Goodbye gout

Help yourself avoid this painful and debilitating disorder by paying careful attention to your diet, in particular, purine-rich foods.

What is gout?

Gout is a type of arthritis that is characterised by sudden and painful bouts of redness, tenderness and swelling around the joints. More common in men than women, it tends to affect the joints in the big toe but can also affect other parts of the foot as well as knees, wrists, fingers and elbows. The first bout of gout usually lasts a week or two and, although the pain and swelling usually subside, another attack often follows.

What causes gout?

Gout is caused by an excess of uric acid in the blood, a condition known as hyperuricemia. Uric acid is a normal waste product when the body breaks down purines, substances that are a natural part of all human tissue and which are also found in many foods. The kidneys process uric acid and excrete it through urine, but when there are elevated levels, the kidneys cannot eliminate it efficiently and it turns into hardened, needle-like crystals that appear in the joint fluid and lining.

During an acute attack of gout, these crystals invade surrounding tissues and cause the immune system to react by flooding the joints with white blood cells to remove the injured tissue. This influx of white blood cells is what causes the painful swelling. Hardened crystals can accumulate in the joint over time and trigger repeated bouts of inflammation that can eventually destroy the joint.

Many factors cause elevated levels of uric acid, including an increased intake of foods high in purines and a high intake of alcohol, particularly beer and spirits. Other contributing factors are kidney disease, obesity, high blood pressure, dehydration, certain medications (such as diuretics, aspirin and chemotherapy for cancer treatment) and having a hereditary propensity towards gout.

Uric acid levels tend to increase in men at puberty, whereas women experience this more at menopause, so men usually develop gout at an earlier age (after puberty) than women.   

Diet and gout

Certain foods that are high in purines, such as red meat, offal, shellfish and yeast, appear to trigger gout so should be avoided (see box). However, not all purine-containing foods cause gout. For example, asparagus, spinach, cauliflower, peas and mushrooms have moderate levels of purines, but are less likely to cause an attack of gout than shellfish or red meat.

Foods that are thought to be helpful for gout sufferers include cherries, strawberries and blueberries, bananas, celery, tomatoes, parsley, kale, red capsicum, oranges, red cabbage and pineapple. 

Low fat dairy foods, such as skim milk, and essential fatty acids found in flaxseed, nuts, seeds and oily fish such as tuna and salmon are also considered good for reducing and preventing gout.

Since purines are found in all protein foods, gout sufferers should aim for a diet high in complex carbohydrates (wholegrains, fruits and vegetables) and low in proteins (about 15 per cent of total calorie intake).

Remember also to drink plenty of fluids throughout the day and consume alcohol in moderation. If you are overweight, be sensible with weight loss as crash dieting or fasting can actually increase uric acid levels and trigger an attack of gout. 

Foods to avoid

• Red meat
• Offal such as livers, kidneys, brains and hearts
• Shellfish such as scallops, shrimp and mussels
• Seafood such as herring, mackerel, sardines, anchovies and fish roe
• Refined carbohydrates (white rice, pasta, bread)
• Baker’s and brewer’s yeast
• Broths and bouillon