Diet for gout

introduction

The cornerstone of an effective therapy for gout is in any case and right from the start a detailed explanation and advice on the subject nutrition and lifestyle.

The goal of the special diet for gout is always permanent Lowering of uric acid levels of the body, because the more uric acid is in the blood the more often can it to Gout attacks come.

If necessary, you should also aim to normalize your body weight.

When creating a nutritional plan, it must be borne in mind that due to certain metabolic processes, the body itself already produces around 300-400 mg uric acid per day.
The amount of purines additionally consumed through food, which is then broken down into uric acid, should not exceed 500 mg urea do not exceed.

Theoretical foundations of nutrition

The aim of the special diet for gout is to permanently lower the body's uric acid levels, because the more uric acid there is in the blood, the more frequently gout attacks can occur.

Those brought in with the food Purines (important components of DNA) are broken down into uric acid in the human organism.
Uric acid is the metabolic end product of purines. Purines are part of the cell nucleus and come in in large quantities

• Offal
• some fish and crustaceans and
• few legumes and
• Vegetables

in front.

You can also read a detailed table about the purine content of various foods at: Diet for gout - you have to pay attention to this

Since an increase in uric acids in the blood is an important risk factor for the occurrence of gout attacks, nutritional therapy aims to

The uric acid content of the food is indicated in food tables.

Dietary protein

An increased intake of protein leads to an increase in uric acid excretion via the kidneys and a decrease in the uric acid concentration in the serum.

carbohydrates

Among the carbohydrates, the sugar substitutes fructose (fruit sugar), sorbitol and xylitol can lead to an increase in serum uric acid levels.
To do this, however, these substitutes have to be consumed in high doses and this will rarely be the case in practice.
Usually, amounts of fructose ingested with food (for example in table sugar) have no effect on the uric acid concentration in the serum.

Dietary fats

A high-fat diet leads to an inhibition of uric acid excretion via the kidneys and thus to an increase in the uric acid concentration in the blood. The origin of the fats (whether animal or vegetable fats) is irrelevant for the increase in serum uric acid.

alcohol

Large amounts of alcohol reduce the excretion of uric acid in the kidneys and the liver produces more uric acid than normal.
In addition, when beer is consumed, its purine content and the associated increased purine load contribute to the increase in uric acid levels.

Obesity and fasting

Often gout sufferers and people with high blood uric acid levels are overweight.
This is usually due to an excessive intake of energy and thus also purine.

Weight loss usually leads to a decrease in the concentration of uric acid in the blood. At total Fast the body burns the stored fat and uses it to generate energy. The so-called ketone bodies, which are increasingly formed, then come from the fat metabolism Uric acid excretion about the Kidneys inhibit.

There is an increase in uric acid in the serum. This effect would be increased if alcohol and fasting were combined. Thus, fasting cures are not indicated for people with elevated uric acid levels and gout. After weight reduction according to the principles of wholesome, energy-reduced mixed food, in most cases new, lower uric acid levels are set in the serum.

Practical nutritional advice for gout

The goal of special nutrition for gout is permanent Lowering of uric acid levels of the body.

The serum uric acid level should ideally be in the range of 5.5 mg / dl move. With an increase in uric acid levels 8,0 to 9.0 mg / dl without symptoms (gout attacks, Kidney stones) compliance with diet regulations is sufficient. If these are not adhered to or if the uric acid rises to values 9 mg / dl or in the case of complications such as gout attack or kidney stones, additional medication must be used.

Since the therapy of the Hyperuricemia a Long term therapy is, it becomes all the more necessary to view and adhere to nutritional therapy as a basis.
It can be used to reduce the dosage of medication.
Consistently adhering to nutritional therapy can even make the use of medication completely superfluous.

Nutritional therapy at Hyperuricemia pursues the following goals:

1. Restricting dietary purine intake
2. Preferring milk and milk products as a source of protein
3. Normalization of body weight when overweight
4. Restriction of alcohol consumption

A low-purine diet should not contain more than 3500 mg uric acid per week.

One portion is allowed at most once a day (100 g) flesh, fish or sausage allowed.
Offal should be avoided entirely. Likewise, pulses and vegetables rich in purine such as Brussels sprouts and cabbage. The uric acid content of the individual foods should best be given in food tables per portion and not by weight units. This facilitates assessment and calculation. The protein intake from almost purine-free milk and milk products does not have to be considered or calculated separately.

If you are overweight, the dietary fat must be reduced by one in addition to the above measures within an energy-reduced mixed diet Weight reduction To achieve (lose weight). In any case, alcohol consumption must be restricted. When consuming beer, in addition to the effects of alcohol on the uric acid level, the purine content of beer must also be taken into account.
beer contains 15 mg uric acid per 100 ml. Alcohol-free beer contains roughly the same amount of purines. Wine is purine-free and affects uric acid levels “only” through its relatively high alcohol content. A strictly low-purine diet is only indicated if drug treatment of hyperuricemia is not possible. This diet does not contain more than 300 mg Uric acid per day or no more than 2000 mg uric acid per week.

protein is supplied in the form of milk and milk products and low-purine plant foods. 100 g of meat or fish are only allowed two to three times a week.
The food should mainly be consumed cooked because some of the purines are transferred to the cooking water during the cooking process. Maintaining this diet requires a high degree of self-discipline.

Summary: Diet recommendations for gout

Dietary recommendations for hyperuricemia

• Weight reduction when overweight
• Low-purine food with no more than 3500 mg uric acid intake through food per week
• One portion (100g) of fish, meat or sausage at most once a day.
• For poultry the skin remove
• Avoid offal

legumes and avoid purine-rich, plant-based foods such as Cabbage and Brussels sprouts

• Preferring milk and dairy products as a source of protein.
• Two to three eggs per week possible (also note the eggs hidden in cakes, pancakes and other egg-containing foods)
• Restriction of alcohol consumption. A maximum of 1 glass of beer or wine per day is allowed. Pay attention to the purine content of beer (15 mg per 100 ml of beer)
• Ensure sufficient fluid intake of 1.5 to 2.0 l daily. Preferably in the form of water and mineral water. Tea and coffee are allowed.

Strictly low-purine food with no more than 300 mg uric acid per day or no more than 2000 mg uric acid per week.

This is only indicated if, for example, in the course of an advanced Kidney disease therapy with drugs is no longer an option.

• A portion (100 g) of fish, meat (cooked) or sausage once or twice a week.
• Remove the skin from poultry
• Protein in the form of milk and milk products and eggs (2-3 eggs per week) and purine-free, plant-based foods.
• Prohibition of offal.
• Ban on certain types of fish and shellfish: herrings, lobsters. Shellfish.
• Ban on alcohol.
• Ban on legumes (white beans, peas, lentils) cabbage and Brussels sprouts, spinach, asparagus.
• Adequate hydration in the form of water and mineral water. Coffee and tea allowed in normal quantities (2 - 3 cups per day).

Further forms of therapy for gout

If a consistent change in diet does not lead to the desired improvement or if an acute gout attack has already occurred, you can Painkiller relieve symptoms. However, gout patients should focus on the active ingredient ASA (e.g. Aspirin®), as this can reduce uric acid excretion from the kidneys.

Furthermore, can also medicinal uric acid production can generally be reduced (for example with Allopurinol, Febuxostat) or uric acid excretion via the kidneys increased (e.g. with benzbromarone, probenecid). A combination of different active ingredients is also rarely necessary.

General information about gout

gout as inflammation of the joints (synovitis) occurs because uric acid crystals, which precipitate in the blood at high concentrations of this degradation product, are deposited in the tissue.

This failure of Uric acid crystals in joints. Since these crystals are foreign bodies that the body does not actually know, the body's defenses are triggered with the aim of eliminating these disorders. This creates a inflammatory reaction.

About every fifth man in Germany can increased uric acid levels can be found in the blood, which does not necessarily lead to a manifest gout disease, but of course a major one Risk factor is.

Ever higher of the Uric acid level is in the blood, the more likely it is acute gout attack. These acute gout attacks occur when uric acid concentrations are already elevated and when the uric acid level suddenly rises even further. This can be done, for example, at increased Alcohol consumption or large quantities purine-rich food, but also for longer ones Fasting periods happen. The diet for gout is therefore immediately elementary Form of therapy and prophylaxis for those not yet affected.

Also read ours Main Products on the subject: gout

Symptoms of gout

A Attack of gout is expressed in almost all cases at so-called predilection sites, i.e. almost always at the same joints. The metatarsophalangeal joint of the big toe is usually affected. One then speaks of the disease "Podagra". Other joints can also be affected.

Affected joints usually meet all of the signs acute inflammation: They are reddened, very warm, very painful, swollen and no longer mobile.

root cause

The clinical picture of gout develops because of Uric acid level in the blood of those affected is permanently increased. The uric acid settles in the joints in the form of uric acid crystals and causes inflammation.

Reasons for this can be either increased production as well as one decreased excretion be of uric acid. This can happen if a Disturbances in uric acid metabolism itself is present - for example at a decreased kidney secretion (little uric acid excretion) or an initial one increased endogenous uric acid production (less often, mostly in the context of genetic diseases) - or in connection with other diseases. Some tumors have been shown to lead to increased uric acid formation and kidney damage to reduced excretion of all breakdown products in the body.

Uric acid crystals

Uric acid crystals can deposit in the following places:

• Joints
• Tendon sheaths
• bone
• Tubules (kidney)
  and
• in connective tissue

Deposits in joints and tendon sheaths are very painful. At the beginning it is usually Big toe joint or that Metacarpophalangeal joint affected.

The fact that gout practically does not occur in times of need, but becomes very common in times of excess, shows how strongly diet-dependent the development of a gout attack is.

Hyperuricemia (med. term for too high uric acid levels) and gout often come as part of a so-called metabolic syndrome which is due to a meeting of:

• Obesity (Apple type = accumulation of fat in the abdomen)
• Lipid metabolism disorders
• high blood pressure
• Sugar metabolism disorders and type 2 diabetes

is marked.

An increase in the uric acid concentration in the blood occurs when uric acid more is formed or less is excreted. Excessive intake of purines with food promotes this development. Uric acid gets through the kidneys and the Intestines excreted, with excretion on the kidney is most often disturbed.

Diagnosis of gout

The diagnosis one Attack of gout is almost always done clinically through precise Questioning the patient and Assessment of the swollen joints. If a typical localization meets other typical signs and a suitable history, one serves Laboratory analysis of the blood actually just confirmation. After a blood sample, the Uric acid level measured.

If the findings are unclear or other possible causes, an X-ray of the affected joint is recommended to be able to rule out a bone fracture or the like. In the following, the Kidney function The patient should be checked regularly to see if the condition is getting worse. If after all these examinations there is still no clear picture and the suspicion of a gout attack could neither be confirmed nor refuted, it remains Colchicine test; colchicine is administered on a trial basis and the patient's response is observed. If there is immediate improvement, the cause of the joint pain and swelling was gout.

forecast

If there is no therapy in the case of increased uric acid levels in the blood or one (or more) gout attacks, there is a risk of therapy Chronification of the disease.

So-called tophus formation occurs in the soft tissues and / or the bones of the patient.
The following show irreversible joint changes.

The deposits, which sometimes also affect the kidneys and may cause kidney dysfunction, can lead to the complete loss of function of the kidneys.
Since this in turn has a negative effect on uric acid excretion, a vicious cycle develops.

It is therefore important to initiate and adhere to a treatment with extreme precision: With adequate nutrition and possible medical support, these processes can hardly be observed.

prophylaxis

A fitting healthy eating and a normal body weight not only help with many other diseases in the context of a metabolic syndrome and various metabolic disorders, but also with gout.

Eating a healthy balanced diet and regular moderate exercise are useful to prevent many diseases before they develop.
In the case of an existing predisposition or gout attacks that have already occurred, special dietary recommendations described above can help to prevent the acute illness in the future.

If you are unsure about this large topic or if you have further questions, an individual Nutritional advice be useful with an analysis of personal eating behavior and advice tailored to this.