The cornerstone of an effective therapy for gout is in any case and right at the beginning a detailed explanation and consultation on the topics of nutrition and lifestyle. The goal of the special nutrition with gout is always the durable lowering of the uric acid existence of the body, because the more uric acid in the blood is, the more frequently it can come to gout attacks. In addition – if necessary – the aim should be to normalize body weight.
With the production of a nourishing plan it must be considered that due to certain metabolic processes daily in the body itself already approximately 300-400mg uric acid result. The additional amount of purines supplied by food, which is then broken down into uric acid, should not exceed a maximum of 500 mg of urea. The goal of the special nutrition with gout is the durable lowering of the uric acid existence of the body, because the more uric acid in the blood is, the more frequently it can come to gout attacks.
The purines (important components of DNA) supplied with food are broken down in the human organism to uric acid. Uric acid is the metabolic end product of purines. Purines are components of the cell nucleus and are found in large quantities in various foods:
- Offal
- Some fish and crustaceans and
- Few legumes and
- Vegetables
Since an increase of the uric acids in the blood is an important risk factor for the occurrence of gout attacks, the nourishing therapy aims at In food-talbels the uric acid content of the food is indicated.
Nutritional protein An increased supply of protein leads to an increase in uric acid excretion via the kidneys and to a decrease in the uric acid concentration in the serum. Carbohydrates Among carbohydrates, the sugar substitutes fructose (fruit sugar), sorbitol and xylitol can lead to an increase in serum uric acid levels. However, these substitutes have to be taken in high doses and this will rarely be the case in practice.
Usually, quantities of fructose ingested with food (for example in household sugar) have no effect on the uric acid concentration in serum. Dietary fats A high-fat diet leads to inhibition of uric acid excretion via the kidneys and thus to an increase in the concentration of uric acid in the blood. Whereby the origin of the fats (whether animal or vegetable fats) has no meaning for the rise of the serum uric acid.
Alcohol Large quantities of alcohol lead to a decrease of the uric acid elimination over the kidneys and in the liver more uric acid is formed than normally. In addition, when beer is consumed, its purine content and the associated increased purine load contribute to the increase in the uric acid level. Overweight and chamfered Frequently gout patients and humans with increased uric acid values in the blood suffer from overweight.
This is usually due to an excessive energy and therefore purine intake. A weight reduction usually leads to a reduction of the uric acid concentration in the blood. With the total chamfered the body burns the stored depot fat and draws it to the power production.
From the fat metabolism then the so-called ketone bodies, which are formed increased and inhibit the elimination of uric acid over the kidneys, originate. This leads to an increase in uric acid in the serum. This effect would be strengthened, if alcohol and chamfered were combined.
Thus chamfering cures are not indicated with humans with increased uric acid values and gout. After weight reduction according to the principles of the full, energy-reduced mixed diet, new, lower uric acid levels in the serum are usually achieved. The aim of a special diet for gout is to permanently lower the body’s uric acid level.
The serum uric acid level should ideally be in the range of 5.5 mgdl. If the uric acid levels rise to 8.0 to 9.0 mg/dl without symptoms (attacks of gout, kidney stones), it is sufficient to follow dietary instructions. If these are not adhered to or if the uric acid level rises to values above 9 mg/dl or in the case of complications such as attacks of gout or kidney stones, additional medication must be used.
Since the therapy of hyperuricemia is a long-term therapy, it is all the more necessary to regard the nutritional therapy as the basis and to adhere to it. The dosage of medication can thus be reduced. By consistently adhering to nutritional therapy, the use of medication can even become completely superfluous.The nutritional therapy for hyperuricemia has the following goals: A low-purine diet should not contain more than 3500 mg uric acid per week.
- Restriction of purine intake with food
- Preference for milk and dairy products as a source of protein
- Normalization of body weight in case of overweight
- Restriction of alcohol consumption
No more than one portion (100g) of meat, fish or sausage per day is allowed. Offal should be avoided completely. Just as purine-rich legumes and vegetables such as Brussels sprouts and cabbage.
The uric acid content of individual foods should be indicated in food tables preferably per portion and not by weight units. This facilitates evaluation and calculation. The protein intake from almost purine-free milk and dairy products does not have to be considered and calculated separately.
In the case of existing overweight, the dietary fat must be reduced within an energy-reduced mixed diet, in addition to the measures mentioned above, in order to achieve weight reduction (slimming). The consumption of alcohol must be restricted in any case. When drinking beer, the purine content of beer must be taken into account in addition to the effects of alcohol on the uric acid level.
Beer contains 15 mg uric acid per 100 ml. Alcohol-free beer contains approximately the same amount of purines. Wine is purine-free and affects uric acid levels “only” via its relatively high alcohol content.
A strictly low-purine diet is only indicated if a drug treatment of hyperuricemia is not possible. This diet contains no more than 300 mg of uric acid per day or no more than 2000 mg of uric acid per week. Protein is supplied in the form of milk and dairy products and low-purine vegetable foods.
Only two to three times a week 100 g of meat or fish are allowed. The food should be eaten mainly cooked, because during the cooking process some of the purines are transferred to the cooking water. Maintaining this diet requires a high degree of self-discipline.
Nutritional recommendations for hyperuricemia Legumes and purine-rich, plant-based foods such as cabbage and Brussels sprouts avoid strictly low-purine foods with no more than 300 mg uric acid per day or no more than 2000 mg uric acid per week. This is only indicated if, for example in the course of an advanced kidney disease, a therapy with medication is no longer an option.
- Weight reduction for overweight
- Low purine diet with no more than 3500 mg uric acid intake via food per week
- One serving (100g) of fish, meat or sausage at most once a day.
- For poultry, remove the skin
- Avoid offal
- Preference for milk and dairy products as a source of protein.
- Two to three eggs per week possible (note also the hidden eggs in cakes, pancakes and other foods containing eggs)
- Restriction of alcohol consumption.
No more than 1 glass of beer or wine per day allowed. Pay attention to the purine content of beer (15 mg per 100 ml beer)
- Ensure sufficient fluid intake of 1.5 to 2.0 l daily. Preferably in the form of water and mineral water.
Tea and coffee are allowed.
- Once or twice a week a portion (100 g) of fish, meat (cooked) or sausage.
- Remove the skin from poultry
- Protein in the form of milk and dairy products and eggs (2-3 eggs per week) and purine-free, vegetable foods.
- Prohibition of offal.
- Prohibition of certain types of fish and crustaceans: herrings, lobsters. Mussels.
- Prohibition of alcohol.
- Prohibition of legumes (white beans, peas, lentils) cabbage and Brussels sprouts, spinach, asparagus.
- Sufficient liquid intake in the form of water and mineral water. Coffee and tea in normal quantities (2 – 3 cups daily) allowed.
If a consistent change in diet does not lead to the desired improvement or if an acute attack of gout has already occurred, painkillers can alleviate the symptoms.
However, gout patients should avoid the active ingredient ASA (e.g. Aspirin®), as this can reduce the kidney’s uric acid excretion. Furthermore, the production of uric acid in general can also be reduced by medication (e.g. with allopurinol, febuxostat) or the uric acid excretion via the kidneys can be increased (e.g. with benzbromarone, Probenecid).
A combination of different active ingredients is rarely necessary.Gout is an inflammation of the joints (synovitis) because uric acid crystals, which precipitate in the blood at elevated concentrations of the same breakdown product, are deposited in the tissue. This precipitation of uric acid crystals occurs particularly frequently in joints. Since these crystals are foreign bodies that the body does not actually know, the body’s own defence is triggered with the aim of eliminating these disorders.
This leads to an inflammatory reaction. With approximately every fifth man in Germany, increased uric acid levels in the blood can be detected, which does not necessarily lead to a manifest gout disease, but is of course a major risk factor. The higher the uric acid level in the blood is, the more likely an acute attack of gout becomes.
These acute attacks of gout develop with anyway increased uric acid concentrations if suddenly the uric acid mirror rises still further. This can happen for example with increased consumption of alcohol or large quantities of purine-rich food, in addition, with longer chamfering periods. The nutrition with gout is therefore immediately elementary therapy form and prophylaxis for not yet concerned.
