Tofu, or soy bean curd, has long been a popular food in China. And with the growing popularity of plant-based vegetarian and vegan diets, it's showing up more often on western menus too. However there's been some confusion over whether tofu is good or bad for people with gout.
Historically, some health care professionals have advised gout-prone patients to minimize consumption of tofu and soy. A 2011 study published in the Asia Pacific Journal of Clinical Nutrition reflects these older attitudes toward tofu and gout.
The research surveyed opinions of Asian dietitians and doctors, and found that nearly half (48 percent) of these health care professionals thought soy foods were likely to cause gout. More recently, expert opinion suggests tofu consumption isn't a problem for people with gout at all and may even be helpful.
The Gout-Diet Link
The Arthritis Foundation explains that gout is a form of inflammatory arthritis caused by high levels of uric acid in the blood. The excess uric acid can form needle-like crystals in joints — typically in the big toe, ankle or knee — causing sudden, severe episodes of pain, tenderness, redness and swelling. Dietary components called purines increase uric acid, increasing the chance of you falling victim to gout.
The Mayo Clinic says purine-rich foods that people on a gout diet might need to avoid or go easy on include organ meats such as liver, kidney and sweetbreads, red meat and some types of seafood, such as anchovies, shellfish, sardines and tuna. (They add that the overall health benefits of eating fish will usually outweigh the risks for people with gout.)
Beer and liquor, like gin, vodka, whiskey and rum (but not wine) also increase gout risk, as does consuming too many sugary foods and beverages, such as sweetened cereals, bakery goods and candies, sodas and fruit juices.
A Tofu-Gout Connection?
The consensus from experts nowadays is that soy bean curd (tofu), soy milk and textured vegetable protein are perfectly fine for people with gout to consume. A February 2015 review in the European Journal of Nutrition found that soy products did not increase uric acid levels in Chinese postmenopausal women at risk of high blood pressure or diabetes.
In fact Northwest Kidney Centers specifically recommend consuming soy bean curd (tofu) and other nonmeat protein sources like nuts, beans, lentils and dairy to help manage gout. They say tofu is good as it is high in protein and low in purines, but also suggest people with gout try other soy foods like soy nuts, soy protein shakes, soy milk or edamame (steamed soybeans still in the pod).
Not every soya product is low in purines. A study in a 2014 issue of Japan's Biological and Pharmaceutical Bulletin reported on the purine content of many foods and categorized natto — made from fermented soya beans — as having a moderate purine content. So gout-prone people may need to take more care with this particular product, and also with tempeh, which is another fermented soya product.
Taho, a dessert of Indonesian origin, is made with low-purine, gout-friendly silken (undrained and unpressed) tofu. The other ingredients are tapioca pearls and — not so healthy — brown sugar syrup. Like all sugary desserts, taho should only eaten as an occasional treat, whether you have gout or not.
Soy Sauce in Gout Diet
The 2014 study in the Biological and Pharmaceutical Bulletin also reported on the purine content of soy sauce as well as two other soy-based seasonings, namely Japanese miso and umami broth.
The researchers didn't find high levels of purines in these soy seasonings, but they did find that one specific purine, called hypoxanthine, made up more than half the total amount of purines in these foods (i.e., the proportion of this purine was unusually high). This could be a theoretical concern for people trying to manage their gout symptoms as hypoxanthine is the purine thought to be most strongly linked with elevated uric acid level, and therefore gout risk.
Fortunately though, soy seasonings only tend to be used in insignificant quantities in cooking, so the gout risk is small. Most people with gout using soy sauce as a flavoring in normal amounts do not need to be concerned about its effect on the condition.
Are Vegetables Bad for Gout?
Vegetables bad for gout are few and far between, but some — in particular mushrooms, asparagus and spinach — do contain quite high levels of purines, and doctors once advised people with gout against consuming these types. However, the Arthritis Foundation says research shows no correlation between the intake of these vegetables and gout risk.
It may be that other beneficial compounds in higher purine vegetables may offset the effects of their purine content, which is much lower than in meats any way.
The bottom line? There aren't really any fruit or vegetables bad for gout. You can, and should, enjoy a wide variety of veggies and fruit on a gout diet.
As well as generally eating more fruits, vegetables and nonmeat protein sources like tofu, there are some specific foods and dietary measures that could help in a gout diet:
- Cherries: The Arthritis Foundation says the evidence for the benefits of cherries for gout is small but growing, with all forms, from fresh cherries to juice and pills, seemingly helpful. The benefit may come from the anthocyanin pigments, with antioxidant and anti-inflammatory properties. Anthocyanins are found in all red and purple fruits and berries, but cherries, especially tart ones, contain particularly high levels.
- Coffee: The Mayo Clinic says drinking coffee in moderation might make you less likely to have a gout attack. But it may not be the right thing to do if you have other medical conditions, so you should talk to your doctor about how much coffee is fine for you to have.
Vitamin C: The Mayo Clinic also recommends that if you get gout regularly, you should talk to your doctor about whether a 500 milligram
vitamin C supplement might work for you. The vitamin can help lower the high uric acid levels that lead to gout.
- Dairy: Consuming low purine, high protein dairy products like milk and yogurt could be helpful a June 2012 study in Annals of the Rheumatic Diseases suggests. In the study, people with recurrent gout consumed lactose powder, skim milk powder or an enriched skim milk powder daily. A decrease in the frequency of gout flare ups was observed in all treatment groups over three months, but especially in the skim milk powder group.
- Water: Don't forget to drink plenty of water, says the Arthritis Foundation. Their recommendation is to drink at least eight glasses of nonalcoholic beverages a day, with plain water being best. And if you're having a gout flare up, increase your intake to 16 glasses a day — the water helps to flush uric acid from your system.
- Asia Pacific Journal of Clinical Nutrition: "Soyfoods, Hyperuricemia and Gout: A Review of the Epidemiologic and Clinical Data"
- Arthritis Foundation: "Gout"
- Mayo Clinic: "Gout Diet: What's Allowed, What's Not"
- European Journal of Nutrition: "Can Soy Intake Affect Serum Uric Acid Level? Pooled Analysis From Two 6-Month Randomized Controlled Trials Among Chinese Postmenopausal Women With Prediabetes or Prehypertension"
- Northwest Kidney Centers: "Managing Gout"
- Biological and Pharmaceutical Bulletin: "Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia"
- Arthritis Foundation: "5 Good Foods for Gout"
- Arthritis Foundation: "How Cherries Help Fight Arthritis"
- Annals of the Rheumatic Diseases: "Effects of Skim Milk Powder Enriched With Glycomacropeptide and G600 Milk Fat Extract on Frequency of Gout Flares: A Proof-of-Concept Randomised Controlled Trial"
- Arthritis Foundation: "Gout Diet Dos and Don'ts"