Excess uric acid: which foods to avoid and favor in case of gout?

Gout is a chronic disease defined as an inflammatory microcrystalline arthropathy. L'uric acid is the molecule incriminated in the appearance of gout. Naturally present in the body, it comes from the degradation of purines: adenine and guanine (constituents of DNA). The causes of excess uric acid are:

• Overeating

• Congenital anomalies (rare)

• Failure to eliminate uric acid (kidney problems)

• Destruction of our own cells (hemolysis, certain treatments, etc.) 

L'hyperuricemia is rarely symptomatic, except when the crystals precipitate around the joints: the gout attack. Crystallization causes an inflammatory reaction which is accompanied by throbbing, intense and sudden pain. In short, gout attacks are very painful. Very often, it is diet that triggers the crisis: overeating or severe dietary restrictions.

During the crisis, the only dietary recommendation is to drink, drink abundantly. The goal is to increase diuresis to eliminate the crystals. Low mineralized bicarbonate water is preferred to ensure the alkalinization of urine. During the crisis, we will try to reabsorb the crystals by relying on bicarbonated water. The bicarbonates will alkalize the urine, an essential factor in fighting against the complication of gout: kidney stones.

Outside of crisis, we must act at the source of the problem: excess uric acid in the blood. For this, a hypouricemic diet is necessary to prevent new attacks. The principles of the diet are simple:

• Reduce purinophoric foods, i.e. those containing a lot of purines and/or uric acid.

• Avoid purinogenic foods, this corresponds to foods that increase the formation of purine bases in the body due to the high content of glycocolle and serine.

• Prohibit phlogogenic foods, the latter directly increase uric acid concentrations in the blood.

• Increase fluid intake, water is the only way to flush out excess uric acid.
  

• Increase alkalizing foods to prevent acidification of tissues and urine. A factor increasing the precipitation of uric acid.

Alcoholic beverages greatly promote the prevalence of gout attacks, it is a food phlogogenic. Alcohol considerably increases the level of uric acid in the blood, since it is one of the factors supporting uricogenesis: formation of uric acid. This hyperuricemia is all the stronger as the liquids do not require digestion work, they enter the blood circulation almost instantly. The harms of alcohol do not stop there: it also interferes with the renal elimination of uric acid.

Beer (without and with alcohol) is all the more concerned since it will increase the risk by two, due to the richness in purine from the malt germ and the presence of hops which influences the metabolism of uric acid.

We recommend you to eliminate all alcohol consumption.

Foods alone can trigger a gout attack. Some are directly involved in the increase in serum uric acid and/or a reduction in the elimination of the latter. Sometimes, the food does not influence purine metabolism, but it still causes an attack, such as chocolate or mushrooms. These intolerances are specific to each person. It's up to you to analyze your diet and find your trigger foods.

The concentration of uric acid in the blood increases significantly with the consumption of animal products. These are foods purinophores : animal purines are metabolized by the body. The waste product of this metabolism is uric acid. Especially since animal products tend to acidify the blood: a factor accentuating the risks of uric acid crystallization.

We recommend you :

• Avoid excess animal products: 1 meat, 1 fish or 2 eggs per day.

• Maximum one slaughter per month.

Products from the connective tissues of animals are rich in glycocolle and serine, compounds purinogens. These two compounds are amino acids that can increase the endogenous production of uric acid.

We recommend you consume a maximum of one gelatin-based product per week.

Fructose is a simple sugar found naturally in many foods. Its strong presence is closely correlated with the increase in serum uric acid, the uric acid content in the blood. The foods richest in fructose are:

• Sodas, these drinks from the food industry are real time bombs. In addition to being fructose concentrates, they are liquid. This means that the absorption of their sugars is rapid, it is a real wave of fructose that the body receives after this consumption.

• Ultra-processed products, manufacturers have understood, sugar is palatable. Many ultra-processed foods contain the famous corn syrup in their compositions. This inexpensive syrup is extremely high in fructose.

• Honey, although this food is a source of multiple health benefits, it remains a sweet product. Honey contains on average 40% fructose, its impact is therefore significant.

• Processed fruits, fruits naturally contain fructose. In jam, juice or dried, we tend to increase the fructose content or the bioavailability of fructose (for juices). The effect of dried fruits is less thanks to their richness in fiber. Fiber reduces the absorption of fructose.

We recommend you :

• Favor home-made cooking.

• A maximum of one glass of soda or fruit juice per week.

• Maximum one teaspoon of honey or jam per day.

• Limit dried fruits that are too rich in fructose: raisins, dates, figs, dried apricots and prunes.

Increasing your water intake is the only way toeffectively evacuate uric acid through the urinary tract.

Be careful, the elimination of uric acid acidifies the urine. This acidification increases the risk of uric acid crystallization in the urinary tract, which causes kidney stones. To remedy this risk, bicarbonate water is favored. Bicarbonate water is made up of a lot of bicarbonates (HCO_3-). In blood and urine, bicarbonate ions correct the pH. Thus, in addition to increasing diuresis, bicarbonated water reduces the risk of crystallization of uric acid around the joints and in the urinary tract.

We warn patients with kidney problems. Kidney failure increases the risk of gout attacks. However, increasing your water intake is not recommended here, as this increases “fatigue” of the kidneys. In case of kidney failure, be sure to follow your personal fluid recommendations.

We recommend you to drink 2 to 3 L of bicarbonated water per day. The bicarbonate waters are as follows: Saint-Yorre^®, Vichy Celestins®, Arvie^®, Quézac^®, Salvetat^®, etc. In case of sweating (heat, physical activity, night sweats), it is imperative to drink more.

Raw fruits and vegetables are real benefits in case of gout, in many ways:

• Fruits and vegetables are the second foods richest in water, in front of the milk. Water represents on average 85 to 90% of their constitutions. They effectively reduce blood uric acid.

• Fruits and vegetables are alkalizing. They minimize the risks of recurrence of seizures.

• Plants are vectors of fibers. Fiber reduces the bioavailability of all other nutrients including purines.

• They bring vitamin C. It seems that the latter inhibits the activity of an enzyme: xanthine oxidase. It is this enzyme that transforms xanthine (a purine derivative) into uric acid. By reducing its activity, researchers observe a drop in the level of uric acid. They also observed an increase in the rate of glomerular filtration (this corresponds to renal activity). Two factors which would encourage the indication of vitamin C in cases of gout. However, the level of evidence for the action of vitamin C against gout remains slim. Further studies are needed to affirm the benefits of vitamin C in preventing the incidence and recurrence of gout.

• They carry vitamin B9. A small case-control study suggests that vitamin B9 reduces gout attacks by 70%. The level of evidence is low, other studies are needed to validate the effect of vitamin B9 on the frequency of gout attacks.

Certain plants enjoy a bad reputation due to their high purine content: asparagus, artichoke, spinach, cabbage, Brussels sprouts, mushrooms and even lentils. However, plant purines are not transformed into uric acid: plants can therefore be authorized. The same goes for coffee and/or tea.

We recommend you :

• Five to seven servings of fruits and vegetables per day (with a majority of vegetables).

• Favor raw fruits and vegetables to preserve heat-sensitive vitamins (including vitamins C and B9).

• The foods richest in vitamin C are such as camu-camu powders andacerola, aromatic herbs, pepper, broccoli, citrus fruits, etc.

• The foods richest in vitamin B9 such as aromatic herbs, pulses, etc.

According to some studies, le milk from a cow would be beneficial in preventing gout attacks while soy milk would not have this uricosuric effect. Additional studies are still needed in this area, but the benefits of milk seem to come from the following constituents:

• L'water, milk is one of the foods richest in water. Still in this same dynamic, we seek to increase water intake to eliminate uric acid.

• There casein and the lactalbumin. These two milk proteins promote the urinary excretion of uric acid, leading to a reduction in serum uric acid.

We recommend you :

• Two dairy products per day.

• For older people, needs increase to 3 dairy products per day.

• Be sure to alternate dairy and cheese throughout the day.

• No too strict diet: Losing weight too quickly increases the risk of gout attacks. Indeed, too strong a restriction leads to urinary reabsorption of uric acid. This reabsorption increases the level of uric acid in the blood and potentiates the crystallization of the latter. Dietary monitoring is preferable to manage weight loss in a moderate manner.

• Avoid excess fat: The influence of diet on the onset of a gout attack is well known. It seems that the frequency of attacks increases during festive meals. It is therefore preferable to limit spontaneous excesses and promote regularity: small pleasures all the time.

• An ice pack on the joint: This reflex may seem trivial, but it is one of the most effective treatments for gout attacks. The cold reduces the pain caused by the inflammatory process.

• Diuretic infusion: dWith the aim of increasing water consumption and urinary excretion, the CREGG (think tank of Hepato-Gastroenterology practices and groups) offers infusions of diuretic plants. Diuretic plants are dandelion, linden, quackgrass, bearberry and even meadowsweet.

• Weight loss: overweight and obesity are risk factors for gout. Therefore, a controlled and supervised reduction in body mass is beneficial for this pathology. Given the risks of crisis in the event of a diet that is too strict, we recommend that you contact health professionals specializing in nutrition (nutritionist doctor or dietitian nutritionist).

• Mobilize the joint: en times of crisis, the affected joint is extremely painful. However, you must face the pain, accept it and try to mobilize the joint. Movement promotes the resorption of crystals and their elimination in the urine