The right diet for gout: the best tips

Definition: What is gout?

Gout is the most painful form of rheumatism. The metabolic disease mainly affects men: around eight out of ten patients are male. What's more, gout tends to be a disease of "old age". It usually occurs after the age of 40. Women often only suffer from it after the menopause. Overall, around one to two per cent of adults in Germany are affected by the disease. 

People with gout suffer from recurring severe inflammation of the joints. As you have already read, the foot is often affected in the first outbreak, more precisely: the metatarsophalangeal joint of the big toe. However, other joints can also be affected - for example the knee, ankle, metatarsal, hand or finger joints. 

Gout is characterised by the fact that it occurs in stages. Those affected usually suffer from sudden attacks of pain - so-called gout attacks. The affected joint then becomes inflamed, becomes very hot, can swell or turn reddish to bluish in colour. The affected area of the body is also very sensitive to touch. If such a gout attack subsides, patients are usually free of symptoms again afterwards. 

However, there is also the chronic variant of gout. In this case, patients suffer from permanent inflammation in their joints, which can cause them constant pain. The risk of chronic progression increases if gout remains untreated. This can also lead to permanent joint deformities. 

When do you get gout? Causes at a glance

The reason why people suffer from the chronic metabolic disease gout has to do with uric acid. It is produced in our body when it breaks down so-called purines. Purines are building blocks of our human cells. However, they are also absorbed through food. They are found there in the protein content. Our body gets rid of uric acid by excreting it via the intestines, kidneys and urine. It cannot break down uric acid. 

However, if our body produces too much uric acid or cannot excrete enough of it, the concentration of uric acid in the blood increases (medically: hyperuricaemia). It then forms crystals (uric acid salt crystals), which are deposited in the joints and can trigger inflammation there. 

Influencing factor purines

But why does it come to this? Why does our body produce too much uric acid? Firstly, there is a genetic factor - the tendency to develop gout can be inherited. 

On the other hand, so-called lifestyle factors play a major role in gout. This refers to an incorrect diet and being overweight (due to eating too much fatty food, for example). In concrete terms, this means that we consume too many purines in our diet, which means that our body is unable to excrete the resulting uric acid. 

You can see which foods are particularly high in purines in our list here. 

• Meat
• Sausage
• Fish 
• Seafood
• Offal (e.g. liver, heart, kidneys) 
• Beer (also non-alcoholic)
• Spirits

The fact that gout attacks often occur quickly after eating such foods shows how strongly the consumption of these foods is linked to the disease. It is therefore important to avoid them. 

However, there is conciliatory news for exceptional meat lovers: Small amounts of turkey or chicken (skinless) are allowed - as are turkey cold cuts. Small portions of lean beef, veal or game are also allowed on the plate from time to time. 

Fish lovers can also breathe a sigh of relief. They can treat themselves to small portions (up to 125 grams raw weight) once or twice a week, but should then choose the following seafood: 

• Eel
• Halibut
• Herring
• Cod
• Carp
• Salmon 
• Smoked mackerel
• Plaice
• Sole
• Crayfish
• Shrimps
• Crabs
• Mussels

Influencing factor fructose

It is not only purines that cause our uric acid levels to rise. A number of studies have now shown that this also applies to fructose (fruit sugar). However, we are not talking about fructose, which is found naturally in fruit, but so-called industrial fructose. It hinders the excretion of uric acid and thus promotes gout attacks. 

For us consumers, it is often not at all clear which foods contain industrial fructose. Here are a few examples: 

• Various ready-made products (e.g. biscuits, ice cream, pizza)
• Sweet drinks
• Household sugar
• Honey
• Sweetened tinned fruit
• Candied dried fruit

If you suffer from gout, you should check the list of ingredients in the supermarket. If glucose-fructose or corn syrup is listed alongside fructose, you should avoid these products. On the other hand, two handfuls of fresh fruit are generally "allowed" for gout sufferers. There are even studies that suggest that two handfuls of cherries a day may reduce the risk of gout attacks. Rhubarb, on the other hand, should actually be avoided. 

These examples show: Nutrition for gout is a broad field! For specific nutritional tips, it is therefore always best to seek professional nutritional advice. 

Influencing factor overweight

From a BMI (body mass index) of more than 25, the risk of developing gout increases. Statistically speaking, being overweight doubles the risk of gout attacks. Severe obesity (adiposity) even triples it. 

Normal weight, on the other hand, helps to bring the uric acid concentration back to a normal level. It is also easy on the joints. Gout patients should therefore try to combat excess weight by adapting their diet and exercising. 

Treating gout: Therapies at a glance

The treatment of gout is based on two pillars: drug and non-drug therapy. Medication is used when the gout is acute, i.e. when there is a gout attack. The aim is then to relieve the patient's pain, which is usually very severe, as quickly as possible. This usually works well with the right medication: if the affected person receives anti-inflammatory therapy within 12 to 24 hours of the onset of symptoms, the symptoms usually improve after just 24 hours. The drugs of choice are non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and colchicine. Without medication, a gout attack can last from three days to two weeks. 

In addition to acute treatment with medication, nutritional counselling and subsequent dietary adjustments play an important role in gout. Because, as you have already learnt, our diet also influences our uric acid levels. A diet in which sufferers take care to eat foods that are as low in purines as possible and avoid industrial fructose can help to reduce uric acid levels by up to 18 per cent. However, several studies show that less than 50 per cent of gout patients surveyed are informed about this connection. 

As diet plays a major role in the treatment of gout, we will now take a closer look at this topic. In the following sections, you will find out which foods you can eat with a clear conscience. Important to know: We have only made an exemplary selection here. There are many more foods that you can enjoy. Please use our tips as inspiration. However, they are no substitute for professional nutritional advice.

What to eat with gout? Low purine foods

We know: People with gout should make sure that their diet is as low in purines as possible. But what does that actually mean? We have put together some foods that you can safely include in your diet: 

• Leaf salads
• Tomatoes
• Paprika
• Radish
• Fennel
• Carrots
• Cucumber
• White cabbage
• Onions
• Potatoes
• Rice
• Pasta
• Cereal products
• Milk and dairy products
• Cheese
• Eggs
• Nuts

As you can see, you can go all out, especially when it comes to vegetables. This also means that a low-purine diet is very compatible with a vegan and vegetarian diet. 

People who suffer from gout should also eat milk, low-fat dairy products and eggs more often, as they are a valuable source of protein. Milk also stimulates the excretion of uric acid via the kidneys. 

And: drinking a lot is important! Two to three litres of water per day are recommended. Unsweetened herbal and fruit teas are also permitted - as are up to three cups of freshly brewed coffee a day. 

Ketogenic diet despite gout?

Many people wonder whether they can follow the so-called ketogenic diet if they have gout. To say it up front: It is not favourable. But let's start with an explanation: the ketogenic diet largely avoids the consumption of sugar, cereals, fruit and starchy plants. Instead, salad, green vegetables and fatty foods such as fish, meat, cheese, nuts, seeds, avocados and olive oil take centre stage. 

The idea behind this is to "reprogramme" the metabolism. The body learns that it draws its energy from fats and proteins - and not from sugar and carbohydrates. It produces a kind of substitute fuel in the liver - ketones. This prevents cravings for sweets due to the increased fat intake. A ketogenic diet is said to have a positive effect on diseases such as multiple sclerosis and Parkinson's. But not everyone benefits. But not everyone benefits: Pregnant women and people with kidney or heart disease should not follow a long-term ketogenic diet. 

And what about gout? It is clear that a ketogenic diet includes many things that are not at all recommended for gout - including meat. In addition, the ketone bodies that form as a result of the ketogenic diet can hinder uric acid excretion and even trigger an acute attack of gout. 

Quick info on osteoarthritis: The most important nutrition tips 

The dietary recommendations for gout are not very different from those for osteoarthritis. Osteoarthritis is a wear-and-tear disease in which the protective joint cartilage wears away over time, becoming rough and fraying. In the final stage, the bones rub against each other, which is very painful. As with gout, osteoarthritis is caused by an inflammatory process. It is therefore important to eat anti-inflammatory foods. Sufferers should have plenty of vegetables on their plates. Like gout patients, they should avoid meat and sausage as well as convenience products. Healthy vegetable oils, on the other hand, are beneficial. 

Quick info on rheumatism: The most important nutrition tips 

Rheumatism is an umbrella term for more than 100 different diseases - the most painful of which is gout. Rheumatism affects either joints, muscles, bones or tendons, which are often inflamed. Rheumatoid arthritis is the most common form of the disease. Rheumatism patients should consume omega-3 fatty acids as they have a positive effect on the disease and reduce inflammation. They are mainly found in herring, salmon, mackerel, sardines and redfish. They are also found in various vegetable oils such as rapeseed oil, walnut oil, linseed oil, soya oil and wheat germ oil. Low-fat dairy products are also recommended. 

What many people don't realise: Rheumatoid arthritis can also lead to changes in the oral cavity. In such cases, the periodontium - the entirety of the gums and bones - is particularly affected. Patients with rheumatoid arthritis are significantly more likely to suffer from inflammation of the periodontium - periodontitis. If it is not treated, it can lead to tooth loss. Would you like to find out more about periodontitis and how you can prevent it? Then read our article: 

Periodontitis: symptoms, causes and the right treatment 

Diabetes type 2 quick facts: The most important nutrition tips 

Diabetes mellitus is a metabolic disease and a common co-morbidity of gout. Sugar accumulates in the blood because the body's cells do not react sufficiently to the hormone insulin and absorb too little sugar from the blood. Diet plays a major role in type 2 diabetes: for some patients, it is enough to change their diet accordingly and also lose weight and exercise more to get the disease under control. It is important that those affected eat a balanced and varied diet and focus on nutrient-rich and minimally processed foods with plenty of fibre. They should avoid high-energy foods with added sugars and highly processed grains (so-called refined grains). 

Quick info on renal insufficiency: the most important nutritional tips

Renal insufficiency is also common in gout patients - as is type 2 diabetes. It is assumed that the increased uric acid level in people with gout puts a strain on the kidneys, which then leads to chronic renal insufficiency, which in turn favours the increase in uric acid levels. Dietary recommendations for those affected are complex and should be made by a doctor. In general, it can be said that the "Mediterranean diet" can be beneficial. This involves a mixed diet of fresh fruit and vegetables, lots of fish and little red meat. Olive oil is used for cooking.