Gout diet: 7 practical tips

With the right gout diet, the painful gout attacks can be brought under control. Because ‘the disease of kings’, as gout (arthritis urica) is also known in English, is certainly no walk in the park.

With gout, tiny uric acid crystals settle in the joint fluid and trigger bouts of inflammation that come on in attacks. Anyone who has ever been torn from their sleep in the middle of the night by extreme joint pain knows how much of a burden this illness is. A special gout diet can however achieve a great deal and prevent the next gout attack. We have gathered the most important basic rules here.

Here we go again: the joints at the front of the foot are badly swollen and red, and on top of that there is this unbearable pain. What is actually going on?

It all starts with an inconspicuous metabolic product called uric acid. It is formed in the liver through the breakdown of so-called purines, which come either from the body’s own reserves or from food. It then enters the bloodstream, to be excreted by the kidney in the end. Normally the formation and the excretion of uric acid balance each other out, so that only small amounts of uric acid are present in the blood.

In around 10% of the population, however, the kidney does not quite manage to keep up with the formation of uric acid: the uric acid values get out of balance and the concentration in the blood rises (‘hyperuricaemia’). At first this is harmless, but in some cases it can become dangerous. Because much like limescale in water, uric acid too dissolves only poorly in blood. That is why it forms crystals of sodium urate, which lodge in the joint fluid. At this point we already speak of so-called asymptomatic gout.

In this way the gout slumbers along for years completely free of symptoms, and more and more microscopically small crystals are deposited in the joints. Until finally individual crystals are released again.

This is where the immune system comes in: it recognises the crystals as foreign bodies and reacts with inflammation. That in turn releases further crystals, which strengthens the inflammation even more, a vicious circle. The joint turns red and swells badly, but what those affected suffer from most is the severe pain.

If you are already plagued by gout attacks, it is correspondingly important to change course, because left untreated gout can lead to damaged, deformed joints and raises the risk of kidney stones.

As is so often the case, with gout too nutrition plays a decisive role in how the illness develops, because with its help you can influence your uric acid balance.

Some foods have a uric-acid-raising effect, either by contributing to the formation of uric acid or by slowing down its excretion. Others, in turn, lower uric acid by stimulating the kidneys to excrete it.

That has a doubly positive effect: on the one hand it prevents further uric acid being deposited in the body, on the other hand acute gout attacks caused by excessive uric acid concentrations in the blood can be prevented.

Anyone who has been hit by a gout attack should try to go for food that is as anti-inflammatory as possible, in order to calm the immune system down again. Alcohol and sugar in particular can under some circumstances fire up the gout even further and make the symptoms worse.

There is also a fascinating connection: in recent years scientists have increasingly been examining the topic of gut bacteria in gout patients. Their composition differs so clearly from that of healthy people that gout could be diagnosed reliably in 80% of cases via the gut microbiome.

Probiotics and a fibre-rich diet are therefore definitely worth a try, even if the connection has not yet been clearly demonstrated. You can find more fascinating information about the microbiome here: Gut flora and the influence of prebiotics and probiotics.

Purines should only be eaten in limited amounts, after all they are the substance from which uric acid is formed. The good news: unlike what was previously assumed, purines from plant sources are not affected by this.

Despite containing purines, dairy products have even been able to help lower the uric acid level, so you can build them into your menu as often as possible.

With meat and fish you should limit yourself to 3 to 4 portions a week and cut out offal, cuts with skin and crustaceans (lobster, crab, prawns) entirely. But do not worry: (almost) vegetarian cooking can be delicious and varied too.

• Avoid: offal, meat or fish with skin, crustaceans, sardines & trout, large amounts of meat or fish
• Favour: dairy products, vegetables, eggs

Alcohol has a doubly negative effect: for one thing it promotes the formation of uric acid in the liver, for another the lactate produced as it is broken down inhibits the excretion of uric acid in the kidney.

For this reason, in order not to trigger a gout attack, you should have a maximum of 3 alcoholic drinks a week and no more than one of them a day. The strongest effects occurred with the consumption of beer and spirits, which makes wine the alcoholic drink of your choice.

• Avoid: beer, spirits
• Favour: wine (in moderation), alcohol-free drinks

Fructose, the sugar found in fruit, contains no purines, but unfortunately it still contributes to the formation of uric acid. Here too, breakdown products are formed which are in turn converted into uric acid, and the raised gout risk that results from this is now clearly documented. Moderate amounts of fruit on occasion are less critical than sweetened soft drinks or other processed foods with a high sugar content, such as jelly sweets or chocolate.

• Avoid: soft drinks, undiluted juices, large amounts of fruit high in fructose
• Favour: fruit varieties lower in fructose, berries

Be careful with sugar substitutes too: xylitol raises uric acid and should be avoided. Erythritol is better suited here.

Even though carbohydrates do not directly raise the uric acid level, a switch to low carb makes sense. High amounts of insulin, such as can be released by carbohydrate-rich meals, inhibit the excretion of uric acid in the kidney and thereby raise the uric acid level in the blood.

For this reason there is also a clearly documented connection between insulin resistance, the precursor of diabetes, and gout.

Sugar in particular is problematic: it contains fructose, from which uric acid is formed, and on top of that it makes blood sugar shoot up. You will find further reasons to do without sugar in this article: Why you should give up sugar as of now.

If you would like to eat a ketogenic (very low carbohydrate) diet, however, you should be a little more careful.

The ketone bodies that are produced in response to the withdrawal of carbohydrates can hinder the excretion of uric acid in the kidney and so trigger gout attacks at the start of the change in diet. After the adaptation phase this risk subsides again, and in the end the ketogenic diet can even ease joint inflammation by inhibiting the so-called NLRP3 inflammasome, an inflammatory body.

• Avoid: sugar, large amounts of pasta, potatoes, white bread
• Favour: sweet potatoes, vegetables, quinoa

The doctor has always said it: drink, drink, drink. (Alcohol-free, of course.) The body needs around 2 litres of fluid a day in order to carry out its tasks optimally, and in summer 0.5 to 1 litre more is welcome.

This is important above all for gout patients, because uric acid can only be excreted via the urine (hence the name).

Make sure you do not choose drinks with sugar or alcohol. The better alternative is mineral waters rich in bicarbonate and, coffee junkies take note, coffee. Coffee can effectively help to lower the uric acid level.

• Avoid: soft drinks, undiluted juices, alcohol
• Favour: mineral water, coffee

It is not unusual for excess weight to occur alongside gout. If this applies to you as well, it is advisable to shed a few surplus pounds, because that too has a positive effect on your uric acid balance.

Even though quick results can be motivating, with a gout diet you should absolutely avoid severe calorie restriction and phases of fasting. Purines are released from your own body reserves in the process, and just like those from food they can trigger gout attacks.

It is better to go for somewhat more leisurely and healthy weight loss with a smaller calorie deficit. That way you feel better while doing it, the weight loss is more sustainable and you do not have to endure painful gout attacks along the way.

• Avoid: fasting, large calorie deficits
• Favour: slower and sustainable weight loss

Several studies have shown that vitamin C lowers the uric acid level in the blood and the risk of gout. The connection has not yet been clearly established here and further studies are needed, but we would still say: it cannot do any harm. A daily dose of 500mg of vitamin C is enough to achieve the positive effects.

Changing your diet when you have gout: that sounds easier at first than it is. And that is entirely normal, because nutrition influences not only health but also social, financial and emotional aspects of life.

A concrete nutrition plan can help you get used to new foods and recipes without constantly living in fear of the next attack.

We know exactly which foods have a good effect and which ones you are better off keeping your hands away from, and we can take the worry about your gout off your shoulders. On top of that we tailor every meal precisely to your needs and take account of your individual eating habits as well as any accompanying conditions.

With our help you will manage to get used to a healthy gout diet, which in the end benefits not just your joints but your whole body, your health and your emotional wellbeing. Give it a try.

Further links:

Gicht und Ernährung (Gout and nutrition)

Role of Vitamin C in Prophylaxis and Treatment of Gout—A Literature Review

Intestinal Microbiota Distinguish Gout Patients from Healthy Humans

Renal clearance of uric acid is linked to insulin resistance and lower excretion of sodium in gout patients

FETeV: Hyperurikämie und Gicht – Ernährungstherapie