Gout is a metabolic disease that can manifest as acute arthritis, chronic arthritis, and even develop into gouty nephropathy, leading to renal failure. It is caused by abnormal purine metabolism in the body, leading to an accumulation of uric acid in the blood, which irritates and inflames the synovial membrane of the joint cavity.
What are purines? What is their relationship with diet?
Under normal circumstances, purines from dietary intake and those generated by the body's own metabolism are excreted in the urine as uric acid through the kidneys. The "input" and "output" are in a dynamic balance. Once this balance is disrupted, it manifests as gout. Therefore, the nutritional treatment of gout must control the diet to minimize purine intake.
For patients in the acute phase, purine intake from food should be reduced to nearly zero to cooperate with medication for rapid symptom relief. Generally, for patients in the remission or chronic phase, purine intake can be controlled at 100-150 mg/day, which is usually effective in preventing symptoms. Food Selection for Gout Patients (1) Purine Content in Food
Food is classified into four categories based on its purine content:
1. Foods highest in purines (150-1000 mg per 100g): Liver, brain, kidneys, tripe, sardines, anchovies, roe, sweetbreads, meat extracts, consommé.
2. Foods moderately high in purines (75-150 mg per 100g): Lentils, dried beans, dried peas, carp, cod, perch, shellfish, smoked ham, pork, beef, beef tongue, veal, pheasant, pigeon, duck, wild duck, quail, goose, lamb, rabbit, venison, turkey, eel, conger, light chicken broth, light meat broth, light liver broth.
3. Foods relatively low in purines (<75 mg per 100g): Asparagus, cauliflower, asparagus tips, green beans, green peas, kidney beans, spinach, mushrooms, oatmeal, herring, fresh fish, salmon, tuna, whitefish, lobster, conger, chicken, ham, lamb, light beef broth, peanuts, bran bread.
4. Foods very low in purines (<30 mg per 100g): Milk, cheese, eggs, fruits, cocoa, coffee, tea, sea cucumber, fruit juices, soy milk, candy, honey, refined grains such as strong flour, polished rice, corn, vegetables such as beetroot, cabbage, carrots, celery, cucumber, eggplant, winter melon, potatoes, sweet potatoes, lettuce, tomatoes, onions, Chinese cabbage, pumpkin, jam. The above classification of purine content in food is mostly based on uncooked foods and is for reference only.
(2) Food Selection During an Acute Gout Attack
During an acute attack of gout, only milk, eggs, refined flour, and low-purine vegetables can be consumed, with more fruits and plenty of water. All meats and purine-rich foods are forbidden (Foods 1, 2, and 3 are forbidden; any food from category 4 can be chosen). A strict low-purine semi-liquid diet, soft diet, or regular diet can be adopted.
(3) Food Selection for Chronic Gout
Patients in the chronic phase can have unlimited milk and egg whites within the total daily protein intake. Limit whole eggs to one per day. Lean meats, white meats (fish, chicken) can be used at 100g per day. Boiled meats can be used, discarding the broth and eating the meat to reduce purine intake. It is suggested to follow the acute phase diet for 2 days a week, and for the remaining 5 days, foods from purine categories 2 and 3 can be chosen. Strictly avoid eating too much meat and purine-rich foods at once, such as animal organs, concentrated meat broths, sardines, etc. Use less or no purine-rich vegetables, such as asparagus tips, spinach, mushrooms, fresh peas, etc. Other choices can include refined grains and low-purine vegetables (preferably more yellow-green vegetables and fruits). (Foods in category 1 are forbidden; limit the use of foods in categories 2 and 3; any food from category 4 can be chosen).
In addition to the basic principle of controlling purine intake, the nutritional treatment for gout patients also has the following precautions:
Weight loss — Maintaining a normal weight is an effective way to reduce gout attacks, but the rate of weight loss should be such that ketosis does not occur, because ketones compete with uric acid for excretion by the kidneys;
Low fat — A light diet can reduce calorie intake and aid weight loss; on the other hand, fat hinders the kidneys from excreting uric acid;
Adequate intake of Vitamin C and B vitamins — This helps dissolve urate crystals accumulated in tissues;
Quit smoking and alcohol, drink more water — Daily water intake should reach 2500-3000 ml to help the kidneys excrete uric acid by increasing urine volume, while also reducing the damage of uric acid to the kidneys;
Be moderate in eating, never overeat — A large intake of purines at one time often triggers an acute gout attack.
Example Diet
Breakfast: 250ml milk, 100g bread;
Lunch: 100g tomato, 50g chicken, 100g cabbage, 100g strong flour, 50g rice;
Dinner: 35g egg, 100g celery, 100g cucumber, 35g egg, 100g rice;
Additional oil for the whole day: 21g
This one-day diet provides 1600 kcal and contains less than 100 mg of purines, suitable for gout patients in the remission phase with a medium build.