Question:

Where can I find a list of purine-free, low purine foods and the approximate amount of purines in these foods?

Answer:

Gout, one of the oldest diseases in recorded medical history, is an inherited disorder of purine metabolism in which abnormal levels of uric acid/urate accumulate in the blood. This leads to uric acid crystals being deposited in the joints and surrounding tissues and subsequent inflammation and pain. Uric acid is derived from the metabolism of purines. About 15% of urate formed each day comes from our diets. The remainder our own bodies produce.

Traditionally gout has been treated with a low-purine diet. Fortunately, it is not necessary, because drugs are more effective in controlling the manifestations of the disease. Diet therapy, however, may be useful for the management of gout in some patients.

Even though limiting dietary purines is unlikely to significantly decrease the uric acid pool, individuals with gout are encouraged to limit or avoid foods high in purines, to reduce metabolic stress and potentially reduce medication (especially during an attack, to avoid adding extra purines to the existing high uric acid load).

Fluids are encouraged, as this will assist with the excretion of uric acid and minimise the possibilities of calculi formation.

Obesity is associated with gout and studies have shown that weight loss causes a lowering of the uric acid. Therefore actions to achieve and maintain ideal body weight are recommended.

What is a low-purine diet?

A typical diet contains from 600-1 000mg of purines daily. Traditionally in cases of severe or advanced gout, the purine content of the daily diet is restricted to approximately 100-150mg.

Because urate excretion tends to be reduced by fats and enhanced by carbohydrates, the diet should be relatively high in carbohydrates, moderate in protein, and low in fat — all a recipe for a healthy diet.

Alcohol is known to increase uric acid production and therefore can precipitate an acute attack of gout. Ideally, it is wise not to consume alcohol, but moderate, infrequent consumption may not be harmful, depending on the individual’s condition.

High purine foods (100-1 000mg purine/100g food):

  • anchovies,
  • gravies
  • herring
  • kidney
  • mackerel
  • meat extracts
  • mincemeat
  • mussels
  • sardines
  • yeast

    Moderate purine foods (9-100mg purine/100g food):

  • Fish
  • Poultry
  • Meat
  • Shellfish
  • Vegetables including: asparagus, dried beans, lentils, mushrooms, dried peas, and spinach.

    Most other foods are known to have negligible purine content.

    Summary of nutritional care for Gout:

  • Moderation of foods high in purines
  • Moderate protein intake with large proportion of protein coming from low-fat dairy products
  • Liberal carbohydrate intake (50-55% of total daily calories)
  • Restrict fat to about 30% or less of total daily calories
  • Maintenance of, or gradual reduction to, ideal body weight
  • Restriction or elimination of alcohol
  • Plenty of fluids to assist urate excretion

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