The surprising health condition you thought had died out – but 96 million people will be diagnosed with in the next 25 years

There is a historical health condition that you might think had died out, but is in fact a rising global health problem. It is increasing across all age groups and projected to affect nearly 96 million people worldwide by 2050 – including an alarming number of younger patients, even as young as teenagers. And while it is a condition many people have heard of, only those who have experienced it can testify as to how exquisitely painful it can be. Have you figured out what it is yet?

The condition on the rise is gout. Not only does gout cause agonising joint pain, it’s associated with kidney disease, including the formation of urinary stones, whilst acute attacks can sharply increase the likelihood of heart attack or stroke.

These predictions are a major wake-up call. The question is not only how we treat gout, but also how we prevent it. Medication is central to management — but diet remains one of the most contested and compelling parts of the story.

Gout has something of a regal history – caricatured as a disease associated with the rich excesses of Stuart and Georgian aristocracy, including Queen Anne and King George IV. Such patients are depicted living debauched lives on port and brandy, seated at tables piled high with roasted peacocks.

We’ve moved on considerably from that picture – although obesity and alcohol remain definite risk factors. But by looking more closely at today’s diet, we can begin to understand what may be making the condition worse – and what might help make it better.

What should you eat if you have gout?

Traditional dietary advice for gout has typically warned against foods high in purines. These compounds are found in high levels in oily fish and some seafood (e.g. mussels and scallops), game, offal and yeasted products like beer and Marmite. High intake of dietary purines can increase blood urate levels, the compound which leads to the development of inflammation-inducing crystals in joints – the famous hallmark of gout.

So, what should you really be eating if you have gout, or deemed at risk of developing it? Should you avoid foods high in purines and focus solely on incorporating low purine alternatives, like low-fat dairy products, starchy carbohydrates, fruit, vegetables, eggs, nuts, and white meat? Or should you try one or two of the so-called magic fixes that are so often publicised?

This sort of dietary advice is actually outdated, inconsistent and built upon persistent misconceptions. It’s not a simple case of exclusion – but instead striking a workable balance.

So, if you do have a confirmed diagnosis or carry risk, here are some key principles that you can use as building blocks to sculpt your diet.

Cutting out purines completely doesn’t cure gout

Evidence shows that completely avoiding high purine foods doesn’t eliminate gout. In patients with a new diagnosis and those whose gout keeps flaring up, removing them from the equation doesn’t appear to act as a cure.

That’s because most purines and therefore urate come from cell turnover in the body – so cutting down purines in diet will not act as a cure.

Gout will often return, especially if it isn’t treated with medication. And many high-purine foods, or those that occupy a middle-ground – such as red meat, white fish like cod and haddock, crustacean shellfish, pulses, soy products and grains – are still healthy food. They don’t need to be entirely cut away – so don’t feel that you need to.

Purines are only part of the picture

While a diet high in purines may contribute to the development of gout, other risk factors often play a larger role. These include a genetic predisposition, obesity, alcohol, taking certain medications, kidney disease and metabolic disorders – and are much more likely to have caused the problem than diet alone.

Not all foods are equal, nor do they behave the same. Vegetables are generally classified as low-purine – but this isn’t always the case. Some can contain higher levels, especially asparagus, cauliflower, spinach and mushrooms.

What’s more, evidence suggests that while eating some high purine foods like meat and seafood increases risk, higher-purine vegetables do not. So it appears that not all foods behave in the same way.

Other non-purine foods can increase the risk

Some foods and drinks can increase the risk of gout in different ways. Take alcohol for instance. Spirits, wine and cider are typically lower in purines than beer and ale, but all alcohol should be considered a risk. This is because alcohol can increase urate levels,  and also has a diuretic effect – increasing the risk of dehydration, which can complicate the problem. Alcohol excess often worsens gout flares and the severity of symptoms, so official guidance recommends limiting intake. Sugary fizzy and energy drinks are also similar culprits.

“Magic fixes” aren’t supported by robust evidence

Certain foods and supplements, such as pomegranate, cherry juice and extracts, apple cider vinegar and celery seed have gained interest and are often promoted as natural gout cures. But the evidence for them is lacking. Whilst taking them doesn’t appear to be harmful, again they shouldn’t be relied upon as a means of reducing the risk or severity of gout flares, or as an alternative to medication. And while we’re at it…

Diet should not replace medication

In most cases, gout can be treated effectively in partnership with a GP. Taking the medication allopurinol daily can help reduce blood urate levels and reduce the risk of flares. And when a flare does occur, there are a variety of medications which can reduce both inflammation, and pain.

So, it’s crucial to see a GP if you notice the signs of inflammation – which are namely redness, swelling, heat and pain within a joint. In gout, the big toe is the most commonly affected site, but it can affect other larger joints, like the ankles, knees and wrists. You can also notice hard lumps called tophi, particularly on the ears, and around the elbows.

But whilst medical therapy is central to treatment, diet shouldn’t be dismissed – instead it should be used in tandem with medication, and modifications made practically to help reduce real risk factors.

So, what is the best and most practical way to rethink your diet?

Attention to purine content is important, but instead of cutting them completely and eliminating any joy you have in eating, aim for moderation.

Start by building a foundation of low purine foods, adding mid to high-purine foods in less frequent amounts (1-2 times a week) and in sensible portions – whilst also limiting sugars and alcohol. And listen to your body – if flares do become more frequent, it may be worthwhile cutting back on some higher-purine foods to see if it makes a difference.

Since obesity is a definite risk factor, construct a healthy diet plan with a good protein intake, balanced with a mixture of starchy and complex carbohydrates, and good fats – this can help support muscle mass, and reduce fat mass.

Exercise is also key – resistance training and cardiovascular exercise can support weight loss and joint health, but also the health of internal organs like the heart and kidneys, which we know can be put at risk by gout over both short and long periods of time.

Diet and lifestyle changes can help prevent gout and reduce the risk of flares. But, the key is balance: foods to enjoy in moderation, alongside those which are safer. Namely, act upon the real evidence and reshape your diet into something realistic, palatable and sustainable – without making each meal a joyless medical calculation.

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source https://www.bbcgoodfood.com/health/what-to-eat-if-you-have-gout