In this article, I will tell you about dietary recommendations, about foods that can be consumed during an acute attack of gout, and which should be excluded from the diet in case of gout or increased levels of uric acid in the body.

I will try to explain in detail how to reduce uric acid levels by following simple dietary recommendations. I will not touch on medications; I talk about them in detail in another interesting article.

What is gout and how is it related to uric acid in the body?

Dietary advice for acute gout attacksGout is a chronic rheumatic disease characterized by elevated levels of uric acid in the blood (hyperuricemia) and deposition of urate (uric acid salts) in joints and other tissues.

This causes inflammation and severe pain, especially in the small joints of the limbs. An acute attack of gout often begins at night with sudden and intense pain, redness, swelling and tenderness in the affected joint. The first metatarsophalangeal joint of the foot is most often affected.

The etiology of gout is associated with impaired purine metabolism, which leads to excessive formation and/or insufficient excretion of uric acid by the kidneys. Factors that increase your risk of developing gout include: high purine diet (eg, red meat, seafood), alcohol consumption, especially beer, obesity, certain medications such as diuretics, and family history.

Treatment for gout is aimed at reducing pain and inflammation during an acute attack, as well as controlling uric acid levels in the blood to prevent future attacks and complications such as the formation of urate kidney stones and chronic joint inflammation. Recommendations about Nephrolithiasis in the article “Types of kidney stones”.

In general, uric acid can be produced either through the consumption of purines and metabolic disorders, or during cancer and chemotherapy, when a large number of cells are destroyed and their contents and derivatives are released. But we will not consider the second aspect in this material either.

Acidity of foods and their relationship with uric acid

For many patients and readers, it may be interesting to know that uric acid precipitates or forms crystals when the acidity of the body and urine is reduced. Yes, acidity is one of the determining factors in a gout outbreak.

Dietary advice for acute gout attacks

The fact is that the acidity of the plasma of our body, i.e. pH varies within strict limits from 7.35 to 7.45 - slightly alkaline. And if this indicator decreases for any reason, then this may increase the likelihood of a gout attack. Of course, not in all patients, but only in those who already have hyperuricemia or a predisposition to it. Therefore, it is worth considering and monitoring the concentration of uric acid in the body.

This leads to the following important conclusion: foods that contain alkali or alkaline foods are “protective” and significantly reduce the risk of a gout attack. There are exceptions, such as lentils and asparagus.

Foods with low pH or acidic foods, on the contrary, run the risk of precipitation of uric acid, and as a result, the risk of an acute attack of hyperurecemia and the cause of a gout attack.

Acid and alkaline products

This is a very interesting and useful table, which consists of four columns, which give examples of products according to their acidity. This table is not unique; it can be constantly updated with various products. However, I tried to list the most common products.
it is forbidden
Very acidic foods
Red meat
Fried foods
Carbonated drinks
it is forbidden
Acidic foods
Ripe fruits
Green fruits
Fruit juices
Refined cereals
Alkaline products
Dry fruits
Very alkaline foods
Some salads
Water and lemon
Lentils* - not allowed

It is almost impossible to list all the food products from around the world, but you can find out and check what acidity a product has on the Internet. However, the main recommendation for reducing uric acid levels is to eat alkaline foods and very alkaline foods.

Note! Not all vegetables and salads reduce uric acid because some foods contain high amounts of purines, so you need to consider both acidity and purine content.

There are also notes about some alkaline foods that contain moderate or low levels of purines. Alkaline foods with a low purine content can be consumed in limited quantities for hyperuricemia, but I still recommend excluding them temporarily from the diet.

Foods high in purines and their direct connection with uric acid

Dietary advice for acute gout attacksIn short, purines are nitrogen-containing chemical compounds that are broken down into uric acid. Moreover, since purines and pyrimidines are structural elements and are part of DNA and RNA, and animal and plant cells contain DNA and RNA. Accordingly, the consumption of purines and their breakdown is a natural process when eating foods.

From here there is another important conclusion: eating foods that contain a minimum amount of purines reduces uric acid levels and reduces the risk of gout. Therefore, you can find food tables that contain information on their purine content. Typically, the amount of purines will be expressed in milligrams per 100 grams of a given food.

  • Low purine foods are foods that must contain less than 50 mg of purines per 100 grams of food and are primarily recommended for patients with high uric acid levels.
  • Foods containing 50 mg to 100 mg of purines per 100 grams of food are classified as moderate uric acid foods and are not recommended but not prohibited.
  • Products with a purine content of 100 mg to 200 mg per 100 grams of product are high purine foods. They are not recommended and contraindicated for gout and hyperuricemia.
  • Very high purine foods are foods that contain at least 200 mg of purines per 100 grams of food. It is, perhaps, even prohibited to use temporarily for this disease, as it will definitely aggravate and worsen an attack of gout.
Foods with purines

Dietary recommendations

For convenience and clarity, I decided to create a table of three columns, which will list prohibited (I do not recommend) food products, allowed (I recommend) and moderate food products (limited)
it is forbidden
Not recommended Prohibited
Meat broths
Sardines and Salmon
Herring and Anchovies
Mussels and Oysters
Shrimp and Crabs
Fish roe
Spinach and Soy
Margarine and Cocoa
Carbonated drinks
A little
Limited use
Legumes all
White fish
Rye bread
Hard cheese
Recommended Allowed
Low fat cheeses
Low fat cheese
Cottage cheese
Corn flour
Olive oil
Chicken eggs

On the Internet you can find a lot of different recommendations. There are many relative disputes about this or that product, and there are also many different and confusing tables. Various people give advice and recommendations, but in fact they do not know the basic principles of biochemistry.

What would I recommend to readers and patients for uric acid control?! If you want to study a certain product, be sure to look at its characteristics in these two important parameters, which I talked about above. Considering the acidity of the food product and the amount of purines it contains, you will never make a mistake when creating a menu for this disease.

Interesting facts and controversial foods for gout

After analyzing various literature, I decided to give examples of some food products that were noticed with different recommendations on different information platforms. And as it turned out, nowhere were not taken into account at the same time the acidity of the product and its purine content. Therefore, you can come across different and erroneous recommendations. Of course, this is not the entire list of products, but only those that we were able to notice and highlight when preparing the article.

Which vegetables can be consumed for gout and which cannot?

Dietary advice for acute gout attacksTo make it even easier for readers to understand, I will give examples of, so to speak, “controversial” vegetables regarding gout, about which there may be doubts. However, if you find these products in the tables above, then there should be no doubt.

Vegetables that Can use for gout:

  • Carrots, onions, cucumber, radishes, peppers, watercress, celery, pumpkin, garlic, parsley, artichoke, potatoes.

Vegetables that it is forbidden use for gout:

  • Tomatoes, cauliflower, spinach, asparagus, mushrooms, leeks, peas, beans, lentils.

The attentive reader will notice that lentils are an alkaline product, which is a protective factor, but they contain from 75 to 150 mg of purines per 100 grams of product. Therefore, the conclusion is that eating lentils is not recommended for gout.

What fish can you eat if you have high uric acid?

In general, all fish contain small amounts of purines, so they cannot be recommended for controlling uric acid levels. Yes, we recommend fish that contains as few purines as possible per 100 grams of product, preferably below 50 mg. But where can you find something like this in nature?!

Dietary advice for acute gout attacks

I can confidently say that white fish contains the least amount of purines, but the amount of purines in this type of fish varies from 50 to 100 gm of purines per 100 grams of product.

For example, you will find recommendations that you can eat fish such as hake, perch, and mullet to reduce uric acid. And since this type of fish contains an averagely small amount of purines, these types of fish are recommended and not prohibited.

However, I would not prescribe fish to my patients during an acute attack of gout, much less to reduce hyperuricemia.

Dietary advice for acute gout attacksWhen writing this material, what struck me most was how different sites mediocrely reprinted the same errors from each other. There are even serious medical clinic websites where the same contradictory errors are present. I have also seen several different and opposing “new recommendations”, for example regarding coffee. Previously, it could not be used for gout, but now suddenly it is possible. And to really understand whether you can drink coffee or not during an acute attack of gout, just look at the pH of coffee, and you will have no doubts or questions.

To summarize, I can say that during an acute attack of gout, it is important to eat right and it is important to see a doctor. Dietary advice is helpful and important, but medication will help with an acute attack of gout, so don't neglect your health.

Dr. Oleg Korzhikov

One thought on “Диетические рекомендации при остром приступе подагры

  1. Guest says:

    We need to take 1 cup of oatmeal and pour 2 cups of water over it. Add dried apricots (can be replaced with other dried fruits) and cook the porridge until tender. Serve hot.

    2. Cabbage salad. Chop white cabbage and mix with grated carrots and fresh cucumber. Pour over lemon juice and add herbs to taste.

    3. Steamed vegetables with chicken. Place chopped chicken pieces and vegetables (broccoli, zucchini, carrots) on the steamer. Serve with sour cream or low-fat yogurt.

    4. Baked fish cutlets. Mix finely chopped fish (salmon, cod) with egg, flour and seasonings. Form cutlets and bake in the oven until golden brown.

    5. Beet and green salad. Grate the beets on a coarse grater and mix with chopped herbs (dill, parsley). Sprinkle with lemon juice and sprinkle with nuts.

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