Health, Canada, fish rich in omega-3 fats is good for health. If you consume fish twice or less per week, ask your doctor if you may continue or get fish oil supplements instead.
High fructose corn syrup: Intake of high fructose corn syrup, a sweetener used in a lot of soft drinks and processed foods, is considered to be a risk factor for gout. This is because fructose metabolism stimulates the production of uric acid in the body. It also promotes inflammation and increases oxidative stress (a condition that negatively affects organ function).
High fructose corn syrup also increases your risk of obesity, one of the risk factors for gout. Therefore, gout patients are told to reduce their intake of all the foods that contain high fructose corn syrup. These include soda, soft drinks, some types of bread, packed fruit juices and frozen foods.
Alcohol: Alcohol is not only a risk factor for high uric acid levels and gout but it is also said to promote gout flare-ups.
However, not all types of alcohol are alike. While beer, sake and spirits have been found to raise serum uric acid levels, one glass of wine a day is said to reduce uric acid levels in men. According to research, the wine needs to be taken in moderation (less than one drink a day, or a 142 mL glass of 12% alcohol) as drinking more than a glass of wine a day may actually cause a gout flare-up. Additionally, this effect is only seen in men and there is no evidence on how wine intake affects gout flares or risk in women.
One of the possible reasons for the negative effects of alcohol on gout patients is its tendency to cause dehydration, which in turn increases the uric acid levels in the body. Also, beer contains a lot of yeast, which is rich in proteins and may cause hyperuricemia.
Tomatoes: A lot of gout patients report tomatoes as a trigger for their flares and if you are one of those, your doubt is correct after all. Researchers say that tomatoes increase serum uric acid levels and may be a trigger for gout flares. There are at least two different compounds in tomatoes that may trigger hyperuricemia. These include phenolic acids and glutamate. Tomatoes affect the excretion of uric acid from kidneys and stimulate the production of urate in body.
A 2015 study compared this rise in serum uric acid levels caused by tomatoes and some other known gout triggers including alcohol, meat and fructose syrup. It was found that the rise was comparable to that of all of these triggers and a serving of tomato in a week increased uric acid levels more than a serving of meat or sugar syrup. However, the study concluded that more evidence is needed to confirm the extent of the effect.