I. Recent studies
Strict low purine diets have limited effectiveness in lowering uric acid and little practical feasibility, making it difficult for patients to comply strictly.
A considerable number of epidemiological studies and short-term intervention studies. They have confirmed the traditional view that foods high in purines such as animal offal, beer and seafood are risk factors for gout, but also found that some foods with high purine content do not increase blood uric acid, such as purine-rich vegetables and soy products.
Some foods with low purine content are also harmful to gout, such as fruits and drinks rich in fructose.
2. Control of total purine
1. Controlling the total amount of purine in the diet is more important than restricting a certain food.
2. Control the daily dietary purine content <200mg.
3. Avoid intake of high purine foods (offal, shellfish, sardines) and reduce intake of moderate purine foods (red meat).
4. A lower standard low purine diet is not recommended
(1) Failure to reduce blood uric acid to below 6mg/dl
(2) Rich in carbohydrates, leading to insulin resistance and thus the development of metabolic syndrome
(3) Insufficient protein intake to meet the body’s daily nutritional needs
(4) Poor compliance of patients
Third, the impact of diet on gout
1.Traditional risk factors.
(1) offal, red meat, seafood, beer, spirits and diuretics
2. Newly discovered risk factors
(1) Fructose-rich or sweetened soft drinks, fruit juices, sugar-rich fruits
3.Potential protective factors.
(1) dairy products, soy products, vegetables, vitamin C
4. Neutral factors.
(1) Total protein intake, purine-rich vegetables
5.Juice, sugary drinks
(1) Sugary soft drinks can significantly increase blood uric acid, and it is more obvious than spirits and comparable to beer, but there is no correlation between unsweetened drinks and blood uric acid level.
(2) The total amount of fruit juice intake is positively correlated with the incidence of gout.
6.Main mechanism
(1) Fructose metabolism in the liver consumes large amounts of adenosine triphosphate increasing the raw material for purine metabolism.
(2) It can lead to insulin resistance, which indirectly leads to a decrease in the excretion of blood uric acid.
7.Fruit
(1) Most fresh fruits are alkaline, and fruits contain a lot of potassium and vitamin C. Thus, it seems that fruits should be a protective factor for gout.
(2) Fruits rich in fructose can increase the incidence of gout.
(3) Fructose can directly promote increased uric acid synthesis in the body.
(4) High consumption of such fruits increases insulin levels in the body, leading to insulin resistance, which indirectly reduces uric acid excretion, and this effect is more pronounced in patients with combined metabolic syndrome.
In 2008, Choi et al. published a prospective cohort study that included 46,393 healthy people over 12 years, suggesting that fructose-rich fruits (e.g., apples, oranges) were positively associated with an increased incidence of gout.
8. Fructose content of different fruits
(1) Patients with gout may increase their fruit intake appropriately, but attention should be paid to the type of fruit.
(2) Gout patients should avoid the intake of fruits with higher sugar content even if they are not combined with diabetes/metabolic syndrome.
-Common fruits with low sugar content.
plums, cucumber, watermelon, coconut water, grapes, strawberries, cherries
pineapple, peaches, plums, olives, etc.
-Fruits with a high fructose content.
Apples, figs, oranges, grapefruit, lychees, persimmons, cinnamon, bananas prunes, pomegranates, etc.
9.Alcohol
(1) Alcohol is an important dietary risk factor for gout, and the risk of gout development increases in a dose-dependent manner with the intake of alcohol.
(2) The effect of alcohol consumption on gout is also related to the type of alcohol
(3) Beer is most strongly associated with the development of gout, with the risk of gout for those consuming 12 ounces (approximately 355 ml) of beer per day being 1.49% of that for non-drinkers.
(4) Spirits may also increase the risk of gout
(5) Moderate consumption of red wine does not increase the incidence of gout.
(6) Low to moderate alcohol consumption is a protective factor against cardiovascular disease, especially in middle-aged men, the most common group with gout.