Why is the relationship between gout and purines so sensitive?
Gout is a metabolic disease caused by high levels of uric acid in the blood. When uric acid concentration is too high in the body, it can form crystals that deposit in joints and soft tissues, triggering severe inflammatory responses. Purines are organic compounds that naturally exist in cells and are direct precursors to uric acid. Both exogenous (dietary) intake and endogenous (cell metabolism) production contribute to uric acid generation.
Humans lack uricase, an enzyme that metabolizes uric acid into more easily excretable substances. This means that once purine intake is excessive or uric acid excretion is obstructed, blood uric acid levels can easily rise. Many foods, such as organ meats, certain fish, rich meat broths, and beer, contain high levels of purines, which can significantly affect fluctuations in uric acid levels.
However, purines are not "toxic substances"; they are one of the building blocks of cells. The issue is not that "purines are harmful," but that the purine metabolism pathway in gout patients has become abnormal, making it difficult to effectively process excess purines, which is why conscious dietary intervention is necessary.
High-purine foods are not all "seafood"
Many people reflexively associate "purines" with "seafood," even equating gout with "eating too many shrimp and crabs." In fact, seafood is not the type of food with the highest purine content; certain red meats, legumes, beer, and processed meat products can have even higher purine levels.
Based on purine content, foods can be roughly categorized as follows:
High-purine foods (containing >150 mg of purines per 100 grams)
Organ meats: liver, kidneys, brain
Certain fish: sardines, anchovies, eel
Shellfish: oysters, clams
Rich broths: chicken soup, bone broth, hot pot base
Yeast products: beer, bread yeast
Moderate-purine foods (containing 50-150 mg of purines per 100 grams)
Red meats: pork, beef, lamb
Poultry: chicken, duck
Legumes and soy products: soybeans, tofu, bean curd (controversial)
Low-purine foods (containing <50 mg of purines per 100 grams)
Vegetables and fruits: most vegetables and fruits contain almost no purines
Dairy and eggs: milk, yogurt, eggs
Refined staples: rice, noodles, white bread, etc.
It should be noted that some vegetables, such as spinach, mushrooms, and cauliflower, do contain certain purines, but since the types of purines are mainly water-soluble and have low bioavailability, their impact on uric acid levels is weak. Therefore, excessive restriction is not recommended.
Dietary strategies during gout attacks
When gout attacks, it is often accompanied by obvious symptoms such as redness, swelling, severe pain, and local heat, which are the body's acute inflammatory response to the accumulation of uric acid crystals. Dietary adjustments during this phase should focus on "reducing burden and combating inflammation," avoiding further stimulation of uric acid elevation or interference with inflammation regulation.
Reduce intake of high-purine foods
During an attack, high-purine food intake should be strictly controlled, especially organ meats, seafood, rich meat broths, and alcoholic beverages. Even moderate-purine red meats should be temporarily limited to avoid exacerbating uric acid production.
Maintain adequate hydration
Water is the solvent for metabolism. During an attack, it is recommended to drink no less than 2.5 liters of water daily to promote uric acid excretion through urine. It is advisable to drink plain water, light tea, or lemon water, and to avoid sweet beverages and strong tea.
Focus on a low-fat, light diet
Excessive fat intake can affect uric acid excretion, so fried foods and high-fat dairy products should be avoided. Cooking methods such as steaming, boiling, and stewing are preferable.
Control protein sources and total intake
It is not advisable to completely ban protein; moderate intake of dairy, eggs, and soy products can be used as substitutes, but attention should be paid to the patient's gastrointestinal tolerance.
Avoid fasting and hunger states
Many people mistakenly believe that "not eating will not produce uric acid," but fasting stimulates the breakdown of fats and proteins in the body, which actually increases endogenous uric acid production.
Dietary approach for gout remission and long-term control
Once inflammation subsides, patients often let their guard down and begin to "feast." However, the remission phase is actually the key stage for establishing a long-term stable dietary pattern.
Gradually reintroduce high-quality protein
Red meat can be moderately reintroduced (no more than twice a week, with each serving not exceeding 100 grams), prioritizing lean meats and low-purine fish such as bass and hairtail. Plant proteins like tofu and soy milk can be tried in small amounts, but individual differences should be considered.
Establish a long-term structure of low purine + low fat + controlled sugar
High-fat and high-sugar diets can lead to insulin resistance, thereby inhibiting uric acid excretion. Long-term management is recommended to focus on coarse grains, vegetables, and fruits as the staple foundation, controlling total caloric intake and maintaining stable weight.
Avoid alcohol, especially beer
Alcohol can promote lactic acid accumulation, thereby inhibiting uric acid excretion, and beer contains yeast, which is itself high in purines, making it very unfriendly for gout patients.
Monitor blood uric acid levels
Dietary adjustments are not about blindly "avoiding" foods, but rather about controlling intake and observing responses in a planned manner. Regular monitoring of blood uric acid levels is the basis for assessing the effectiveness of dietary management.
Case analysis: Reasonable purine control is the key
Case 1: Mr. Lin's "seafood-free life"
Mr. Lin has suffered from gout for many years and has a strong aversion to "seafood," avoiding shrimp, crabs, and even seaweed soup. However, he drinks beer daily, eats sausages, and indulges in heavily flavored dishes, often quenching his thirst with sweet drinks. As a result, the frequency of attacks has increased rather than decreased. The doctor pointed out that the problem is not seafood, but the overall dietary structure imbalance and high sugar beverage intake. After adjusting his diet, the frequency of attacks significantly decreased within two months.
Case 2: Aunt Wang's "tofu taboo" misconception
After one gout attack, Aunt Wang was warned by her neighbor that "tofu is the enemy of gout." As a result, she avoided all legumes for three years. However, due to her long-term vegetarian diet, her protein intake was severely insufficient, leading to muscle loss and decreased immunity. A nutritionist advised her to reassess the purine utilization rate in soy products, to appropriately reintroduce tofu and soy milk, and to increase her intake of milk and eggs. This not only balanced her nutrition but also did not trigger further gout attacks.
These two cases illustrate that it is not that certain foods "cannot be eaten," but rather that "how to eat, how much to eat, and whether it is reasonable" is the key. Instead of getting caught up in the black-and-white thinking of "good and bad foods," it is better to understand the nutritional logic behind "purine load."
Family dietary management and common misconceptions
Misconception 1: "Not a single bite can be eaten"
Some patients refuse all protein out of fear, which leads to malnutrition and decreased physical strength. Purine control does not mean absolute fasting, but rather a combination of total control and quality choices.
Misconception 2: "Only focus on seafood, not on beverages"
Many patients overlook the purines and metabolic burden in sugary drinks, beer, rich broths, and hot pot bases, which are the real "hidden killers."
Misconception 3: "Once diagnosed with gout, one must always take uric acid-lowering medication"
Medication treatment should be conducted under the guidance of a doctor, rather than relying on a single indicator to adjust the dosage. Diet is just one part of management and should be coordinated with medication.
Family management suggestions:
Plan weekly menus to avoid high-purine foods with high repetition.
Provide patients with ample fruits and vegetables, diverse staples, and low-oil, low-salt combinations.
Family members should improve their eating habits together to avoid temptations and misleading information.
Record dietary intake and attack situations to establish an individualized dietary "map."