2011 Gout Diet Restriction Update
Since writing this, I have published an article, Sensible Gout Diet Restrictions, which addresses the points I have covered here. Please read that article, and add comments below if anything is not clear
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Do Not Be Ruled By Food
I’m not worried that it’s wrong to think about what you eat – just don’t get obsessed.
Over half of the messages I receive are about food and drink.
“What food should I eat with gout?”
“What food should I avoid with gout?”
“Will [food] make my gout worse?”
The gout sufferer’s diet questions are endless, and the gout doctor’s diet advice is monotonous.
No Alcohol. Avoid purines. Lose weight.
Not particularly bad advice, but too general to be helpful, and too restrictive to be accepted.
The real danger here is that gout patients focus on food, and not on what really matters – controlling uric acid.
It’s heartening to see that some doctors are realizing that strict low purine diets are not the right way. “In treating gout, don’t overdo diet restrictions” is a refreshing article from Dr Robert Shmerling. He does not…
recommend strict dietary modifications after an initial attack of gout.
Like me, he points out the research showing weaknesses in strict low purine diets. Significantly he continues:
these studies looked at people who had not had gout before. They did not assess the effect of diet on people who already had gout.
In a nutshell, you need to stop obsessing about specific foods. Eat a healthy varied diet that satisfies you. Enjoy what you eat, but just eat enough to maintain a healthy weight, and exercise as often as you can.
Drastic changes simply do not work, and some can make your gout worse. Small improvements every few days soon make a big difference. Most importantly, you feel better because you’re in control.
To feel even more in control, learn more about gout. When you understand how gout pain is caused, and why uric acid control is so important, you are much better placed to help yourself, and ask the right questions of your doctor.
Your added bonus is that, when you are learning about gout, it helps you to stop worrying about food.
It’s amazes me about gout flare ups to begin with. My father-in-law (62 years old) is extremely active. He works out everyday and eats very healthy. (Than man is obsessed with salads and has to have one every night with his meal). And yet he gets gout at least once a year.
You make a good point. People will eat what they’ll eat, but if they obsess over what they eat, it makes it a lot less enjoyable.
I agree. My doctor told me that if you totally restrict your diet (he said that is really unrealistic) your uric acid will only lower by 1 point at the most. Only one
thing can lower the uric acid is to take Allopurinol at the correct dosage.
He told me that once my uric acid is maintained under 6, I can eat “bad gout food” in small (3-4 oz) portion starting once a week and may be more often after a while.
Also, each person has some trigger food that can trigger gout attack but no problem for other sufferers. Just have to do trial and error and see what works for you.
I follow Gout Pal’s advice and try to eat more alkaline good to balance an acidic
food. So far so good.
I agree that we cannot make ourselves crazy over which foods to avoid. I have tried everything, and in the end, it still did not prevent attacks. Currently, I am suffering from the consquences of a bad attack which resulted in my going back on the allopurinol. I have been watching my diet, taking the medicine, and yet, I am still getting the attacks 60 days into the drug therapy. In the last two weeks, I have had 2 attacks in the knee. Something that has not happened to me in the last 7 years avoiding the medication. I had to get the knee drained along with a cortisone shot. A week later, it returned in the same knee, with less swelling, but more pain. I went back to colchicine, but not before taking about 1800 milligrams of Ibuprophen per day, along with an occassional Indocin. All of this, and I am really watching what I eat. To top it all off, I wake up this weeking with a nose bleed. A side effect of allopurinol and NSAIDS because both affect clotting ability. I have been worse it seems since starting the medicine and watching my diet. I was better before I started the allopurinol. Now, it’s back to the doctor. It’s my fault and I know it. I should have relented and started the medicine a decade ago. The more years of gout suffering, the longer it takes for the allopurinol to be really effective.
Giovanni,
Since November, have your attacks stopped?
NEVER go on and off allopurinol, it is a sure way of triggering more attacks. Once on it STAY on it.
Nosebleed: Very likely caused by the NSAIDs and not the allopurinol.
I like the “OR” offered by modern medicine as in:
1. You can either eliminate many of the most delicious foods OR take allopurinol.
2. If you have hear diisease you can eat a diet of 10% fat with no meat at all, OR you can takke Lipitor at night.
3. A diabetic can avoid all carbohydrates for his very short life OR take insulin.
Three cheers for the “OR!”
Yeah, the useless dietary “treatment” was recommended in the time when there was NO useful treatment for gout. It has no use in modern gout treatment and joins bloodletting the medical museum.
So eat that plate of $40 sweetbreads if you are lucky enough for someone to offer it to you! Fat chance though…I haven’t had a plateful for 20 years, and I LOVE them.
Does gout cause your stomach to gain weight? It seems like mine just flared up were I can’t wear my clothes, this is very discouraging!
Hi, excellent site, just found it, I have had gout for 8 yrs and get a flare up about twice a year. I was always told to stop taking allopurinol during an attack and I note here that this is bad advice so hopefully this will be a help in future. I work in the middle east in hot conditions mostly and one thing that I notice is that dehydration can quickly lead to a flare up.
It has been quite frustrating to try and get good advice on the net about gout and often there seems to be conflicting advice so I am very happy to find this site.
I have recently had a bad flare up of gout which coincided with a change in my diet where I have been eating a lot of almond nuts for about 3 weeks before, could this have lead to my flare up anybody please?
Once again, great site,
Thanks very much
Richie
Because of the poor advice you have received, you have not been able to manage your uric acid properly. You need to make sure you keep to a safe uric acid level. Daily allopurinol at the right dose will do this, and allow you to eat anything you like (within the bounds of weight control and adequate nutrition – i.e. a healthy diet with no restrictions beyond the normal nutritional requirements). The part played by food is almost always overemphasized. If you take allopurinol it is irrelevant.
What should be diet restriction of a person having higher Uric Acid count. My age is 36 and Uric acid count is at 07.34.
Thank you for your question, as it has prompted me to improve this page, and link to Sensible Gout Diet Restrictions (An overview of the way food affects gout. How gout diet restrictions are only sensible in the right context.)
To be safe, we set 5mg/dL (0.30mmol/L) as the safe upper limit for uric acid. In theory, 6.5 should be safe, but natural daily fluctuations in uric acid can easily raise your level by 1 or 2 mg/dL, and low temperature can easily lower the point at which uric acid forms. Using diet alone to move from 7.34 down to 5 is difficult, but not impossible.
The starting point is to assess any medicines that you currently take, and seek alternatives from your doctor if they are known to raise uric acid.
You then need to assess your entire diet for calories, gouty purines, and iron. If the total of any of these is high, look at the biggest contributors, and try to switch to better foods. If you are lowering calories, do this slowly to avoid sudden weight-loss, which can raise uric acid. 2 to 3 pounds per week is sufficient, though you can discuss a different target if you wish. Combine calorie restrictions with slightly more exercise for best effect.
Remember to get uric acid tested each month, or invest in a uric acid meter. You can only judge your diet restrictions by the change in uric acid – pain is not relevant in this context, as it might be caused by uric acid getting lower.
Other dietary measures include switching to foods and drinks that lower uric acid naturally, but you should take it a step at a time and analyze your current diet first.