Supporting Gout Through Diet

Transcript:

LEAH: Welcome to Dishing Up Nutrition brought to you by Nutritional Weight & Wellness. We are a small Minnesota company with the big goal of spreading the real food message and helping people draw the connection between what they eat and how they feel. We also provide real life solutions to healthier living through eating real food. My name is Leah Kleinschrodt, and I'm a Registered and Licensed Dietitian.

I am here today with the one and only Teresa Wagner, who is also one of our fabulous registered dietitians. And today we have yet another show for you that we have not comprehensively covered in the 20 years we've been on the air. Teresa, I thought for sure the last show we did together on losing body fat and gaining muscle and perimenopause was going to be our last uncharted frontier, but alas, I was wrong. So Teresa, do you want to kick us off? Do you, should we keep our listeners in suspense a little longer or are you ready to dive in?

TERESA: I'm not really one for drawing things out or keeping secrets. Today we're going to focus this podcast on tips for eating to support our body if we have gout or to prevent it. Before we push full steam ahead into the show today, I want to remind and encourage listeners out there that we would love to know what's on your mind and what things you find the most helpful.

If you have nutrition related topics that you would like us to cover, topics you want us to refresh or do some more investigative work on, just please let us know. And the best way to do this is by posting a comment in our private Dishing Up Nutrition Facebook page, or by leaving a brief voicemail message at 952-641-5233.

I'll bet there are at least a few more topics out there that we have not thought of or that we are due to do an update on. But for now, let's get back to the topic at hand: gout.

LEAH: Yes, gout. This isn't something I see super commonly in clinical practice, but when I have, or when I've talked to clients who have experienced a gout attack or a flare, I understand this is a very serious and painful condition. Just an interesting little tidbit as I was doing some background research for the show. I read that gout used to be called the disease of kings and king of diseases. I thought that was an interesting saying.

TERESA: It is. And I, my guess is because kings had access to foods and beverages that the common people did not.

LEAH: Absolutely.

TERESA: And probably unlimited access.

LEAH: Yes. Yes. Exactly. Yes. There definitely was a connotation that went along with that with gout. So this is all to say that gout has been around for a very long time. This is an old and ancient type of disease. And nowadays it is the most common cause of inflammatory arthritis in the United States. In the U.S., it's estimated that 3 to 4 percent of the adult population will experience gout at some point.

Gout is a kind of arthritis where uric acid or urate crystals get deposited in joints or tendons and some of the surrounding tissues. And then the body has an inflammatory reaction to those crystals. 85 to 90 percent of gout flares occur in the lower extremities. So think feet, think ankles or knees, and it will usually only hit one joint at a time.

Now, when I think about gout, I always think about it being more in the big toe. This is what the literature bears out as well. 50 percent of first time gout attacks will be in the big toe. And if if you unfortunately are the person who is going to get multiple gout attacks, chances are there's a 90 percent chance that at least one of those attacks will be in the big toe. So that is a very common site where this pops up. Leah, when we were talking about naming this show, I wanted to name it “Gout: It's a Pain in the Toe”.

LEAH: Yeah, I love that. I think that would have been very creative also, but you were overridden on that apparently. Yeah, that big toe, very common for that gout to settle in. And oftentimes, so that big toe, it'll swell up, it'll turn red, get warm and become very painful.

And usually again, like this happens very quickly over the course of even about 24 hours. And as I was doing some more reading, I was reading just some like anecdotal accounts of people who have had gout. And there are some out there that say even like a light blanket or even clothing touching that affective joint can just be too much to bear when they're in that kind of gout attack or a gout flare.

TERESA: That sounds so intense. Just to think that just something that's so lightly touching or even soft and touching would cause that sort of an intense reaction. And it honestly, it sounds like it can really just take you out fairly quickly. So if a blanket is going to hurt your toe, how do you manage the rest of your day?

LEAH: Yeah.

TERESA: I can only imagine that once people have one gout attack, they'd want to avoid another at all costs. Or if someone has seen a loved one or a friend or a coworker experience a gout attack, they'd probably say, I'd rather not go down that path if I can do anything to help it. The good news is that there are things that you can do to reduce your risk of getting gout that are within your control.

And we are going to talk about some of those things today. Of course, there are some things you don't have control over, like getting older, being biologically male or going through menopause, if you're a woman. If your kidneys have been damaged from say trauma or longstanding diabetes, you have a higher risk of gout because you can't get rid of that uric acid effectively.

You might have to be on medications that can increase your risk for gout, like a diuretic for blood pressure. Sometimes people just call that a water pill. You might be on a low dose aspirin or Levodopa, which is a Parkinson's medication. But our job is to take a look at nutrition related factors that can play a role and that you can dial into in order to suit your individual situation.

LEAH: Yep. Absolutely. So if you get gout, the treatment is actually pretty straightforward. We have to lower uric acid in the bloodstream. In the United States, the medication most commonly prescribed for this is called allopurinol, but we're about to talk about lifestyle factors that can also achieve that same thing.

How can uric acid be lowered?

If we have lower uric acid levels in the blood, the lower the chance that those crystals form and then get lodged into those cells susceptible joints, like the big toe or the heel is another area. So the question becomes, how do we lower uric acid? So we either have to try to lower the body's production of uric acid, or we try to help the body clear out uric acid better.

So if you think about it like with a bathtub analogy, if we have a bathtub overflowing with water, we can help reduce how much water is coming into the tub, and we can do that by turning the faucet down or you turn it off completely. And we can help the water go down the drain better. So making sure that drain is big enough or that there aren't any hair clogs in that drain. So I don't know if that's a common problem in your household, Teresa, but that's something we have to pay attention to.

TERESA: Yes. We have three girls in our house, two with long hair. Yes.

LEAH: Yeah.

TERESA: Yes. And that's a great visual though, Leah, with that idea of, okay, if this bathtub is overflowing, how do we stop it from overflowing? Well turn off the faucet and open up that drain.

LEAH: Definitely.

TERESA: So that first question is how might we turn down the faucet or reduce how much uric acid is coming into our tub? This is where people who have had gout might have been counseled to avoid purine rich foods and beverages. This would be things like liver and other organ meats, shellfish, red meat, and beer.

Purines, there are these little nitrogen based compounds that make up a part of our DNA. Purines break down into uric acid, so it makes logical sense that if we eat or drink less purines, that may lead to less uric acid in the blood. Now, I say may, because it's often not as simple as staying away from these high purine foods.

Actually, according to Dr. David Perlmutter, who is a board certified neurologist, who wrote a book about uric acid a few years ago called Drop Acid, the majority of purines in the body come from the normal wear and tear and breakdown of cells and tissues of the body.

And many of these high purine foods have other redeeming nutritional qualities to them. We can't really argue so much for the beer. But red meat and seafood are powerhouses for nutrients like protein, iron, zinc, selenium, and so much more. So we do have foods that are higher in purines, which will technically break down to more uric acid in the body.

However, there are also foods and beverages that increase how much and how quickly we break down these purines. The two big entities here are alcohol and fructose, and especially foods and drinks with high fructose corn syrup. Alcohol and fructose increase the breakdown of purines and thus increase uric acid levels.

LEAH: That was a lot of information there, Teresa. And we will, I promise listeners will back up and dive a little bit more into some of that stuff and do a deeper delve there, but I do want to share that I do have a perfect example of this.

When I first started as a dietitian with Nutritional Weight & Wellness, so then we're talking six to seven years ago now, I met with a client who had already been seeing one of our other counselors for chronic gout flares. And he was a younger guy. He was in his early 40s or so, athletic, not that typical picture of somebody who gets gout.

And I don't remember for him if there was much of a family history of gout, but his big risk factors was he was a huge beer drinker and a soda drinker. So we think lots of alcohol, lots of yeast from the beer, so it's that yeast component, that's the high purine part of that, and lots of high fructose corn syrup coming in the form of those sodas.

So we had, again we have some more high purine stuff coming in, but he also had the alcohol and the fructose part, which means he was just tearing through those purines mad and breaking them down, and his body was not able to keep up with that pace.

So the previous dietitian that he had worked with had already honestly done most of the legwork for me. She had already worked really hard getting him off those beverages and helping him balance out his food choices better. So by the time I saw him, I was just making some small tweaks and recommendations to make sure that he felt confident that he could stay the course with these recommendations.

And I just remember he was so ecstatic to be out of pain, to not have to rely on the gout medications anymore, and that he didn't feel worried about having another flare at that point. And then on top of that, he had lost something like 15 to 20 pounds. So it was a win all around for him.

TERESA: Yeah. That's such a great example, Leah. I feel like just, and what a relief to know that you're not going to be in that kind of intense pain.

LEAH: Yeah. Yeah. So for him, we sussed out what those big players were for him. And does that mean he could never have a beer ever again? No, but it means that like the habits that he was having of doing, I think it was, there's beer league softball in there and just some of the lifestyle habits that we had to take a look at and be like, okay, is it worth it that again, We might run into another flare.

TERESA: Right? And I think that's a good example of it's what we do consistently versus what we do on the exception. And if we're consistently having high fructose corn syrup based drinks or lots of beer, if we're consistent with that then we might get that result but if it's just once in a while and you're having a beer or it's probably not going to cause a gout flare.

LEAH: Yeah. That's a huge point there. Absolutely. Yeah. So that was definitely a fun one to see and experience. And I did, I wanted to reiterate another point that you had made, Teresa, is that when we are looking at the approach of reducing purines and thus, so again, reducing uric acid in the body by cutting out or reducing high purine foods, we want to first look at the foods that are culprit foods that are harming the situation and they're not doing anything to add to our nutritional profile. So they're not doing anything to help things.

So again thinking like red meat, liver or organ meats, those types of things, they might be higher in purines, but they have other qualities that actually make them important components in our bodies with protein, with some of those micronutrients.

But if we look at beer, if we look at alcohol, if we look at high fructose corn syrup, those things are doing harm and they're not doing any good. So why not start with those first? Those are like the big things. If we're looking at priorities, that's how I would categorize it in my brain.

Think about high fructose corn syrup, for example. Where are we finding that? So for my one client, soda was a big one. Energy drinks is another one. And we've highlighted a lot of these before, our ultra processed foods. So things like candies, sweets, pastries and baked goods, but even things like sweetened yogurts and mixed fruit cups and ketchup and barbecue sauces.

So like a high fructose corn syrup can really sneak in a lot of places. You just got to look at those ingredients list closely and it may plainly say high fructose corn syrup on that list. But you also may see just the term fructose or you might see just corn syrup or corn syrup solids. You might even see something like isoglucose. So there's, there could be a lot of these sneaky terms for the same type of thing, a sweetener that's fructose based.

TERESA: That's right, Leah. There are so many different names for fructose. It's a really sneaky sweetener. I also want to highlight that when we're talking about fructose being a compound we want to avoid for gout, we're not talking about plain whole fruit, and actually some vegetables have naturally occurring fructose, some more than others, but they also have fiber, which slows down how quickly that fructose gets into your system and thus impacts uric acid.

And we're going to talk about that just a little bit more when we come back. You are listening to Dishing Up Nutrition brought to you by Nutritional Weight & Wellness. I am Teresa Wagner along with Leah Kleinschrodt and we are your hosts for this episode covering all things gout and nutrition. We'll be back after a short break.

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More on foods that aggravate gout & which are recommended to consume

LEAH: And we are back with your weekly Dishing Up Nutrition episode. Before we went to break, we were talking about refined fructose, high fructose corn syrup, how that can be a big aggravator for gout. It hides in a lot of things. So we need to really look at our ingredients list closely.

And actually one that Teresa pointed out on our break that I thought was worth mentioning as well, because it's had its moment in the spotlight several years ago is agave nectar. That's one that tends to have more of that health halo around it. But agave nectar is actually 90% fructose. So you are getting a really high fructose load using agave nectar as a type of sweetener.

So not that you can't have agave nectar ever, but it would be something that you don't want to sweeten every little thing that you're using in the kitchen with because you are adding to that fructose load.

TERESA: Yeah. And I think just for reference, high fructose corn syrup is 60 percent fructose, whereas agave nectar, like you said, 90%.

LEAH: Yeah. Yeah. High, very high fructose. But that also let's dive into fructose a little bit more, Teresa, because not all fructose is created equal. It doesn't mean like we have to, stay away from all fructose ever again, never to touch our lips again, because fructose occurs naturally in some foods.

TERESA: Yeah, it does. It's natural in fruit, for example, and probably how fruit got its name from fructose, or maybe the sugar got its name from fruit. I don't know. We'll have to do a history of sugar naming, but fruit and some vegetables have naturally occurring fructose. Some more than others, but they also have fiber, which slows down how quickly the fructose gets into your system and thus impacts uric acid.

Whole fruits and vegetables also have vitamin C and natural flavonoids and polyphenols that help the body break down and get rid of the uric acid. In other words, eating an apple with the peel on is a much different scenario than drinking an apple juice or an apple flavored beverage that contains high fructose corn syrup.

With these apple drinks, you're losing out on the fiber and those beneficial plant compounds, and maybe the vitamin C also, so in using your earlier analogy, Leah, you are turning the faucet up, filling the tub quicker while also plugging the drain on that bathtub or your body, right? Your body is going to start to overflow with that uric acid.

LEAH: Yeah. Yeah, that yeah, that's an important point. I'll add a finishing touch to that as well. So if you're going to eat that apple, also eat it with some peanut butter or have a hard-boiled egg on the side because that will also help slow down the absorption of fructose from that apple.

Vitamin C plays an important role in preventing/healing gout

But let's circle back to that idea of vitamin C because vitamin C, that's a very common micronutrient. Most people know about it, especially for the immune system. But it has a really important role in gout also. There is longstanding research to show that vitamin C can help decrease uric acid levels and help reduce the risk of gout. So back to the bathtub, we talked about the things we can do to turn that faucet down.

That was reducing the beer, the alcohol, the high fructose corn syrup, and some of those ultra processed foods. Vitamin C is one thing that helps the water drain out of our tub easier. So now we're looking at the other side of the equation. Vitamin C helps our kidneys get rid of uric acid. We find vitamin C mostly in our fruits and our vegetables.

So again, here's that we're looking at, what are the redeeming qualities of food? And then what are some of the maybe not so redeeming qualities of these foods? So yes, fruits and vegetables are going to contain some natural fructose, but they also contain compounds that help our bodies get rid of. That uric acid easier. So again, here's foods where there are a lot of benefits to eating it, even if there might be some technical small minuses along the way.

TERESA: Yep. That's a great point. We do want our clients to still be striving to get at least one cup of vegetables with every meal, including breakfast. And including some fruit in their day, like berries or kiwi at a snack. Supplementing with vitamin C can also be a nice insurance policy. A 2021 meta analysis study published in the Journal of Complementary Therapies in Medicine showed that people who supplemented with anywhere from 200 to 1,000 milligrams of vitamin C per day significantly lowered their serum uric acid level.

LEAH: Yes. Again, we've talked about those higher levels of vitamin C like that, especially for immune support before. And let's just for fun, do some comparisons of vitamin C between different foods, because we do want food first, of course.

So a cup of red bell peppers, and this could also be yellow peppers, orange peppers. We're talking about the bell pepper family. So one cup of that is 74 milligrams of vitamin C. A kiwi is 64 milligrams of vitamin C. So that's just one packaged up little goody of vitamin C right there. You can have one cup of broccoli for 81 milligrams of vitamin C, a cup of strawberries, which they're still in season right now is 85 milligrams of vitamin C.

So really like you can, again, if we're plugging in some of these fruits and vegetables throughout our day, including breakfast, so we're getting started right away in the morning, like we can really get into those hundreds of milligrams of vitamin C just by eating real foods. It's another example of real food for real health and less gout.

Quercetin lowers uric acid levels

TERESA: Yes. And they're all such delicious ideas; every one of those. I love the idea of this. You mentioned polyphenols and flavonoids and those important plant compounds a few minutes ago. I want to highlight one of those polyphenols called quercetin. Quercetin, like vitamin C, is well known to lower uric acid levels and is also a compound that helps fight inflammation; both important things when we are talking about gout.

We naturally find quercetin near the peel or the surface of plants like apples, berries, onions, broccoli, and leafy green vegetables. But here's the thing that I found the most interesting about quercetin. Quercetin works on the same enzyme that the medication, Allopurinol, does.

We mentioned earlier that Allopurinol is the main medication used in the United States to treat and prevent gout attacks. So quercetin is nature's Allopurinol. The research points to 500 milligrams per day of quercetin being a good dose to help decrease uric acid levels.

LEAH: Yeah. Yeah. Quercetin is something I knew nothing about before I worked at Nutritional Weight & Wellness, but it is so helpful for a lot of different things. Many of our listeners might know it for some of its antihistamine benefits. And it is in one of the most popular supplements that we sell called D-Hist from Ortho Molecular. It is a seasonal allergy product and quercetin is also in a new product from the same company, Ortho Molecular.

They released it and we are just starting to carry it and getting it on board for gout sufferers and that product is called UA-X Pro. So UA-X Pro contains 500 milligrams of vitamin C, 500 milligrams of quercetin, and a few other ingredients known to be helpful in reducing uric acid levels. There's a compound called luteolin in there, tart cherry extract. There's some apple extract and celery seed extract.

TERESA: Tart cherry extract and tart cherry juice is likely one thing that people have probably heard about when it comes to treating gout. The anthocyanins in tart cherry juice, which are just another little plant compound, known to decrease oxidative stress, decrease uric acid levels, and support the kidneys.

Drinking 8 ounces of tart cherry juice per day may be helpful for gout prevention, although more research is needed in this area and I just want to say with any of the juices always look at the sugar level

LEAH: Absolutely.

TERESA: Look to see I mean if it's tart cherry juice, it should taste tart.

LEAH: Yep.

TERESA: It shouldn't taste sweet.

LEAH: Yeah, it's probably not going to be the easiest thing to get down in the world. So yeah, absolutely. And yeah, as I was reading through some of the research with this, I found studies that say, yep, it, this can be a helpful tool for gout. And then I saw some research that said maybe not so much. So again, like there's more that needs to be done there, but if we're thinking even a couple of ounces of tart cherry juice every day, for some of those plant compounds, again, relatively harmless; maybe helpful.

It's something that you can easily slide into your routine. So to keep it simple, yes, Ortho Molecular created this supplement to include as many of those beneficial compounds as possible to lower uric acid levels and to help just lower inflammation in general. The serving size is three capsules, but people who are in a gout flare may want to up that a little bit and take two capsules twice or even three times per day. Maintenance may look more like one or two or three capsules total per day. So again, you can increase or decrease based on wherever you are with gout.

TERESA: Yeah. I'm excited to have this supplement in our arsenal. Anything that helps our clients get out of pain quicker and stay out of pain long term, it's always worth it.

LEAH: Absolutely.

Inflammation plays a role in gout attacks

TERESA: I'm happy that a lot of the ingredients in this product also reduce inflammation in addition to lowering the uric acid levels. One thing we didn't spend time on earlier in the show is that, yes, high uric acid levels are needed for a gout attack, but high uric acid on its own is not sufficient to trigger an attack.

There also needs to be a component of inflammation in the picture where the immune system mounts some kind of response to the high uric acid and the crystal deposits in the joints. So if we can establish and maintain lifestyle habits that keep our inflammation levels low or that fight inflammation, we stand a better chance of avoiding a gout encounter.

LEAH: Yeah, I agree. We need to sleep well, move our bodies, have a supportive community around us, spend time outside, and when it comes to nutrition, a great place to start is eating real food in balance and getting rid of the stuff where the ingredients lists are a paragraph long, and it looks like a science experiment.

Tread lightly with alcohol & high fructose corn syrup

These are just natural or easy beginning steps to lower some of those inflammation levels. We've done many shows in the past about how this way of eating is anti-inflammatory. For gout specifically, you'll want to tread lightly also with alcohol and high fructose corn syrup, which this time of year, I'll often hear from clients, this is patio season, this is cabin going season, this is out on the boat and out on the dock kind of season.

So some of those beverages, this is a time of year where that can be very tricky. So this is a time where you do want to be intentional or mindful or have some thoughts about how am I going to navigate, especially some of the alcohol and sugary drinks aspect of things when I'm in those social situations because it is a part, a lot of times, of how we socialize.

TERESA: And if you have gout, it might be a really easy consideration to take as far as, do I want to be able to be on the boat, out on the dock, on the patio and relaxing and having a good time with my friends? Is this particular beverage, is it worth it? Is this particular food, is it worth it?

LEAH: Yes.

TERESA: Because it might take me out completely.

LEAH: Yep, absolutely. And I know I do want to take a moment to plug our Nutrition for Weight Loss Foundation series that we have a new round of that coming up in July. I believe the starting date is July 9th and we have a couple of virtual rounds going.

This is a topic that gets covered a lot of times in Nutrition for Weight Loss. I know you know this, Teresa, cause you teach it also, but how, again, it covers that anti-inflammatory eating plan and it gives so many great tips and ideas, the instructors, but also other students of how do we navigate some of those beverages and how do we navigate the social situations when we do have illnesses or we do have things that are going on with our health, but that food might actually impact.

So I do want to throw that out there if anybody is looking for additional guidance or for some of that group support, look into our Nutrition for Weight Loss Foundations series that we have coming up at the beginning of July.

Sign Up for Nutrition for Weight Loss Foundations

So we have our anti-inflammatory eating plan. And as we mentioned, there are a couple of supplements that may be helpful; targeted supplements like vitamin C and quercetin and tart cherry extract or drinking a little tart cherry juice. And we have that UA-X supplement now that kind of combines all those great things into one combination. So of course we're here to help in any way we can. I hope this information in this show has given people just some avenues to pursue and to consider, especially if you or a loved one needs a helping hand along the way and in making some of these changes.

Hopefully this show had some of that information, but if you do need that extra little push or that to have that group experience to walk along with you, don't hesitate to connect with us and start that discussion. Our phone number is 651-699-3438. And there's a whole host of resources about anti-inflammatory eating on our website, weightandwellness.com.

TERESA: Our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple yet powerful message. Eating real food is life changing. Thank you for listening. And if you enjoyed this show, please head over to iTunes or your favorite podcast app to leave a review and help others find our show.