High uric acid is becoming the “fourth high” outside of the “three highs,” causing more and more people to suffer from the pain of gout. According to relevant statistics, there are already over 80 million gout patients in China, with an annual growth rate of 9.7%. As the “reserve force” of gout patients, the number of patients with hyperuricemia has reached 170 million.
I am also one of the over 80 million people.
The day I was diagnosed with gout at the hospital, I felt wronged because I usually pay attention to health, have regular meals, like to eat noodles, rarely indulge in excessive eating or drinking, drink little beer, and consume even less seafood. How did I get gout?
After hearing my situation, the doctor was also puzzled at first. Upon closer questioning, it turned out that the soup I used for noodles was the problem—I like to use fish broth, chicken broth, and beef broth for the soup base when eating noodles. While I ate less meat when stewing, I drank more soup.
The doctor said, “Purines dissolve in water, and they are all in the soup. A bowl of meat soup noodles contains about 400 milligrams of purines. Even though you seem to have eaten little meat, eating two bowls of meat soup noodles, drinking several bowls of soup, you have already exceeded the body’s daily capacity of processing 600 to 1000 milligrams of purines. Of course, uric acid is high!”
After in-depth communication with the doctor, I realized that I was confused about eating high-purine foods, and there were many foods that I didn’t realize I should eat less of. The doctor told me that my situation was not unique.
How should people with high uric acid eat? The following are practical tips and common misconceptions, hoping everyone can patiently read through.
How to determine if a food is high in purines?
It is common knowledge that gout patients should eat fewer high-purine foods. However, which foods are high in purines and which are low? I have summarized 4 distinguishing techniques for everyone.
1. Foods with dense cellular tissue have high purine content; conversely, the content is lower.
What is purine?
Purine is a key substance in synthesizing uric acid. If there are issues with the body’s purine metabolism, blood uric acid levels will rise, leading to gout.
From a food perspective, purine is an essential component of genetic material in the cell nucleus. Therefore, foods with more cells have higher purine content, such as animal organs (liver, kidney, stomach, etc.) and some aquatic products (fish roe, small shrimp).
Food with fewer cells has lower purine content, such as an egg, which looks large but is only one cell with a single set of genetic material, generally containing no more than 5 milligrams of purines (this is also the reason the doctor recommended that I switch to eating tomato egg noodles). For example, although milk seems to have many cells, it is actually secreted by the cow’s mammary gland cells, almost lacking cellular structures, nuclei, and thus having very few purines. The purine content of 100 milliliters of milk is approximately 1.4 milligrams, and gout patients can safely consume it.
2. Broths with meat are high in purines because purines dissolve in water.
Once animal products are boiled into a thick soup, purines will dissolve from the tissues into the water. Thus, popular meat soups, fish soups, seafood soups, hotpot soups, and mutton shabu-shabu soups all have very high purine content.
This is why people in Guangdong who like to eat seafood and drink soup have very severe gout flare-ups. In the “2017 China Gout Status Report White Paper,” the number of gout patients in Guangdong Province ranked first nationwide.
If you are a gout patient who enjoys drinking soup, tomato and egg soup and seaweed egg flower soup have very low purine content and are relatively safe choices.
3. Legumes and fungi are high in purines.
Each bean is a cell with complete genetic information. Therefore, common legumes we eat, such as soybeans, mung beans, black beans, kidney beans, adzuki beans, and bean sprouts, all have relatively high purine content.
Common foods we consume, like soy milk, mixed grain porridge (containing brown rice, Job’s tears, oats, etc., and legumes), and eight-treasure porridge (mainly made with glutinous rice, sticky rice, or black glutinous rice as the main ingredient, with additional green beans, adzuki beans, peanuts, etc.) are all high-purine foods that those with high uric acid should eat less of.
Mushrooms we commonly eat (such as mushrooms) are eukaryotes that carry DNA genetic material, which results in higher purine content. The purine content of black fungus is 166mg/100g, while that of shiitake mushrooms is even higher at 214mg/100g.
4. Foods with high water content have lower purine content.
This is easy to understand because higher water content means lower purine content per unit area of food. Following this logic, we find that the purine content in vegetables and fruits is relatively low.
With this summary, our eating guidelines become clear: animal offal, meat soups, legumes, and fungi are high in purines and should be placed on the blacklist, while eggs, dairy products, fruits, and vegetables are low in purines and can be consumed in moderation.
Now, some may say, “I rarely eat the high-purine foods mentioned above, so why do I still get gout?” This brings us back to the title—
The culprit of gout is not just high-purine foods!
Only about 20% of the uric acid in the body is synthesized from purines in the food consumed. Approximately 80% of uric acid is synthesized from the body’s own purine metabolism. Even if we eat nothing all day, the body will still produce a significant amount of uric acid. If there are issues with the body’s uric acid metabolism, it can still lead to high levels of uric acid.
In other words, if the intake is fine but the excretion is the issue, then the exit is blocked!
Let’s give two examples, which are common misconceptions you need to be aware of—why does beer contain no purines still cause gout?
Many gout patients know that beer is high in purines, so they opt to drink purine-free white wine instead.
However, many patients find that excessive consumption of white wine can still trigger gout. Why is this so?
Simply put, our bodies have a mechanism for uric acid metabolism, and when alcohol enters the body, it affects this mechanism. Ethanol in liquor (the main constituent of alcohol) is converted into acetaldehyde in the body, and an excess of acetaldehyde increases the level of lactic acid in the body.
See, lactic acid and uric acid are somewhat similar, right?
While they are not the same substance, both need to be excreted through the body’s acid excretion pathway (renal tubules). If there is an excess of lactic acid, the excretion of uric acid is also affected. This is akin to a toll booth on the highway where an influx of trucks would impede the passage of cars, causing traffic congestion.
This explains why beer consumption is prohibited for gout patients. Because beer contains a significant amount of purines. Drinking excessively not only increases the amount of uric acid in the body but also makes it difficult to excrete, leading to a rapid rise in blood uric acid levels.
Be cautious with the drinking snacks. Common side dishes often consumed with alcohol include many high-purine foods such as lamb skewers, crayfish, peanuts, boiled edamame, and more. Consuming high-purine foods alongside alcohol can easily trigger gout. Excessive consumption of sweets can also lead to gout.
Sodas, fruit juices, milk tea, ice cream, candies—these seemingly “innocent” foods, how can they raise uric acid?
This is related to the fructose (high-fructose corn syrup) in sweet foods.
It’s not sugar from fruits but an additive commonly used in the food industry.
Consuming excessive fructose can lead to a significant accumulation of sugar in the body, causing a spike in blood sugar levels and disrupting purine metabolism. When there are issues with purine metabolism, more uric acid is produced, leading to elevated blood uric acid levels.
Therefore, many obese individuals suffer from gout. In the book “You Are What You Eat,” nutritionist Xia Meng shared a case.
She had a patient who was a 20-year-old college student.
This patient was 178cm tall but weighed 220 pounds, with very high uric acid levels that were rapidly rising. Through communication, Xia Meng discovered that he had a sweet tooth since childhood, enjoying sweet bread, pastries, and particularly, drinking soda. Back in high school, with his parents’ supervision, he could control his diet to some extent. However, after starting college, he would eat cake as a meal, having soda as water, and his weight increased by 50 pounds in a year, accompanied by gout. These sweet foods contain no purines, but the high fructose content affected kidney metabolism, becoming the root cause of his gout.
When he was first diagnosed with gout, he took uric acid-lowering medication, and his uric acid levels started to decrease, with the pain disappearing. His family researched some health knowledge, advising him to eat less offal, seafood, and meat and abstain from alcohol. He followed these guidelines but continued to consume sweets.
During a follow-up visit, not only were his uric acid levels still high, but his creatinine levels had also increased, indicating that his kidney function had been affected. His family was deeply concerned.
After communicating with Dr. Xia Meng, he started controlling his intake of sweets, and his uric acid levels gradually decreased, with the gout also easing up. Therefore, if a gout patient is obese, they should try to avoid sweets, maintain a normal weight, which helps control blood uric acid levels.
Losing weight but having high uric acid
Losing weight may lead to gout.
I know such cases around me.
I have a friend who always talks about losing weight but struggles to control her appetite. She eats less for a few meals but then can’t resist overeating in one meal, feeling full. After eating to capacity, she feels guilty and then starves herself for several meals. This cycle continues until one day, her big toe starts to ache.
During a hospital visit, the doctor told her that such erratic weight loss would not be effective and, in fact, would increase uric acid levels due to frequent cycles of overeating and fasting, causing gout.
As previously explained, the body’s uric acid metabolism has a fixed pathway with limited capacity.
Weight cycling of overeating and fasting affects this pathway.
When a person is hungry, due to the extended fasting period, liver glycogen is released to provide energy for bodily functions. If the released liver glycogen becomes nearly depleted and no food is consumed, gluconeogenesis occurs. At this point, the body starts breaking down fats and proteins, producing a large amount of ketones and lactate, substances that need to be excreted from the kidneys. This again leads to a congestion in uric acid excretion pathway. Gout—does this mean no more meat?
You can eat it, in moderation.
Although fat is essential nutrition for the body, the demand for fat in gout patients is not significantly different from that of a normal individual. It is advisable to control fat intake to around 30% of total daily caloric intake.
It’s important to note that foods containing trans fats, such as cakes, cookies, refined bread, potato chips, candies, margarine, etc., easily trigger gout and should be limited.
Here’s a tip for gout patients who want to eat meat. Since purines dissolve in water, before frying meat, you can first boil it in the pot to reduce the purine content. If you’re still unsure, you can slice the meat, then blanch it in water. Another reminder is to eat meat in moderation, but try to avoid meat broth.
In conclusion: Every system in our body is interconnected. When one aspect has a shortfall, other aspects will be affected. Therefore, we should not only restrict high-purine diets but also limit alcohol consumption, reduce sweet intake, and pay attention to maintaining a balanced and regular diet. This way, we can ensure a smooth exit for uric acid, preventing the buildup and controlling the uric acid levels effectively.
