Diet taboos for gout

There are only three core dietary taboos for gout patients - strict restrictions on high-purine animal foods, strict control of all types of drinks with added fructose, and avoidance of any alcoholic drinks. The rest of the so-called "taboo requirements" are mostly individual adjustments, and there is no universal "definitely not to eat" statement.

Don’t believe it. I just met a 26-year-old young man in the outpatient clinic last week. He had his first gout attack and was throbbing in pain. He said that he neither ate seafood nor drank beer. How could he be infected? After questioning for a long time, he said that it was hot the day before, so he gave me three bottles of iced black tea to cool down, and two pounds of braised duck heads. You see, the two pitfalls are fructose and high-purine braised food. Many people have no idea that the risk of sweet drinks is higher than a meal of ordinary seafood.

When it comes to high-purine foods, there is no need to blacklist all meat dishes. The only ones that are really high-risk are: animal offal (liver, kidneys, brains), shelled seafood (oysters, scallops, shrimps), thick broth/hot pot soup/old hot soup that has been simmered for several hours. The purine content of these can easily reach hundreds of milligrams per 100 grams. A single bite during the attack may cause you to be unable to get out of bed, and it is best not to touch it during the stable period. As for the commonly eaten poultry meat, such as pork, beef, sheep, and chicken, the purine level is at a medium level. After blanching to remove most of the purine, it is perfectly fine to eat two taels per meal. There is really no need to chew on cabbage leaves every day to starve yourself. I met a patient before who was newly diagnosed with gout and did not even dare to touch eggs and milk. He lost 12 pounds in three months, but his uric acid rose from 580 to 620. The ketones produced by starvation will compete with the excretion channels of uric acid, which will hinder his progress.

As for the "you cannot eat high-purine vegetables" that has been circulated for many years, the academic community has not yet reached a unified conclusion. Traditional nutrition believes that the metabolic rate of plant purines is different from that of animal purines. Even spinach, asparagus, and beans, which are high in purine vegetables, will not significantly increase uric acid. The guidelines of the Chinese Nutrition Society also clearly state that gout patients can eat soy products normally. ； However, some clinicians will recommend eating as little as possible during an attack. After all, there are a few patients who will feel uncomfortable after eating. In this case, there is no need to stick to the guidelines. If you are fine with it, eat normally. If you feel uncomfortable, eat less. Individual differences are huge.

Another hidden pitfall is fructose. Many people think that it’s okay to not eat sweet foods. In fact, this is not the case: even if the commercially available milk tea, carbonated drinks, and bottled juices are not very sweet, the added fructose syrup will generate a large amount of uric acid during the metabolic process. Even freshly squeezed juices that you think are healthy are highly concentrated in sugar after the dietary fiber is removed. Drinking one cup is equivalent to eating the sugar of several fruits, and the risk is not low. Nowadays, people often ask whether sugar substitutes can be eaten. Current research conclusions are inconsistent: some studies believe that a small amount of sugar substitutes will not affect uric acid levels, while other follow-up studies have found that long-term consumption of large amounts of sugar substitutes will interfere with metabolism and increase the risk of gout. If you really want to drink something sweet, it is okay to drink a cup of sugar-free sparkling water to relieve cravings once in a while. Just don't drink it as water.

As for the issue of alcohol, the academic community’s understanding has actually been updated several times. A few years ago, it was said that drinking a small amount of red wine would not affect uric acid and could even soften blood vessels. However, the latest rheumatology guidelines in 2024 have clearly recommended that gout patients avoid all types of alcohol intake - whether it is beer, white wine or red wine, alcohol will affect uric acid excretion, but the risk is different. Of course, we have indeed encountered many old patients in clinical practice. After drinking a small glass of red wine every day for more than ten years, their uric acid has been very stable. There is no need to force quitting. Their body's reaction is more realistic than the guideline standard.

To be honest, there is really no need to regard the gout diet as a scourge, and there is no need to calculate the purine table every day. Keep the three core red lines, and slowly figure out the laws of your own body for the rest: If others eat crabs that are fine and you feel pain after eating them, then you won’t eat them in the future. ； If you don’t have any reaction to the soy milk that others say you shouldn’t touch, then it’s not a big deal if you drink one cup every day. After all, you have to live your life, and you can't spend the rest of your life avoiding delicious food just to avoid gout, right?