This weekend, I finally met some friends (with all the COVID safety precautions) over dinner. As usual, halfway through dinner, we started talking about nutrition. One of my friends told me that her mom warned her about how she should avoid beans – otherwise her uric acid would go up. She was wondering if that was true. 

Also, for the past few years, my dad’s family doctor back in Portugal instructed him to cut his beans consumption without even asking about his 200 grams plus of meat and fish that he eats at every meal (yes, our portions back home are massive!). I tried to tell them the recommendations, but he prefered to listen to his doctor – his uric acid levels never went down.

I am a big advocate of pulses in general and always encourage my patients to include them in their diet. This is a topic that I am quite passionate about. So in support of this superfood, I decided to tell you about gout, what is it and how we – in our nutrition clinic, manage it. 

What is Uric Acid?

Uric acid is a chemical created when the body breaks down substances called purines. Purines are produced mainly from the liver, muscle and intestine, or come from our diet. 

Typically, excess uric acid is filtered out from our system through the kidneys or digestive tract. 

High Uric Acid

Genetics play an important role in the regulation of our blood uric acid levels, especially how your kidneys process it, and your body’s inflammation response to it. 

For people with gout, excessive uric acid leads to the development of urate crystals that will deposit in the joints and soft tissues, causing inflammation and gouty arthritis. 

High uric acids levels in the blood occur because:

1. It is not adequately excreted by the kidneys through the urine; 
2. the body is overproducing (obesity is one of the culprits);
3. medical conditions such as kidney disease;
4. regular use of medications such as diuretics; or
5. high dietary purine intake (purine is converted to uric acid)

Not everyone with high uric acid levels will develop gouty attacks or gouty arthritis.

What is Gout?

Overall, gout affects about 1-2% of adults. Men are more affected by this condition than women, especially as they get older.

Gout is a type of arthritis (inflammation of the joints) that causes severe pain and swelling in the joints. The most common joint that can be affected is the joint between the ball of the foot and the big toe (known as the First metatarso-phalangeal joint). 

Gout develops after the build-up of high uric acid over a long period, the formation of urate crystals (called monosodium urate) and inflammation. 

Gout diet management

If you develop gout, your doctor will prescribe you medication that will help manage gout attack, and also prevent future attacks and the deposit of the urate crystals. These include pain killers, anti-inflammatories and medicine that help to lower uric acid.

For diet regulation, you should see a dietitian. The dietitian will help you to reduce the amount of uric acid in your blood and reduce your chances of developing other gout episodes. She will also work with you to help you identify your gout triggers. 

Most physicians would recommend cutting overall purine intake from the diet, and a lot of the focus is on beans and soya. In fact, research shows that vegetarian purines and soy are not linked with the risk of high uric acid or gout. Only animal purines, including organ meats, are related to hyperuricemia and gout.  

A diet low in purines is important to control uric acid and gout attacks. It is not the only approach necessary to manage it. These are some of the other diet and lifestyle strategies that your dietitian will advise and guide you:

• Moderate and healthy weight loss (not high protein diet)
• Reduce alcohol consumption
• A healthy diet high in fibre, fresh fruits, vegetables, whole grains but avoidance of fruit juices and sugar-sweetened beverages (especially sugar-sweetened soft drinks)
• Strategies on dairy products, caffeine and vitamin C may benefit some people. 
• Increase in water consumption. 
• Help manage other medical conditions that people with gout also usually have such as high blood pressure, high cholesterol, high Body Mass Index (BMI), diabetes, cardiovascular disease, kidney disease and others.

The bottom line

• Gout affects a small percentage of the population and not everyone that eats a lot of purines will have gout.
• If you have high uric acid and gout, you don’t have to restrict beans – there is no evidence that this will work. Restricting animal purines is the recommended advice. 
• A diet to manage gout and high uric acid goes beyond a low purine diet. 

If you have been diagnosed with Gout, MyDoc dietitians can help you!

Always caring for you,
Claudia Correia
Lead Dietitian, MyDoc

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