A purine restricted diet is a diet intended to decrease your overall daily purine intake. Purines are found in foods that we eat as well as in our bodies and are broken down into uric acid. A buildup of uric acid in the joints and tissues of the body can lead to medical problems such as gout. By following a diet low in foods containing purine, you can work to decrease the amount of uric acid that accumulates in your body, which can then improve or prevent gout-like symptoms.
Background
Purines are found in all living cells. They help make up things like DNA and play an important role in the body. When cells die, purines are broken down into uric acid. Most uric acid dissolves in blood and eventually passes out of the body in your urine. However, if your body makes too much uric acid or for some reason can't get rid of it, the excess acid can create crystals that may settle in your joints and cause pain. Purine intake and uric acid accumulation can be treated in multiple ways, including medication and dietary management. By controlling the amount of purine containing foods you consume, you can control, at most, about a third of the uric acid levels in your blood.
Purpose
The purpose of a purine restricted diet is to decrease the amount of purines you consume, which can lead to less uric acid production. In some cases the body may have problems getting rid of uric acid due to problems such as kidney failure, dehydration, diuretics and ethanol intake. Watching your purine intake will not solve the problem, but it can help to control the pain or reduce the severity of symptoms.
Dietary Guidelines
Purines from food intake contributes up to a third of all uric acid levels in the body. A diet higher in carbohydrate, lower in fat/cholesterol, and moderate in protein is recommended. Carbohydrates have been shown to help get rid of excess uric acid, whereas fats tend to act more like uric acid magnets. It is important to limit or avoid foods known to be high in purines as well to decrease the amount of uric acid your body makes. In cases of severe gout, daily purine intake can be limited to 100 to 150 mg. Consume adequate fluids to help flush excess uric acid from the body. Avoid high-protein diets because meats can contain moderate to high amounts of purines. Tofu, nuts and eggs can be used as alternative protein sources.
Foods to Avoid
Some of the following foods can contain anywhere from 100 to 1,000 g of purines and should be avoided whenever possible: Anchovies, bouillon, brains, broth, consomme, goose, gravy, heart, herring, kidney, mackerel, meat extracts, mincemeat, mussels, partridge, roe, sardines, scallops, sweetbreads and yeast.
Organ meats, red meats and fatty fish also contain high amounts of purine and should be avoided.
Alcohol can interfere with uric acid removal and cause an increase in uric acid production. It should be avoided as well.
Foods to Limit
The following foods contain anywhere from 9 to 100 g of purines and can be eaten more often than those on the high list: Meats, fish, and shellfish not on the high list, asparagus, dried beans, lentils, mushrooms, dried peas, spinach.
One to two servings of these foods are generally permitted daily in a low purine diet.
Aside from the above mentioned foods, most foods contain very low amounts of purines and can be eaten daily.
Results and Risks
Following a purine restricted diet can help to decrease your uric acid production. It will not cure diseases such as gout nor will it reduce your uric acid levels to the point where medication isn't needed. A purine restricted diet can be used to help with flare-ups and pain associated with gout and other purine metabolism disorders. There are really no risks to trying a restricted purine diet as long as you make sure to consume a balanced diet by finding alternative protein sources, drinking enough fluids and watching fat intake. By consuming more complex carbohydrates, low fat dairy, and fewer high fat foods you can also help to improve your overall health and promote a healthy weight, which will also improve gout symptoms. As with all diets, consult a dietitian before making any drastic diet changes.
References
- "Krause's Food, Nutrition, & Diet Therapy 11th ed."; L. Kathleen Mahan and Sylvia Escott-Stump; 2004
- "Modern Nutrition in Health and Disease 10th ed."; Maurice E. Shils, Moshe Shike, A. Catharine Ross, Benjamin Caballero, Robert J. Cousins; 2006
- "Bulletin of the NYU Hospital for Joint Diseases"; M.H. Pillinger, R.T. Keenan; 2008
- "US Pharmacist"; The Diagnosis and Treatment of Gout; Robert G. Smith, DPM, MSc, RPh, CPed; 2009
- "Annals of Internal Medicine"; Pathogenesis of Gout; Hyon K. Choi, MD, DrPH, David B. Mount, MD, Anthony M. Reginato, MD, PhD; 2005
