Nutritonal Advice for David Gray

Dietary Advice for Gout in Kidney Disease.

Gout causes painful and swollen or inflamed joints when excess uric acid (a normal waste product from body processes) is deposited as needle-like crystals in the joints. This can be due to an inherent overproduction of uric acid or due to reduced excretion by the kidneys. Drug treatment is most effective in treating acute episodes of gout, and in controlling the condition in the longer-term. However, there are some dietary factors that can help to reduce the likelihood of experiencing an attack of gout.

 Alcohol

Drinking alcohol increases the risk of gout attacks, because it stimulates the production of uric acid in the body. Beer can often be more problematic than spirits or wine. A reduction in alcohol consumption is important, particularly for those drinking more than the recommended healthy intake of 21 units per week for men or 14 units per week for women (1 unit = ½ pint 3-4% beer/lager/cider, 125ml 11% wine, 25ml spirits, or 50ml sherry/fortified wine).

 Body weight

If you are overweight, gradual weight loss to achieve a healthy body weight will help to reduce the likelihood of gout. However, very low calorie diets should be avoided, since rapid weight loss can trigger a gout attack (and they often do not achieve sustainable weight loss). Healthy eating principles and regular physical activity should be used. Try choosing low fat varieties of dairy products, lean meats, and use spreads and oils sparingly; avoid high fat/sugary snacks; and aiming for 5 fruits or vegetable portions daily (from within your potassium allowance, if you follow a low potassium diet). If you are nearing dialysis, and have a reduced appetite, it may not be an appropriate time to lose weight. Ask your dietitian for advice, if you are unsure.

 Fluid intake

Drinking adequately helps to prevent uric acid crystals forming in the kidney. Aim to drinks at least 2 litres daily (unless you have been advised to follow a fluid allowance/restriction by your doctor).

 High purine foods

Uric acid is produced from purines, which are found in foods. Although the purines from diet have only a small effect on the uric acid production in the body, regular and excessive intake of high purine foods should be avoided. Protein foods (e.g. meat, fish, cheese, eggs and milk) are often rich in purines, therefore by avoiding excessive portion sizes of these foods, which can be beneficial for advancing kidney disease, you are already helping to limit you intake of purines. For example, including 50g (2oz) of meat, fish, cheese or eggs in a sandwich as your snack meal, and 100g (4oz) at your main meal would be a good portion guide. Your dietitian can advise you further on how to achieve this appropriately. The foods listed below are those highest in purines, and therefore best avoided:

Meat sourcesFish sourcesOther sources

LiverAnchoviesYeast extract (e.g. marmite)

HeartSardinesBeer

BrainMackerelBeans, peas & lentils

SweetbreadsHerringAsparagus

Meat extracts (e.g. Oxo)Whitebait/spratsCauliflower

Fish roeSpinach

ScallopsMushrooms

MusselsBran

Eel

Crab

Shrimps

 Nutritional supplements

Some research suggests that Vitamin C may reduce the risk of gout, although this is only with doses higher than usually recommended, and there is no proven benefit in people with kidney disease. Since oily fish are cardio-protective, but high in purines, it would be appropriate to take Omega-3 supplements (without vitamin A or D content) should you so wish.

January 2012 – Refs: Manual of Dietetic Practice 4th Ed (2007) & UK gout Society