Eating with Gout

This post is about how to prepare foods for people living with food restrictions due to gout.

Our family has people living with gout and as a result, when they come to eat, we take care with what foods we make. While I am not a medical person, just a cook, here is what I know about cooking for people with gout. Honestly, it is a disease that can be managed in part by diet, but what foods to eat or avoid can be very complicated.

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Learn About Gout

Gout has been around for quite a while, so we know a fair amount about this disease. Since that time, it was generally thought of as a rich person’s disease, because they had a clear idea that rich food and alcoholic consumption (largely beer then) brought about painful bouts of the disease.

• Diet that avoids purines as much as possible
• Medication
• Avoid or mitigate known triggers (trauma, surgeries, etc.)

Also remember, although there is a lot of information in the web-wilds, most of us cook bloggers are not medical doctors, nutritionists, nor dietitians, so do not rely on any post of mine for medical advice. Please speak to medical professionals for advice on what best serves your medical needs. This post is just information on what I do to prepare food for my friends and family who have gout.

Gout is Excruciatingly Painful

Gout (aka hyperuricemia) is an arthritis type affliction that is caused by high levels of uric acid blood levels. Uric acid is created in our bodies as a chemical byproduct of breaking down purines in foods. If you are healthy, uric acid dissolves in blood, travels to the kidneys, and is expelled via urine. For people with gout, they create too much uric acid or cannot process and eliminate the acid well enough, and it collects in joints, causing inflammation, swelling, and extreme pain.

These “attacks” can be extremely sudden, paralyzingly painful, and can occur in toes, feet, legs, and lower extremities. While it can happen to anyone, mostly it effects men over the age of 30. Luckily, this disease can be managed, in part, with diet, and medication. Note, I am not saying it can be cured or prevented, or even managed by food alone (1). You need to work with your doctor to live a good, pain-free life with this disease.

Pseudo-Gout is not Gout

A personal note regarding pseudo-gout, or calcium pyrophosphate deposition disease (CPPD); I have this condition. Gout and pseudo-gout are both a type of crystalline arthritis that causes inflammation, swelling, and extreme pain in joints. Both are caused by sharp crystals that collect in the joints; uric acid crystals for gout, and calcium crystals for pseudo-gout. Pseudogout normally happens in 50+ year old women.

Unfortunately, pseudo-gout cannot be managed by diet, and can affect the hips, ankles, elbows, wrists, shoulders, and hands. It is awfully painful and can attack at any time for unknown reasons. I generally have this condition strike my knees, although it can hit me elsewhere.

Learn About Purines

Wikipedia writes that dietary causes account for about 12% of gout, and write that there are strong associations with flareups tied to the consumption of alcohol, sugar-sweet beverages, meat, and seafood. What those items have in common are purines.

Wikipedia has a chemical definition of purine that really is outside of my expertise. (When I took biology the science was not the Molecular + Cell Biology now being taught; it was more basic.)

From a cook‘s perspective, purine is in all foods (as far as I can tell). When I search “foods without purines”, the responses I get are lists for foods that are low in purines. What I also find is that there are lists published everywhere on the web indicating those foods low, medium, or high in purines. Obviously, gout sufferers need to eat low purine foods, as I believe eliminating purines totally from our diet is probably impossible.

High, Medium, Low Purines

Avoid These Foods

The Arthritis.org and Arthritis-Health provide guidance on foods. Their short list of high purine foods are:

• AVOID High Purine Foods
  • All alcoholic beverages (wine has less than beer)
  • Yeast: brewers yeast, beer, and yeast supplements
  • Sugary foods and beverages: sodas, fruit juices
  • Added sugars: high fructose corn syrup, honey, agave nectar
  • Certain fish, seafood and shellfish: anchovies, crabs, shrimp sardines, herring, mussels, codfish, scallops, trout, sardines and haddock 
  • Meats: bacon, turkey, veal, venison, pheasant, and organ meats like liver, kidneys, sweetbreads, and brain 
  • Meat gravies
  • Processed foods with high fructose corn syrup)

Moderate These Foods

Using other references like HealthLine, MedicineNet, and MedicalNewsToday, indicate that some of the “avoid” foods can be consumed provided the portion size is small. The person with gout will have to try and see if they can tolerate smaller amounts of these items.

• LIMIT Medium Purine Foods
• Eat only 1 serving/day only when gout is under control
  • Meats: 2-4 oz portions of poultry
  • Meat-based broths and soups
  • Fish: Fresh or canned salmon
  • Veggies: no more than 1C/day of asparagus, spinach, green peas, mushrooms, cauliflower
  • Beans + Legumes: Kidney beans, lentils, lima beans

Healthy Gout Diet

This diet is complicated, so no matter what I suggest, you need to read up on this diet and refer to your doctor, nutritionist, or dietitian for exact suggestions. After reading several experts on what can be eaten, here are the guidelines I use when cooking dinner for someone with gout.

• EAT Low Purine Foods
  • Whole Grains and starch: whole grain bread and pasta, brown or wild rice, and yams
  • Fruits: Fruits should be okay, especially cherries and citrus
  • Legumes: Should all be ok, including lentils, beans, soybeans and tofu
  • Veggies: Veggies, except the ones listed above should be okay, but some have more or less purines so check the lists
  • Veggie broth
  • Nuts + Seeds: All should be ok to consume, including peanut butter
  • Low to No-Fat Dairy or some plant mlks
  • Eggs
  • Vitamin C: grapefruit, oranges, pineapples, strawberries, bell peppers, tomatoes, avocados
  • Herbs + Spices: All should be ok to consume
  • Plant-based oils: Olive, flax, avocado
  • Beverages: Coffee, tea, water

Helpful Ingredients

While there are not many foods to list here, there are some ingredients that research indicates may help.

• Vit C may help prevent bouts (2)
• Cherries
• Low fat milk products (3)

Menu Ideas

Check Dietary Needs First

Whenever I cook for people, I always check in with them to make sure I know what their dietary needs are. I follow that by online research, to find out what they can and cannot eat based on their condition. Using that research, I come up with a menu, and go over the details with them to make sure they can eat the food I am going to cook. It is only then, I start to make sure I have all the ingredients.

Holiday Feast Ideas

Since we mostly invite people over during holiday dinners, here is what I consider for a good holiday feast.

Breakfast: Probably oatmeal porridge with a bit of low-fat Greek yogurt, and dried cranberries or cherries.

Lunch: Whole grain bread or wrap with mustard-egg mixture for a sandwich, and side of quinoa + veggie (or quinoa + fruit) salad with a vinegar + oil dressing.

Main Holiday Dinner: You can cook poultry (chicken or turkey) but cut and weigh out 2-3oz portions for the person with gout. You can also make an herby salmon dish (herbs + lemon are great), but again, weigh out 2-3oz portions. Better would be a vegan or tofu version of a main dish. For example, perhaps making a vegan version of “Cottage Pie”.

• Where one serving has: ~3 small diced dark colored mushrooms (limit use to ~3oz), French lentils, mashed cauliflower (using olive oil with limited 1-3T butter to smooth out), diced carrot, 3 oz peas (limited), 1 minced garlic, thyme, vegan Worcestershire sauce, and a good veggie broth.
• Gravy: Avoid any meat-based gravy, but veggie gravies could be made.
• Stuffing: Skip bread or cornbread stuffing and select to make a pasta-based “stuffing” with similar herbs and spices.
• Cranberry Sauce: Make your own so you can reduce the sugar, or make a version using sour cherries (which reportedly helps gout). Some write that Stevia is okay to use with gout, so sweeten this sauce with stevia as the sweetener. Taste often as you make, for Stevia is very sweet tasting and it would be easy to over do it.
• Side Dish: Use my citrus, lentil, twice stuffed sweet potato dish topped with pecans and no honey.
• Fruit Salad: This would be a great dessert to have with a nice cup of green tea.

My Story

I hope this gives you a broad idea of what you can cook for a person who has gout. My philosophy with food I make for others is that I want to nourish you, not cause you harm. So making a menu around someone’s diet needs does not have to “ruin” your dinner plans. Just be creative and work with the set of foods they can eat. Often the dinner can turn up exciting and unexpected dishes.

• One thing I do is provide some information on making any recipe I provide, with information on how to make it with limited purines.

What I do not do is make a special dinner for one person and everyone else gets something else. For example, if I make a stuffing for a gluten free person, it means I make two stuffings, one from cornbread and one from sourdough bread, but each have different ingredients so it is just another dish on the table for people to try.

I do not want to go out of my way to make something special in that it often makes people uncomfortable, as it calls attention to their diet. I would rather introduce the dishes and people can take from what they want without a fuss.

So for a gout-friendly dinner I look at the list of low purine food and try to build a menu around those ingredients. Additionally, I look at any research that indicates any food that may actually help, and try to use those ingredients as well.

— Patty

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