Diet for Hyperuricemia: Diet for Gout 🆙

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The hyperuricaemia (or high uric acid) diet is a specific diet to combat excess uric acid in the blood which, if neglected, can give rise to gout.
The subject characterized by hyperuricemia is called "hyperuricemic", while the one suffering from gout (gouty attacks) is referred to as "gouty".

What is uric acid?

Uric acid is a derivative of the metabolism of purines, nitrogenous compounds that enter the DNA structure.
Normally, uric acid is eliminated by renal filtration and, to a lesser extent, by digestive secretions.
The bodies of people with hyperuricaemia and gout tend to accumulate much more purines and uric acid than normal.

What is hyperuricaemia?

Hyperuricemia is an excess of uric acid in the blood, which is based on an inherited genetic predisposition.
This tendency favors metabolic decompensation, which can worsen in the presence of various behavioral factors (including diet).

When do we talk about hyperuricemia?

Hyperuricemic is considered to be the person who, after 5 days of a hypopurinic diet and without taking drugs that affect uricaemia (vitamin C, vitamin PP, salicylic, diuretics), has blood uric acid values higher than:

7,0 mg / dl if man
6,5 mg / dl se donna.

Beyond 9 mg / dl the gout risk becomes high and one proceeds with the administration of specific drugs (see drugs for the treatment of gout).

What is gout?

Definition of gout

Gout is a chronic and hereditary metabolic disease caused by severe hyperuricemia, which tends to form crystal deposits in the joints and kidneys.
These accumulations of uric acid in the joints cause acute inflammation, triggering painful symptoms that are sometimes very intense.
The same goes for kidney deposits that cause stones.

Symptoms of gout

The disease manifests itself with acute recurrent inflammatory arthritis.
It causes pain, redness and swelling of the joints.
Uric acid lithiasis, on the other hand, triggers symptoms similar to other types of stones (see symptoms of kidney stones).

Causes and predisposing factors

As we have said, hyperuricemia and gout are disorders caused by one or more hereditary genetic defects, which can worsen due to predisposing factors.

Causes

The hereditary genetic factors of severe hyperuricaemia and gout can intervene on two very distinct fronts:

Excessive synthesis of purines
Reduced urinary excretion of uric acid; in this case we are talking about normoproductive and hypoexcretory patients.

Ultimately, hyperuricaemia may be the consequence of increased uric acid synthesis and / or decreased urinary elimination.

predisposing factors

The predisposing factors for hyperuricaemia and gout are:

Incorrect diet
Overweight
Low level of physical activity.

Diet

The current availability of drugs effective in fighting hyperuricaemia and gout has helped to reduce the importance of the traditional, and strict, dietary regimen.
In light of this consideration, and bearing in mind the hereditary nature of the disease, the contribution of the diet is now considered negligible.

Fundamentals of the diet

The basic principles of the diet for hyperuricaemia and gout are:

Fighting overweight.
Reduce the overall intake of nitrogenous compounds and nutrients that worsen uric acid metabolism.
Increase the amount of water and nutrients that improve uric acid metabolism (see below).
Avoid a globally excessive diet (see below).

Medicines associated with the diet

The drugs most used for hyperuricemia and gout are aimed at preventing the excess of uric acid, its accumulation and the appearance of joint as well as renal symptoms.

The drugs used as antigout agents, on the other hand, are mainly those that promote the excretion of uric acid (such as colchicine) or that inhibit its synthesis (such as allopurinol).
The reduction of symptoms affecting only one joint, on the other hand, is carried out through the administration of non-steroidal anti-inflammatory drugs (NSAIDs, such as diclofenac, ketoprofen, etc.).

NB. It is not recommended to take acetylsalicylic acid.

Food Advice

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If necessary, lose weight.

This aspect plays a fundamental role in the event that the body mass index exceeds the obesity threshold (BMI> 30).

The diet should be characterized by caloric moderation, in order to avoid, as far as possible, binges and excesses.

In fact, the gradual reduction of superfluous weight seems to bring more benefits than a dietary regimen that is attentive only to the elimination of foods rich in purines. Not surprisingly, heavier people usually have higher uric acid levels.

But be careful! Better to stay away from prolonged fasting and drastic or too restrictive diets, which have the reputation of triggering gouty attacks.

Reduce your intake of purines and proteins

Purine

Above all, it is important to reduce purines and, to a lesser extent, proteins.
To do this, the diet must be:

Free from purine-rich foods.
With few foods with medium purine content.
At the same time, preferring the intake of low-purine foods.

The table below shows the details of the purine content in the most consumed foods.

Foods with a high purine content (yes 150 to 800 mg / 100 g)	Anchovies or anchovies, sardines, herring, mackerel, mussels, sweetbreads, liver, kidney, brain, meat extract, game
Foods with a medium purine content (yes 50 to 150 mg / 100 g)	Meat, poultry, fish (except those with a high purine content), oysters, shrimps, crabs, crustaceans, cured meats and sausages in general; peas, beans, lentils, asparagus, spinach, cauliflower, mushrooms, peanuts, wholemeal products
Foods low in purines (yes 0 to 50 mg / 100 g)	Milk, eggs, cheeses, greens, vegetables (except those listed above), fruit, pasta and other grains (except for wheat germ and wholemeal products)

Protein

Reducing your overall protein intake is a fairly simple dietary fix.
Generally, it is sufficient to reduce the overall quantity of: meat, products of the pasca, eggs, cheeses and purified vegetable derivatives (wheat muscle, seitan, etc.).

Cut down on alcohol

Alcohol is bad for purine metabolism.
All alcoholic beverages should be avoided, especially in excessive quantities.
In the event of a pre-existing and indispensable habit, it is advisable to limit its intake to very little wine drunk with meals.
Due to the high alcohol content, spirits are to be banned.
Also, beer is particularly not recommended, because it has a high purine content compared to wine and other spirits.

Moderate the introduction of fructose

Fructose is a sugar that worsens uric acid metabolism and promotes its accumulation.
It is mainly contained in certain sweeteners, sweets, sweetened drinks and sugary fruit (persimmons, figs, grapes, mandarins and bananas) or preserved (jam, candied fruit, syrup, etc.).

Preventing excess fat

A high-fat diet appears to be related to worsening uric acid metabolism.
They are to be avoided:

Too many toppings
Meat, fish and fatty cheeses
More than two or three egg yolks a week
Fatty fruits like avocado, coconut etc.
Cooking methods that require the use of a lot of fats, especially frying.

Ensure a sufficient amount of complex carbohydrates

Complex carbohydrates, of which the major progenitor is starch, favor the urinary excretion of uric acid.
It is not necessary to exaggerate, the recommended ration typical of the Mediterranean diet is considered sufficiently adequate (i.e. at least half of the daily calories).

Ensure proper hydration

It is very important to ensure the body the right amount of water.
Drinking plenty of it can prevent kidney stones that gouty people are particularly prone to.
Herbal infusions can also be a good solution to increase the intake of liquids with the diet; moreover, some diuretic teas can promote the excretion of excess uric acid and reduce blood pressure.
It is advisable to take at least one milliliter of water per calorie present in the diet.
A normal person who follows a 2000 kcal diet should introduce at least 2 L of water per day contained in food and drinks; for a hyperuricemic person or for a gouty person, it is advisable to drink at least 2 L of water (which added to the food can help to exceed 3 L daily).

Increase the consumption of omega 3

In the diet for hyperuricemia and gout, at least two or three portions of fish rich in omega three per week (especially blue and cold seas) cannot be missing.
Omega 3, in fact, help to modulate the inflammatory state of the body by reducing the incidence of inflammatory diseases including gouty arthritis.
Other sources of omega 3 are: salmon, cod liver, krill, seaweed, squid and certain vegetable seed oils (eg chia, kiwi, etc.).
The intake of fish must be done avoiding species with a high purine content such as sardines.