Nutrition and Well-being Articles

Our Nutrition and Well being section features a range of articles written by our company’s Accredited Practising Dietitian (APD), providing you with the latest research and updates in diet and lifestyle.

by: Zehra Celepci published at: 20/02/2015 Print
All about Gout
Pain, all of a sudden, lots of pain. Your joints are swollen and the slightest move you make leaves you desperate for fast relief from the agony. If this sounds like you, then be sure to ask your doctor to check you out for gout.
What is it?

Gout is one of the 100 forms of arthritis (1) characterized by inflammation and painful swelling at the joints around the body (like the ankle, knee, wrist, elbow or finger), particularly the big toe (2). The cause for these painful attacks of gout is the build up of uric acid which forms crystals at the joints either due to inefficient excretion via urine or over production in the body(3). Although it may appear to be an uncommon condition, the latest statistics show that currently 3.85 million Australians suffer from arthritis, with this number increasing to 7 million by the year 2050 (4).


The Risk Factors

You are more likely to experience a gout attack if you (5):

  • Have high alcohol intake
  • Consume high amounts of fructose (fruit juice and soft drinks) (6)
  • Consume a purine-rich diet (e.g. meat, poultry and some seafood)
  • Are overweight or obese
  • Are dehydrated
  • Crash diet or fast
  • Use diuretic medication (medication which removes water from the body)
  • Male (6)

Prevention/Management

Both lifestyle and dietary modifications can be effective in preventing the onset and re-occurrence of gout (7)(8).

Diet

Fructose, mostly found in fruit and honey (9), is the only carbohydrate known to increase uric acid levels in the body (10-14). Interestingly, the mechanism fructose uses to stimulate uric acid production is the same mechanism used by ethanol (alcohol). This is why recommendations are based around reducing alcohol, soft drink and fruit juice consumption to reduce the risk of gout attacks(15-19). Note that a healthy diet based on dietary guidelines encourages the intake of fruits and vegetables on a daily basis.

Keeping hydrated (with water) is another essential. It helps your body flush out the excess uric acid that can otherwise build up (20).

Additionally more and more studies are confirming that the reduction of foods rich in purine (mainly from animal sources) reduces incidence of gout (8). This is because purine also breaks down to uric acid in the body, the causal factor of gout.

To reduce levels of uric acid in body, limit your intake of foods such as (21):

  • Anchovies
  • Sardines
  • Offal foods such as liver and kidney
  • Sweetbreads
  • Gravy
  • Stock cubes
  • Meat and yeast extracts (e.g. vegemite)
  • Beer and other alcohol
  • Fruit juice and soft drinks (5)
Interesting!

Research has found that the intake of low-fat dairy is associated with a lower risk of gout (22)

Physical activity

During an attack of gout, or a ‘flare’, you may feel like resting the affected joint. It’s always important to listen to your body’s signals– so rest when the joint is causing you pain, and try to take on some physical activity once the flare is over (23). If you are experiencing pain after exercising, Arthritis Victoria suggests using the ‘two hour pain’ rule as a guideline- meaning, if you are feeling pain for more than two hours after exercising, it is an indication that you’ve done too much23. So next time you may like to slow down or reduce your exercise time. If pain persists, speak to your physiotherapist or exercise physiologist.

As an overall recommendation, all individuals, if able, should aim to be active on a regular basis, completing at least 30 minutes of physical activity on most days of the week.

Gradual Weight Loss (if overweight/obese)

Obese persons are predisposed to gout and hyperuricemia (high uric acid levels in the blood) (24). Gradual weight loss has many beneficial effects associated not only with enhancing the excretion of uric acid from the body, but also with regulating high blood pressure and cholesterol levels (25-27).

Body Mass Index (BMI) is used as a measure to define an individual’s weight status; whether they are underweight, overweight or an ideal weight based on their height. Keep in mind this tool has limitations and may be affected by gender, age and ethnicity.

Visit www.heartfoundation.org.au for access to the Body Mass Index Calculator (BMI).


Wealthy Health- Super Urinary Gout Support Supplement

Super Urinary Gout Support is formulated using ingredients that have traditionally been used for the management of gout and other rheumatic conditions.

This supplement uses the natural goodness of dried cranberries, cherries and garlic to help:

  • Support and maintain the health of the urinary tract (28)(29)
  • Relieve of the symptoms of the cold (30)
  • Support the health of the male reproductive system (31)

Additional Recommended Product: Celery Seed 3300mg is an excellent additional choice for supporting individuals with joint conditions. By flushing the urinary tract and reducing levels of uric acid in the body this urinary antiseptic (32) is a must have!


  1. The Australian Institute of Health and Welfare. (2010). The Nature of Musculoskeletal Conditions. Available: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442452997. Last accessed 21st Jan 2015.
  2. Better Health Channel. (2013). Arthritis and Diet. Available: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Gout. Last accessed 22nd Jan 2015.
  3. Better Health Channel. (2014). Gout. Available: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Gout. Last accessed 22nd Jan 2015.
  4. Access Economics 2007. Painful Realities: The economic impact of arthritis in Australia in 2007
  5. Choi HK, Curhan G: Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ 336 : 309– 312, 2008
  6. Nakagawa T, Tuttle KR, Short RA, Johnson RJ. Hypothesis: fructose induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome.Nat Clin Pract Nephrol 2005;1:80-6.
  7. Dessein PH, et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000; 59:539–43.
  8. Zhang,Y et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453?
  9. Women's and Children's Health Network. (2012). Low Fructose Diet for Children . Available: http://www.wch.sa.gov.au/services/az/other/nutrition/documents/Low_fructose_fact_sheet.pdf. Last accessed 22nd Jan 2015.
  10. Nakagawa T, Tuttle KR, Short RA, Johnson RJ. Hypothesis: fructoseinduced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome.Nat Clin Pract Nephrol 2005;1:80-6
  11. Fox IH, Kelley WN. Studies on the mechanism of fructose-induced hyperuricemia in man. Metabolism 1972;21:713-21.
  12. Stirpe F, Della Corte E, Bonetti E, Abbondanza A, Abbati A, De Stefano F. Fructose-induced hyperuricaemia. Lancet 1970;2:1310-1.
  13. Emmerson BT. Effect of oral fructose on urate production. Ann Rheum Dis 1974;33:276-80.
  14. Perheentupa J, Raivio K. Fructose-induced hyperuricaemia. Lancet 1967;2:528-31.
  15. Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Ann Intern Med 2005;143:499-516.
  16. Fox IH, Kelley WN. Studies on the mechanism of fructose-induced hyperuricemia in man. Metabolism 1972;21:713-21.
  17. Gibson T, Rodgers AV, Simmonds HA, Court-Brown F, Todd E, Meilton V. A controlled study of diet in patients with gout. Ann Rheum Dis 1983;42:123-7.
  18. Puig JG, Fox IH. Ethanol-induced activation of adenine nucleotide turnover. Evidence for a role of acetate. J Clin Invest 1984;74:936-41.
  19. Faller J, Fox IH. Ethanol-induced hyperuricemia: evidence for increased urate production by activation of adenine nucleotide turnover. N Engl JMed 1982;307:1598-602.
  20. Ngo TC, Assimos DG. Uric Acid Nephrolithiasis: Recent Progress and Future Directions. Reviews in Urology 2007;9(1):17-27.
  21. Dietitians Association Australia . (2014). Gout. Available: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/gout/. Last accessed 22nd Jan 2015.
  22. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 350:1093–1103.
  23. Arthritis Victoria . (2012). Gout and Exercise. Available: http://www.arthritisvic.org.au/Conditions-and-Symptoms/Gout/Exercise. Last accessed 22nd Jan 2015.
  24. Ekeruo WO, Tan YH, Young MD, et al. Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients. J Urol. 2004;172(1):159-163.
  25. Carey DGP. Abdominal obesity. Curr Opin Lipidol 1998;9:35-40.
  26. Tinahones JF, Perez-Lindon G, C-Soriguer FJ, Pareja A, Sanchez-Guijo P, Collantes E. Dietary alterations in plasma very low density lipoprotein levels modify renal excretion of urates in hyperuricemic-hypertriglyceridemic patients. J Clin Endocrinol Metab 1997;82:1188-91.
  27. Nicholls A, Scott JT. Effect of weight-loss on plasma and urinary levels of uric acid. Lancet 1972;2:1223-4.
  28. Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321.
  29. Jepson, R. G., and Craig, J. C. A systematic review of the evidence for cranberries and blueberries in UTI prevention. Mol. Nutr. Food Res. 2007;51(6):738–45.
  30. Campbell JD, Cole M, Bunditrutavorn B and Vell AT: Ascorbic acid is a potent inhibitor of various forms of T cell apoptosis. Cell Immunol 1999, 194:1-5
  31. Hirt HM, M'pia B. Natural Medicine in the Tropics. Anamed. 2nd Edition. Winnenden: Druckerei Bauer; 2001.
  32. Ahmed B, Alam T, khan SA, Hepatoprotective activity of two plants belonging to the Apiaceae 2002 Mar 313-6

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