How does gout occur?
Gout occurs when there is an abnormally high amount of uric acid in the blood (hyperuricaemia). This can occur from an error in the metabolism of purines. This build up normally leads to the deposit of sodium urate crystals in some of the body’s joints and surrounding tissues. These crystal deposits are known as tophi.
What are the symptoms of gout?
Gout presents as localised arthritic like pain that has a sudden onset. It usually starts in the toes. Flare ups can last a few hours to a few days. Often the pain is accompanied with redness and swelling.
Over time, the urate deposits can cause permanent damage to the joint tissue and the arthritic pain can become chronic.
Gout attacks occur more frequently and for longer lengths of time as the condition progresses.
Where does gout occur?
Common sites where gout can be experienced include toes, elbows and ankles. People who have had gout long term can form tophi on the helix of their ear.
Who is at risk of gout?
Gout most commonly affects men over the age of 35. Individuals with familial gout will normally have a younger onset than those with environmental gout. Risk factors include:
- Overweight/ obesity
- High purine diet
- frequent alcohol intake
- Medications e.g. diuretics
- Family history of gout
- Gender – men are more inclined to get gout at an earlier onset
- Other medical conditions
Medical intervention is the main treatment for gout. Medication is often provided to manage acute attacks, prevent future attacks and to slow down the formation of tophi. However, adhering to a healthy, low purine diet can also assist in management of gout.
How can nutrition help to manage gout?
Weight loss to a healthy weight range can help to manage gout. However, weight loss must be gradual! Rapid weight loss or exclusion of carbohydrates from the diet can result in ketosis which can actually bring on an attack .
Uric acid can be formed from the metabolism of purines that are derived from food and some bodily processes. Adherence to a diet low in purines used to be the main course of action for managing gout attacks. However, medication has now largely removed the need for a semi restrictive diet avoiding purine rich items. Much of our daily purine load actually comes from endogenous cell turnover and roughly only 1 third comes from diet .
Though dietary changes will only make a small impact on our uric acid pool , people who want to ensure they are taking all measures to manage their gout can opt to avoid or reduce foods that are rich in purines. The purine content common foods is outline in the table below.
Group 1: High Purine Content (100 to 1000mg of Purine Nitrogen per 100g of Food)
Foods in this list should be omitted from the diet of patients who have gout (acute and remission stages).
- Meat extracts
- Yeast (baker’s and brewer’s), taken as supplement
Group 2: Moderate Purine Content (9 – 100mg of Purine Nitrogen per 100g of Food)
One serving (57 – 85g) of meat, fish or fowl or one serving (1/2 cup) of vegetables from this group is allowed daily.
- Meat and fish
- Beans, dried
- Peas, dried
Group 3: Negligible Purine Content
Foods in this group may be used daily.
- Bread, white, and crackers
- Butter and margarine (in moderation)
- Cake and cookies
- Carbonated beverages
- Cereal beverage
- Cereal and cereal products
- Cream (in moderation)
- Fats (in moderation)
- Vegetables (except those in group 2)
- Gelatine desserts
- Ice cream
- Macaroni products
- Rennet dessert
- Sugar and sweets
- White sauce
Table taken from Krause’s Food and Nutrition Therapy 
Main dietary management goals
- Gradual weight loss to a healthy BMI
- Elimination of alcohol or no more than 2 standard drinks per day. Beer is the worst offender followed by spirits. Wine appears to have a lesser impact on gout.
- Reduced meat intake – can be supplemented with more vegetables
- Choose low fat products and remove any visible fat from meats
- Dairy intake can be beneficial
- Eat a healthy, balanced diet
- Keep fluid intake up
Contact us for results focused nutritional advice
This article was written by our dietitian Belinda Elwin who is a Dietitians Association of Australia member and Accredited Practising Dietitian and Nutritionist. If you have questions about healthy eating, make an appointment. We‘ll provide you with a simple and effective routine targeted to your concerns. Contact us today.
- Mahan L, Escott –Stump S. Medical Nutiriton Therapy for Rheumatic Disease. Krause’s Food and Nutrition Therapy. 12th Missouri: Elselvier; 2008. P. 1057-1059.