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Gout Part IV

Gout diet
High purine and low purine foods:
Introduction :
About Purines:
Purine is a colourless crystalline compound with basic properties, forming uric acid on oxidation.
A substituted derivative of purine, especially the bases adenine and guanine are present in DNA.
Purines are one of two chemical compounds that cells use to make the building blocks of DNA and RNA. Examples of purines are adenine(A) and guanine(G). Purines are also found in meat and meat products. They are broken down by the body to form uric acid, which is passed in the urine.
Functions of Purines:
Purines act as metabolic signals, provide energy, control cell growth, are part of essential coenzymes, contribute to sugar transport and donate phosphate groups in phosphorylation reactions (Jankowski et al., 2005; Handford et al.,2006).

What is the gout diet?
Gout is caused by high uric acid levels in your blood. Extra uric acid forms sharp crystals that settle in your joints, causing swelling and pain. But you can help reduce the amount of uric acid in your body by maintaining a low-purine diet. Reducing uric acid levels can help prevent new crystals from forming, reducing gout attacks.

(A)High purine diet:

The top 10 foods and drinks that trigger gout are:
•Sugary Drdrinks and sweets.
•High fructose corn syrup.
•Organ meats.
•Game meats.
•Certain seafoods, including herring, scallops, mussels, codfish, tuna, trout and haddock.
•Red meats, including beef, lamb pork and bacon.
•Gravy and meat sauces.
•Yeast and yeast extract
•Purine rich vegetables

The top 10 foods and drinks that trigger gout aread follows:
(1) Sugary drinks and sweets. Standard table sugar is half fructose, which breaks down into uric acid. Any food or drink with higher sugar content can trigger gout.

(2) High fructose corn syrup. This is a concentrated form of fructose. If you start looking at labels, you’ll find high fructose corn syrup in all kinds of packaged food products that you wouldn’t necessarily expect.

(3) Alcoholic beverages (all types):Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.
Also beers.

(4) Organ meats:These include liver, tripe sweetbreads, brains and kidneys.Organ meats like liver.If you have gout, dishes like chopped liver and liver and onions are best avoiding, along with other organ meats like kidney, heart, sweetbread, and tripe, since they're high in purines.

(5) Game meats. Specialties such as bacon, turkey, goose, veal and venison are among the reasons why gout was known in the Middle Ages as the “rich man’s disease.

(6) Certain seafoods, including herring, scallops, mussels, codfish, tuna, trout and haddock. Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock.

(7) Red meats, including beef, lamb pork and bacon.
Turkey. This leaner meat is nonetheless high in purines. Especially avoid processed deli turkey.

(8)Gravy and meat sauces.

(9)Yeast and yeast extract.

(10)Vegetables high in purines:
Vegetables help in reducing high uric acid level and also keep uric acid under control. However, if you are diagnosed with high level of uric acid, vegetables such as spinach, asparagus, peas and cauliflower should be avoided a they may contribute to increase the uric acid levels.

Eat plenty of vegetables such as kailan, cabbage, squash, red bell pepper, beetroot, but limit the intake of vegetables with moderate purine content such as asparagus, spinach, cauliflower and mushrooms. Eat fruits high in vitamin C such as oranges, tangerines, papaya and cherries.
Mushrooms, green peas, spinach, asparagus, broccoli sprouts and cauliflower are the vegetables that contain the highest amounts of purines. The Beth Israel Lahey Health Winchester Hospital recommends limiting these vegetables to no more than 1/2 cup total per day.
On the other hand, purine-rich plant-based foods such as peas, beans, lentils, spinach, mushrooms, oats, cauliflower and broccoli were found to have little to no effect on the risk of a gout attack. Overall, there hasn't been much good quality research into the link between certain foods and gout attacks. Mushrooms are low in calories and help control your appetite. Mushrooms are a great food to help control your weight which is an important benefit to the gout sufferer. To date there is no evidence that fruits, vegetables or mushrooms cause gout or make your gout worse.

A healthy diet full of vegetables is great for everyone, but for those who suffer from gout it is essential. Research now shows that even vegetables high in purines do not increase chances of gout, so even mushrooms, spinach and asparagus are safer.
Beets and Gout:
One concern with eating beets is that eating a lot of beets may cause gout. Gout is an extremely painful condition caused by an increased uric acid level in your blood. The oxalates found in beets can increase your uric acid level, meaning that too many beets can lead to gout.

(B) low purine diet:

Purines are chemicals that are naturally found in certain foods and drinks. When your body breaks down these chemicals, uric acid is the byproduct.
The following foods are low in purine.
All fruit and fruit juices.
Bread, pasta, rice, cake, cornbread, and popcorn.

Tomatoes are low in purines.
Although tomatoes are low in purine, some research suggests they may cause gout flares. In a study of more than 2,000 people diagnosed with gout, 20% said that tomatoes were a trigger, making it the fourth most common trigger food reported. It's unclear why tomato consumption causes gout flares in certain individuals
(2) Eggs:Eggs are a good protein source for people with gout, because eggs are naturally low in purines.

(3) Low-fat and fat free cheese and ice cream.
Skim or 1% milk.Coffee: You may have heard that coffee is acidic, but the type of acid in coffee is very different from uric acid. In fact, drinking coffee daily can reduce your uric acid levels by several means. It slows the breakdown of purine into uric acid and speeds the rate of excretion.
Skimmed yogurt.Peanut butter .

(4) Potatoes:
Potatoes are a satisfying, low-purine food that is also abundant in vitamin C, which lowers uric acid levels. They are also one of the most popular foods in the United States, and they can be prepared in a variety of ways.
Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.

(6) Starchy carbohydrates:
Plenty of starchy carbohydrates are low in Purines.These may include rice, potatoes, pasta, bread, couscous, quinoa, barley or oats, and should be included at each meal time. These foods contain only small amounts of purines, so these along with fruit and vegetables should make up the basis of your meals.

(7) Apples and other fruits:
Apples are low in purines.
Apples, pears, pineapples, avocados are low-purine fruits and therefore can be eaten in moderation.

(8) Water, Coffee and tea:
Drink at least 8 glasses of water every day unless you are advised to restrict your fluid intake due to medical reasons. Coffee and tea are safe for gout sufferers.

(9) Lemon:
Freshly squeezed lemon juice lowers the blood uric acid in hyperuricemic patients. Lemon water soluble extracts lower the blood uric acid level in hyperuricemic mice. There is no obvious side effects of consuming lemon juice in patients with hyperuricemia.
Lemon fruits lower the blood uric acid levels in humans and mice.

(10) Citrus fruits:
Citrus fruits are the best fruits for uric acid.
Eat Citrus Fruits.
Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks.

(11) Cucumber:
Cucumbers are very low Purines .Cucumber works as a diuretic: The high water content cleanses the body by removing toxic and old waste material. Cucumbers help eliminate uric acid, which is beneficial for people with arthritis and joint pains. The magnesium content in cucumber relaxes nerves and muscles and helps blood circulating smoothly.
Cucumbers are very low in purines, containing only 7.3 milligrams of purines in every 100 grams of the vegetable. In comparison, high-purine foods contain over 200 milligrams of purines in every 100 grams, such as the 411 milligrams of purines in 100 grams of anchovies.

(12) Carrots:
Carrot are quite low in purine.
Carrots are good choice, with about 3.5 grams of fiber in 1 cup of chopped raw carrots, plus they're also quite low in purines.

(13) Red and green cabbage:
After analyzing nutritional data from the U.S. Department of Agriculture, Best Gout Remedies concluded that red cabbage contains substantially more gout-fighting properties than its green counterpart.

Eat plenty of vegetables such as kailan, cabbage, squash, red bell pepper, beetroot, but limit the intake of vegetables with moderate purine content such as asparagus, spinach, cauliflower and mushrooms. Eat fruits high in vitamin C such as oranges, tangerines, papaya and cherries.

(14) Broccoli:
The study's authors placed broccoli in the low purines group — very high purine foods have more than 300 mg per 100 g. This means broccoli is a good choice for those with gout (and for most people trying to eat a healthy diet).

(15) Avocados:
Avocados are a beneficial addition to any healthy diet, including one that can help manage gout. They're naturally low in purines and contain large amounts of antioxidants, vitamins, and minerals.

(16) Garlic:
Garlic is an incredible cure for gout. It helps in removing the excess uric acid from the body. How to use: Swallow one pod of garlic and if you find it difficult then you can finely chop the garlic and then consume it. It will help cure gout from its roots.

(17) Ginger:
Ginger is known to help with digestion and ease nausea, but it can also help with inflammation, including gout. One animal study, for example, found ginger lowered uric acid levels in subjects who consumed ginger internally.

(18) Cherries:
Scientists are currently researching the benefits of cherries and cherry juice for managing gout symptoms, and early results are promising. Cherries have known anti-inflammatory properties, and they may also help reduce uric acid in your body.

The anti-inflammatory properties of cherries may also help with gout. Gout causes sudden and severe joint pain. This is triggered by high levels of uric acid in the blood. One 2018 review stated that the consumption of cherries could help a person maintain moderate levels of uric acid in the body.
Interestingly, when cherry intake was combined with allopurinol use, the most commonly used urate-lowering drug, the risk of gout attacks was 75% lower than over the period without either exposure. Several biological mechanisms have been elaborated to link cherry consumption to the risk of gout attacks.
Cherries lower uric acid:
According to the study, cherries reduce uric acid because they contain anthocyanins.

(19) Berries:
Berries, in general, have anti - inflammatory properties made out of the substance called anthocyanins. This particular substance is beneficial and helpful in reducing high uric acid levels. It also prevents the uric acid from crystallizing and getting deposited in the joints that may later lead to joint pains.

Information compiled by: Dr. Bhairavsinh Raol