Given the Men’s Health focus that comes with the month of November, or Movember, there is hardly a better time to discuss the dietary considerations for gout – a painful condition which is much more likely to occur in men (especially when it occurs at a younger age).
Gout is an inflammatory condition that presents as arthritic joint pain and is largely caused by an increase in the presence of uric acid which leads to crystal deposits in joints/tissues.
The prevalence in Canada is at around 4% of males and 1% of females greater than the age of 20.
The likelihood and severity of a gout diagnosis depends on how high uric acid levels in the bloodstream get and for how long they remain elevated, which means there is some room for nutrition intervention to modify these important markers.
Let’s take a closer look at what that intervention might look like.
Section 1 – Foods/Nutrients To Consider Reducing
Meat, Alcohol & Sugar Sweetened Beverages: Traditionally the primary points of transition upon a gout diagnosis is one that trends towards a reduction in the intake of most types of meat, seafood and alcohol.
Red meat, organ meats and seafood/small fish like sardines may be particularly high in purines which can cause an increase in uric acid levels.
It should come as no surprise than that those who follow vegetarian diets tend to hold a lower risk of gout diagnosis.
Mindfulness around fish intake should be balanced with the fact that some evidence suggests omega-3 fatty acids have a role to play in reducing gout flares.
Products that are very high in fructose, such as pop and fruit flavoured beverages, are also generally considered products to minimize throughout the gout literature.
Section 2 – Foods/Nutrients To Consider Increasing
Polyphenols: Polyphenols are a family of bioactive antioxidant compounds that have generated some interest in the world of gout research owing to a potential role in enhancing uric acid clearance from the bloodstream.
Some food selections that are particularly high in polyphenol content including a variety of herbs/spices, flax, olives, pecans, almonds, apples, spinach, black beans, berries, peaches, plums, carrots, tofu, tempeh and broccoli, among many others.
Vitamin C: Observational studies have demonstrated that higher vitamin C intakes have been linked with a lower incidence of gout, even if Vitamin C supplementation has not been definitively proven to improve outcomes in those already living with the condition.
A review of Vitamin C status via fruit/vegetable intake, also considering the polyphenol content of fruits and veggies, appears warranted.
Fruits and vegetables can, however, also contain varying amounts of purines yet it appears that the scientific consensus is that they do not raise the same level of concerns as the purines ingested via animal-based foods.
This quote from a 2019 paper out of Nutrients provides an apt account:
“Despite some outdated guidelines that continue to promote the avoidance
of high-purine vegetables, it is important to emphasize that there are no
data from long-term cross-sectional or interventional studies that would
show that high-purine plant-based foods represent a clinically meaningful
increased risk for hyperuricemia or gout development.”
And while the sense I get from the summative literature is that purine-content awareness of plant-based foods is not as relevant as it is with animal sources, it may still be relevant in those already living with gout or kidney conditions. With that in mind I’ve provided a table here outlining the purine content of various foods.
Dairy: Low fat dairy products such as milk and yogurt have been observed to reduce the incidence of gout, and their inclusion for the management of gout is recommended by the 2012 American College of Rheumatology guidelines.
Final Thoughts
Despite a large body of observational evidence relating to nutrition and gout management, my sense is that the quality of these data are moderate at best. Dietary modifications also only represent one piece of the gout management puzzle.
I’ve tried to make sense of the science encountered to the best of my ability to offer up meaningful and actionable guidance for those of you who encounter patients with gout. I hope you found it insightful.
-Andy De Santis, RD MPH