The basics
A low-purine diet is often prescribed for people with gout and Lesch-Nyhan Syndrome (a rare genetic disorder that occurs in 1 out of 100,000 people). People with diabetic nephropathy need to restrict proteins, a regimen that includes, but is not limited to, the restrictions imposed by a low-purine diet.
- Completely avoid very-high-purine foods such as anchovies, broth, and dried legumes.
- Eat very little high-purine foods such as some fish, poultry, or meat.
- Eat modest amounts of moderately high-purine foods such as oatmeal, soy, and spinach.
- Consult a healthcare professional before you make major changes to your diet. Avoiding foods high in purines can lead to a very-low-protein diet if you don’t substitute appropriately.
Best bets: Cereals, eggs, cheese, fruit, nuts, milk, and many vegetables
Why do people follow this diet?
In people who have gout, uric acid production in the body is increased while its elimination is reduced. The excess uric acid builds up in the bloodstream, is deposited in the small joints or soft tissues, and causes symptoms that resemble arthritis. Purines are compounds that are mainly found in animal protein and are metabolized to uric acid in the body. A high-purine diet, obesity, regular alcohol consumption, and diuretic therapy can all contribute to elevated uric acid levels in individuals with gout. Preliminary research suggests that insulin resistance may also play a role in the development of gout. A low-purine diet and medications—such as nonsteroidal anti-inflammatory drugs, corticosteroids, and allopurinol—are commonly used to treat gout. An effective diet is important in avoiding or reducing complications and lessening the expense of drug treatment. Restricting calorie intake and alcohol consumption, and losing weight (if overweight), can also reduce uric acid levels. It is important to drink plenty of fluids to increase uric acid excretion from the body. Alternative sources of protein should be included in a low-purine diet.
What do I need to avoid?
To avoid purines ask about ingredients at restaurants and others’ homes, and read food labels. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet.
The following foods have very high purine levels, and should be avoided completely:
- Anchovies
- Bouillon
- Brains
- Broth
- Consommé
- Dried legumes
- Goose
- Gravy
- Heart
- Herring
- Kidneys
- Liver
- Mackerel
- Meat extracts
- Mincement
- Mussels
- Partridge
- Roe
- Sardines
- Scallops
- Shrimp
- Sweetbreads
- Yeast (baker’s and brewer’s)
- Yeast extracts (for example, Marmite, Vegemite)
These foods have high purine levels
- Fish
- Shellfish
- Poultry
- Meat (except those with very high purine content, noted above, or those with moderately high purine levels, noted below)
These foods have moderately high purine levels
- Asparagus
- Cauliflower
- Legumes
- Lentils
- Mushrooms
- Oatmeal
- Peas (dried)
- Soy
- Spinach
- Tripe
Best bets
- Beverages (carbonated)
- Butter
- Cereals and cereal products
- Cheese (all kinds)
- Cocoa (however, caffeine is prohibited in Lesch-Nyhan Syndrome)
- Corn
- Cornbread
- Eggs
- Fruit juices
- Fruits
- Gelatin
- Ice cream
- Milk
- Noodles
- Nuts
- Refined wheat flour
- Tapioca
- Vegetables (except those noted above)
- White bread and crackers (but not whole wheat, which is moderately high in purines)
- White rice
Are there any groups or books?
National Institute of Arthritis and Musculoskeletal and Skin
Diseases
www.nih.gov/niams
Arthritis Foundation
www.arthritis.org
The Purine Metabolic Patients Association
www.pumpa.org
Bibliography
Dessein PH, Shipton EA, Stanwix AE, 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.
Emmerson BT. The management of gout. N Engl J Med 1996;334:445–51.
Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy. 10th ed. Philadelphia, PA: W.B. Saunders Company; 2000.
www.marinurology.com/articles/calculi/foods/purines.htm
Wolfram G. [Diet therapy in gout]. Ther Umsch 1995;52:524–7.