The "accomplice" that secretly raises your uric acid level is not just purine! There are also these foods you love to eat...

Summer is here, the temperature is high, and it’s time to call friends over for “beer and seafood”. Some friends with high uric acid or gout can’t help but feel anxious. Do they dare to “keep the appointment”? What can gout patients eat and what can’t they eat?

In fact, people may have a misunderstanding about the "gout diet": they think that as long as they do not eat or eat less high-purine foods, such as seafood or other meats, they can avoid the occurrence and development of high uric acid and gout.

But in fact, in addition to "high-purine" foods, there are some dietary factors that also have a great impact on the increase of uric acid and the onset of gout. And these factors that are usually ignored by us may need more attention from us.

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Limit the amount of purine in food

Maybe it's not as important as you think.

Gout is a disease caused by the deposition of uric acid, a metabolite of purine, in the joints and tissues of the human body. Its main symptoms are redness, swelling, and severe pain in the joints. Therefore, in the past, when people mentioned gout, they often hated "high-purine foods". However, in recent years, some medical scientists and nutritionists have expressed different opinions on the view that "purine intake through food increases the risk of gout". There are two main reasons for this change.

On the one hand, dietary intake only accounts for 20% of the source of purine in the human body, and the remaining 80% is produced by the body's own cell metabolism. In other words, even if we control the dietary purine content to the extreme, we can only reduce 1/5 of the purine, and the remaining 4/5 must be solved by other methods. Moreover, purine metabolism is greatly affected by genes. In other words, a strict low-purine diet may not have as much effect on the occurrence and development of gout as we think.

On the other hand, considering that most high-purine foods are meat, such as seafood, red meat, animal offal, etc. If the dietary purine intake is strictly controlled and the correct nutritional combination is not done, malnutrition is likely to occur, which will have a negative impact on the health of gout patients.

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At the same time, under the condition of strictly restricting animal food, people may eat too much staple food in order to supplement energy. However, the intake of a large amount of staple food may cause abnormal blood sugar and insulin resistance. Insulin resistance will affect the excretion of uric acid, and may eventually lead to high uric acid and gout. Isn't this a loss?

It can be seen from this that in order to prevent gout, limiting food purine is indeed helpful, but it also requires a correct attitude and moderation.

For example, the "Guidelines for Primary Diagnosis and Treatment of Gout and Hyperuricemia" issued by the Chinese Medical Association in 2019 pointed out that the harm of food to patients with hyperuricemia and gout cannot be simply defined by purine content. Although a healthier and more balanced diet cannot directly control uric acid levels in the short term, it is beneficial to overall and long-term health.

How should you eat to properly control uric acid?

1. Stay away from high-sugar, fructose, and sweet drinks

Since it is not recommended to simply focus on the "purine" content of food, what other dangerous factors in the diet do we need to pay attention to?

The first to be affected are high-sugar foods, especially sweetened drinks containing fructose.

High-sugar foods and sweet drinks have three sins on the occurrence and development of gout:

1. The metabolism of fructose not only directly promotes the production of purine, but also inhibits the excretion of uric acid, thereby leading to increased uric acid levels in the body and gout attacks.

Studies have found that the incidence of gout increases as long as sugary drinks are frequently consumed, and the greater the amount consumed, the greater the increase. This may be because almost all sugary drinks on the market contain fructose or fructose-glucose syrup. Even if fructose is not added and only white sugar, rock sugar or honey are added, they will still be metabolized in the body to produce fructose.

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2. High-sugar foods and sugary drinks can easily increase the risk of obesity and high blood lipids, which are risk factors for high uric acid. In other words, obese people and people with high blood lipids are more likely to suffer from gout. Experiments have studied the uric acid concentration levels of people who are losing weight and found that sticking to low-fat, low-calorie diet foods can reduce uric acid levels.

3. High-sugar foods and sugary drinks will increase the risk of various cardiovascular diseases by affecting blood sugar, blood lipids, blood pressure, etc., and the complications of severe gout also include cardiovascular and cerebrovascular diseases. If the two are superimposed, it will have a more serious impact on the patient's life and quality of life.

Therefore, for those with high uric acid and gout, sugary drinks, regardless of whether they contain white sugar, fructose or fructose syrup, should be avoided. Even fruits with high fructose content, such as lychee, durian, jackfruit, etc., as well as fruit juice, should be eaten/drunk less.

2. Avoid alcoholic beverages

All gout guidelines at home and abroad mention strict control of alcohol. For example, the "Guidelines for the Diagnosis and Treatment of Gout and Hyperuricemia" points out that alcohol intake increases the frequency of gout attacks in a dose-dependent manner. This means that the more you drink, the greater the chance of hyperuricemia and gout attacks, and the more serious the condition.

Alcohol will first directly affect the excretion of uric acid, causing uric acid accumulation. At the same time, drinking can accelerate the metabolism of purine, which will cause the blood uric acid level in the body to increase rapidly and lead to acute gout attacks. Moreover, people often pair some high-purine foods as snacks when drinking, which increases the intake of purine. "Three-pronged approach", it is difficult to avoid gout attacks after drinking.

The "Guidelines for Dietary Treatment of Hyperuricemia and Gout in Adults (2024 Edition)" mentions that rice wine has a high purine content, followed by beer. Although the purine content of white wine is not too high, the high alcohol content of white wine can easily cause lactic acid accumulation in the body and inhibit uric acid excretion. Therefore, patients with gout or hyperuricemia should try to avoid drinking rice wine, beer or high-proof white wine, and also control the intake of red wine and other alcoholic drinks.

Specifically, patients with acute gout attacks and chronic tophaceous arthritis should strictly abstain from alcohol; those with gout intermittent periods should limit their daily alcohol intake to: 145 ml of 12% alcohol red wine, 497 ml of 3.5% alcohol beer, or 43 ml of 40% distilled spirits, i.e., less than one liang of liquor, less than one bottle of beer, and less than one small glass of red wine.

I would like to remind you that in addition to beer, red wine and white wine, there are some premixed drinks on the market that combine fruit juice and alcohol. Although they do not taste strong, the alcohol content cannot be ignored. You must be careful to identify and avoid them when purchasing.

3. A high-fat diet can also be a risk

A high-fat diet is likely to cause the occurrence and development of gout by increasing the risk of obesity, that is, forming a "high-fat diet-obesity-gout" pathway.

Long-term and large intake of high-fat diets, especially fried, grilled and roasted foods, will induce the production of pro-inflammatory cytokines in the body and increase the level of inflammation. This inflammatory environment will make uric acid more likely to crystallize in the body, ultimately leading to the development and acute onset of gout.

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So, does this mean that in order to avoid purine and high-fat foods, we can only eat vegetarian food?

Absolutely not.

For patients with high uric acid who have not yet developed gout, and those who are in the intermittent period of gout, it is completely okay to eat properly selected and properly processed meat and seafood in moderation. They can provide the body with necessary high-quality protein.

For example, it is generally OK to eat no more than 150 grams of meat per day. But it should be noted that from the perspective of a balanced diet, it is recommended to eat different meats together, such as no more than 75 grams of livestock and poultry meat and no more than 75 grams of seafood. In addition, shellfish has a very high purine content and is not recommended for patients with high uric acid. You can choose some fish with relatively low purine content, such as turbot, sardines, cod, whitebait, etc. But it should be noted that it is best to use boiling or steaming methods to process it, and try to use light and less oil. You can choose to season it with sauce, which can be delicious and healthy.

Which foods should gout patients avoid?

Can it actually be eaten?

Many foods that are on the “gout taboo” list are actually edible.

According to the "Dietary Guidelines for Hyperuricemia and Gout in Adults (2024 Edition)", foods with purine content between 150 and 1000 mg/100 g are high-purine foods, foods with content between 75 and 150 mg/100 g are relatively high-purine foods, foods with content between 30 and 75 mg/100 g are relatively low-purine foods, and foods with content less than 30 mg are low-purine foods.

For example, people mistakenly believe that eggs and milk are animal foods and should not be consumed by gout patients. In fact, the purine content of eggs and milk is very low. The purine content of chicken eggs and goose eggs is only 1 mg/100 g; the purine content of milk is also only 1 mg/100 g, which can be said to be good news for gout patients. They can supplement high-quality protein without worrying about excessive intake of purine.

Another commonly misunderstood thing is soy products. Everyone knows that soybeans have a high purine content. The purine content of dry beans is as high as 218 mg/100 g, but the purine content will be significantly reduced after soybeans are made into tofu, soy milk, and natto. For example, the purine content of northern tofu is 68 mg/100 g, the purine content of southern tofu is 94 mg/100 g, the purine content of soy milk is 29 mg/100 g, and the purine content of natto is 110 mg/100 g. None of them are high-purine foods, and some are even relatively low or low-purine foods. Soy products, as foods that can supplement high-quality protein and are low in fat and cholesterol, are also beneficial for gout patients.

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The last one that is easily banished is coarse grains. Indeed, most coarse grains have a higher purine content than fine grains and are medium-purine foods. However, some coarse grains have very low purine content, such as cornmeal (12 mg/100 g), corn grits (8 mg/100 g), potato starch (5 mg/100 g), sweet potatoes (13 mg/100 g), sorghum rice (15 mg/100 g), etc., which are all low-purine foods. As long as you can make a good combination of coarse and fine grains, you don’t have to worry about excessive purine intake, and you can also enjoy the positive effects of dietary fiber, minerals and B vitamins in coarse grains on the body.

Finally, I want to emphasize that patients with high uric acid or gout must drink more water. Drinking water can directly promote the excretion of uric acid, which is of great significance for improving the deposition of uric acid crystals and the formation of tophi. You should know that most patients with high uric acid in my country are caused by excretion disorders.

Therefore, if your kidney function is normal, in order to improve the symptoms of high uric acid or gout, it is best to increase your daily urine volume to 2000~3000 ml, which means you need to drink more than 2000 ml of water, the amount of 4 bottles of mineral water.

Don't worry if you don't like drinking water. The water mentioned here includes not only boiled water, but also water without sugar or other sweeteners such as light tea, lemonade, and soda water. If you are worried that you really can't remember to drink water, it is recommended that you try to set an alarm to remind yourself to drink water, and develop the habit of carrying a water bottle with you. I believe that this summer, you will gradually "drink enough water"!

References

[1]NICE guideline .Gout: diagnosis and management (NG219). Published: 9 June 2022.

[2] Chinese Medical Association. “Guidelines for diagnosis and treatment of gout and hyperuricemia at the primary level” (2019).

[3]Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. Jama. 2010;304(20):2270-8.

[4]Effects of Low-Fat, Mediterranean, or Low-Carbohydrate Weight Loss Diets on Serum Urate and Cardiometabolic Risk Factors: A Secondary Analysis of the Dietary Intervention Randomized Controlled Trial (DIRECT). Diabetes Care 2020 Nov; 43(11): 2812-2820.

[5] National Health Commission. Dietary Guidelines for Adults with Hyperuricemia and Gout (2024 Edition).

Author: Wang Lu, registered dietitian

Review丨Zhang Yu, researcher/PhD, Chinese Center for Disease Control and Prevention, national health science expert