Sometimes, it starts in the middle of the night after a luxe New Year’s Eve celebration in which steak, caviar and booze were flowing freely. Other times, I’ll see it hit later in the month after a patient has undertaken a New Year’s resolution to follow a lower-carb diet –whether paleo or Atkins-style – in which intake of meat goes way, way up. New Year’s “cleanses” – weeks on end of high-fructose juices coupled with avoidance of coffee, grains and dairy – may also be a dietary pattern that triggers this unexpected outcome.
Whatever precipitates it, the telltale signs are the same: fiery pain in the joints – most commonly at the base of the big toe –that’s so severe even the sensation of bedsheets passing over the foot sends you howling.
Welcome to gout, a form of arthritis in which tiny crystals accumulate in the joint fluid as the result of too-high levels of uric acid in the blood. Uric acid is a metabolic byproduct of certain naturally-occurring food compounds called purines. Other foods can also raise uric acid levels, including fructose-rich beverages and alcoholic drinks (especially beer). Gout typically affects men more than women, but post-menopausal women are at increased risk. Unlike osteoarthritis, which typically affects older adults, gout commonly affects even young and middle-aged adults. The condition is often hereditary, possibly related to how one’s genes affect the efficiency with which their kidneys excrete uric acid in the urine. People who are overweight, obese or have diabetes or kidney disease are also at increased risk for gout.
Preventing future flares of gout requires keeping your uric acid levels in check, which is often done by some combination of diet and medication. If you’re one of the 12 million Americans (3 to 4 percent of the population) who have experienced gout, here’s the lowdown on dietary measures that can help keep flares at bay:
Limit intake of red meat and seafood. Red meat – including beef, pork, lamb and game meats, organ meats and fish and seafood – are the highest purine proteins. The scientific data are pretty clear that diets highest in these foods are associated with increased risk of gout attacks compared to diets lowest in them. Moreover, isolated periods in which intake of high-purine animal foods is especially and abnormally high – say, a two-day surf-n-turf bender at your buddy’s alcohol-and-bacon fueled bachelor party weekend – may be all it takes to trigger a flare in susceptible people. Be aware that bouillons (soup broth bases) and gravies derived from meat or meat extracts can be extremely high in purines, so consider these foods high-risk as well.
Reducing your intake of these purine-rich animal proteins and replacing them with alternatives such as beans, tofu, eggs, nuts, lean poultry and low-fat dairy is one of the primary dietary changes to help control gout flares. Indeed, low-fat dairy foods in particular have been shown to have a protective effect against gout attacks, so if you’re not regularly consuming foods such as fat-free plain Greek or regular yogurt, low-fat plain kefir, skim milk or low-fat cottage cheese, perhaps you should be. (Lactose-free versions of all these foods are widely available for the digestively-sensitive crowd.)
Of note, evidence has shown that moderate consumption of plant-based foods with higher purine content – such as oatmeal, cauliflower, asparagus, beans, lentils, mushrooms and spinach – is not associated with increased risk of gout attacks. With regard to beans and lentils in particular, data actually suggest that diets highest in vegetable protein are associated with a protective effect against gout compared to diets with the lowest amount of vegetable protein. This may result from relatively poor bioavailability of purines in vegetarian foods compared to animal-derived foods. Therefore, there’s no need to eliminate these healthy foods on your anti-gout diet.
De-fructosify your diet. Concentrated sources of fructose – whether from 100-percent natural fruit juice, sodas, energy drinks or sports drinks – increase uric acid levels and, therefore, the risk of a gout flare. But even if you never drink sweet beverages, be aware that many “natural” sweeteners are quite high in fructose as well – notably agave nectar and honey – and should be limited as well. There is no evidence to suggest that eating whole, fresh fruit in typical portions has any association with increased risk of a flare, so don’t use your gout as an excuse to pass on that apple a day. Besides, diets high in low-calorie, high-fiber fresh fruits and veggies are associated with decreased risk of obesity – which is itself a risk factor for gout.
Get your buzz from coffee, not alcohol. Good news for latte lovers: Daily coffee consumption has been associated with a reduced risk of gout in both women and men. Despite coffee’s reputation as a vice, I consider it a virtuous health food; an antioxidant-rich beverage that has far-ranging health benefits from gout and diabetes prevention to management of migraines and constipation. (Try to drink yours without any added sweetener, though.) Conversely, alcohol raises uric acid levels, with beer having particularly pronounced effect. If you're susceptible to gout, therefore, cutting back on alcohol intake is recommended. And if you do choose to drink occasionally and in moderation, wine is a better choice than beer or fruity mixed drinks.
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