Are foods that cause gout just foods high in purines?

No, there are many other gout causing foods, and not all purines are bad.

It is not even all about food. You know from my page about Gout and Obesity – Avoid Excess Calories that more uric acid is generated from the meat of our bodies than we generate from the meat we consume.

That is not to say that we can ignore gout diet totally, but we should not be obsessed with it. Food can affect gout, so it makes perfect sense to check that our gout diet supports our gout treatment plan, not hinders it. So, if we can identify foods that work against our gout treatment plan, we should avoid them.

Note that this is a personal decision based on your treatment requirements and your current diet.

You will notice elsewhere in these gout diet guidelines that trying to create general rules about gout foods never works. A food that is bad for an overweight gout patient with uric acid at 10mg/dL and difficulties controlling it may be an important part of the diet of a different patient who has normal weight and allopurinol-controlled, safe uric acid levels. I maintain that, when it comes to gout foods, they are never good or bad – just suitable or unsuitable for different patients.

Identifying Foods That Cause Gout

But do foods really cause gout? The short answer is NO. However, some foods, especially foods rich in animal purines, do affect uric acid. The biggest problem with this is that certain health care providers support the use of lists of foods to avoid, or lists of foods that are supposed to be good for gout. This leads to gout patients eating unnaturally. It promotes a tendency to limit the range of food, and this can lead to malnutrition. Malnutrition is usually associated with starvation, and there is certainly a bad side-effect of starvation for gout sufferers, as we will see. But, malnutrition simply means badly nourished, i.e. our bodies may not get all the nutrients we need, so it is perfectly possible to be obese, yet malnourished through lack of essential minerals and vitamins.

I am not aware of any studies on eating patterns and gout. In their absence, it is best to look at generally accepted nutritional principles. Then adopt a diet that is healthy according to government guidelines. I cannot find examples of specific nutrient deficiencies associated with gout (if you know any, please share them in the gout forums), but there are some more general nutritional studies that do measure uric acid.

One such study[1], reveals that selenium and carotenoids are associated with lower uric acid. This is not specific enough for us to be certain. But it gives a strong indication that some groups of foods are a good source of essential vitamins and minerals. So omitting them is likely to have a bad effect on uric acid. In fact, this is supported by evidence that Vegan Diet can be bad for Gout. But note that this evidence only deals with averages. So Vegans can still have a gout-friendly diet. But it must be planned with gout in mind. Which means you might omit gout-friendly foods such as dairy products. But you must replace them with equivalent gout-friendly plant foods.

Establishing good eating habits by consuming a wide range of food seems to be a good way to stay healthy, and I include it here despite the lack of detailed gout-specific studies. Good eating habits regarding meal timing are much clearer based on several studies, some of which are gout specific.

Foods That Cause Gout Through Bad Timing

We know from comparisons of meal timings that uric acid increases when food intake is confined to a small number of meals per day compared to many snacks spread through the day. A study of eating habits[2] has compared eating three meals per day with seventeen snacks. This snacking habit of eating little and often is called nibbling, and the study informs us:

concentration of uric acid was significantly lower during the nibbling period as compared with the three-meal period

This becomes more significant as food intake becomes more concentrated with fewer, larger meals. One significant aspect is the effect of starvation. There are several studies on uric acid effects from fasting during Ramadan. I will summarize these reports later, but for now, consider the effects of starvation on uric acid.

A 2009 review[3] concludes:

it has long been appreciated that uric acid is increased under conditions of starvation (Lennox 1924[4]; Ogryzlo 1965[5]).

Lennox looked at 22 periods of starvation in 19 volunteers. Though none of the volunteers started with uric acid in the gout zone (over 5mg/dL / 0.30mmol/L), every case showed uric acid increases. Most of these increases took the patient into the range of gout, though the report was strictly limited to uric acid changes, so no incidences of gout were included.

None of this explains the mechanism of how starvation can raise uric acid. Ogryzlo offers:

The problem of uric acid retention in fasting is probably, in its essentials, the old, unsolved problem of gout.

Not a good explanation of what happens scientifically when we eat badly, but a reminder, perhaps, that common sense plays a huge part in managing gout.

Poor Food Timing Causes Gout
Avoid fasting and bingeing with gout.

Foods That Cause Gout: Next Steps

Every day in the gout forums, I read that people are mystified because they have cut out all the foods that cause gout, but they still get gout flares. With no mention of uric acid levels, gout treatment plans or healthy eating habits, it is clear to me that they are focusing on the wrong things. Do not look for foods that cause gout. Because if you have bad eating habits, then any food can cause gout.

If you manage gout with uric acid lowering treatment, you can forget all about foods that cause gout, and simply ensure that you are eating a healthy diet that will help ward off other diseases. If you want to try control gout through diet, then return to the gout diet introduction, and follow a positive plan based on clear goals – that way you can identify which foods affect you personally, rather than relying on pointless lists that can never relate to your personal situation.

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Foods That Cause Gout References

  1. Title: The interplay between uric acid and antioxidants in relation to physical function in older persons. Authors: Ruggiero C, Cherubini A, Guralnik J, Semba RD, Maggio M, Ling SM, Lauretani F, Bandinelli S, Senin U, Ferrucci L. Published:J Am Geriatr Soc. 2007 Aug;55(8):1206-15.
  2. Title: Effect of nibbling versus gorging on cardiovascular risk factors: serum uric acid and blood lipids. Authors: Jenkins DJ, Khan A, Jenkins AL, Illingworth R, Pappu AS, Wolever TM, Vuksan V, Buckley G, Rao AV, Cunnane SC, et al. Published: Metabolism. 1995 Apr;44(4):549-55.
  3. Title: Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? Authors: Johnson RJ, Sautin YY, Oliver WJ, Roncal C, Mu W, Gabriela Sanchez-Lozada L, Rodriguez-Iturbe B, Nakagawa T, Benner SA. Published: J Comp Physiol B. 2009 Jan;179(1):67-76. Epub 2008 Jul 23.
  5. Title: Hyperuricemia induced by high fat diets and starvation. Author: Ogryzlo MA. Published: Arthritis Rheum. 1965 Oct;8(5):799-822.

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