Imagine waking up in the middle of the night with a searing pain in the joint of your big toe. A pain that burns so bright that even a lightly draped bed-sheet is intolerable. Walking is nearly unbearable and wearing shoes? A joke. If this happens, you may be suffering from gout, a painful type of acute arthritis that can come on very quickly. Attacks of gout can last days or weeks, can come and go over time, not recurring for months or years–or showing up far more frequently.
Even though gout usually starts with the big toe, it can show up elsewhere in your feet, ankles and other joints of the extremities. It is the result of the buildup of uric acid, which happens as the body breaks down purines, which are found in all of our cells as well as in most all foods we eat. Uric acid acts as an antioxidant in the body, protecting our blood vessels and preventing damage caused by oxidative stress. Like many things–too much of a good thing can turn the tables and become a detriment. Elevated levels of uric acid are associated with flare ups of gout, so it would make sense that finding ways to keep this in check could help to minimize or eliminate this painful situation.
Back in 1997, results were published from a famous clinical trial, conducted to determine if a specific diet could impact blood pressure and cholesterol levels. For three months, hundreds of participants either ate a typical American diet–or the DASH diet (Dietary Approaches to Stop Hypertension). The DASH diet focuses on whole grains, fruits, vegetables, low fat dairy and reduction of red meat, simple carbohydrates, saturated fat, sweets and sodium. The results were compelling in terms of favoring the DASH diet and it has been widely accepted as a means of positively impacting hypertension and cholesterol. We think increased vegetables is the real key.
Recently, a group of medical professionals from Johns Hopkins Medicine took a look at the study results through a new lens. Additional data captured from the blood samples taken during the study included uric acid levels. Over the course of the three months, participants who ate the DASH way experienced a reduction in their levels of uric acid. The most notable decreases were seen in the people whose uric acid levels were highest to begin with. These decreases rivaled what could be achieved using medications prescribed for gout.
Why does diet have such a big impact on the levels of uric acid in our bodies? It may have a lot to do with the dietary purines that we take in. This conversation gets a little too scientific for most of us very quickly, but here is a high-level overview. There are four purine bases, two of which are adenine and guanine, major components of DNA. The other two are hypoxanthine and xanthine. All foods contain varying ratios of each. They are not created equally in terms of their ability to impact the increase of uric acid levels in the body. Adenine, guanine, and xanthine seem to have little effect as long as overall purine levels are relatively low. When a higher ratio of hypoxanthine is part of the equation, it is associated with higher reported levels of uric acid and higher reported instances of gout flare-ups.
Let’s circle back to the food. The DASH diet calls for a reduction of red meat, while increasing vegetables, fruits, whole grains and low-fat dairy. When you examine the levels and types of purines in each of these categories, it makes sense why this might really have an impact on how much uric acid is present in the body as a result of what we’re eating. Animal products, most fish, and shellfish are very high in purines, and the ratio of hypoxanthine to the other purines is quite high in most cases. Conversely, vegetables, dairy, eggs, grains, and legumes are all very low in purines.
What does all this really mean for us, particularly if gout is something we’ve either experienced or are concerned about? There is enough correlation between high levels of uric acid in the body and gout flare-ups to warrant taking a look at the foods we’re eating to determine if some rebalancing should be done. A renewed focus on fruits and vegetables, whole grains and low fat dairy are a great place to start. Moderating animal protein (red meat in particular) is another big step. This is a great reminder that on so many levels, feeling better can be all about the food.
Schedule an appointment with one of our nutritionists today to learn how certain foods can help you manage flare-ups.
Written by Samantha R., Bastyr University student intern
 Blood pressure diet improves gout blood marker: Effect on uric acid levels nearly matches impact of gout medicines. ScienceDaily. 2016. Available at: https://www.sciencedaily.com/releases/2016/08/160815064759.htm. Accessed September 7, 2016.
 Kaneko K, Aoyagi Y, Fukuuchi T, Inazawa K, Yamaoka N. Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia. Biol Pharm Bull. 2014;37(5):709-721. doi:10.1248/bpb.b13-00967.