Gout is a type of arthritis that causes sudden, severe joint pain, and it is caused by having too much uric acid in the blood (NHS). Food is only part of the story. The 2020 American College of Rheumatology guideline says diet changes likely make only small changes to uric acid levels, but that dietary factors may act as triggers for attacks (FitzGerald et al., 2020). This guide looks at one meal: breakfast. The NHS advises against skipping it, and says a healthy breakfast high in fibre and low in fat, sugar and salt can form part of a balanced diet (NHS eight tips).
This article is general information, not medical advice. If you have gout, follow the food list and treatment your own doctor gives you.
Choose the protein with care
In a case-crossover study of 633 people with gout, a 2-day period in the highest fifth of purine intake carried 4.76 times the odds of a gout attack compared with a 2-day period in the lowest fifth (Zhang et al., 2012). Animal purine carried the higher risk. The top fifth of animal purine had odds of 2.41, against 1.39 for plant purine.
The same authors wrote that plant foods, especially nuts and legumes, should be the preferred protein sources for people with gout. A handful of nuts on the breakfast plate follows that advice.
Prep the night before
Oats soaked overnight in milk or yoghurt need no cooking in the morning. Stir in some chopped dates and a few nuts before bed and the bowl is ready when you wake up.
Oats do need a note. Oatmeal appears on the Zhang study's list of high-purine foods, next to meats, seafood, beans, peas, lentils, spinach, asparagus, mushroom, yeast and alcoholic drinks. The authors found the short-term effect of plant purine was substantially smaller than that of animal purine. The NHS says higher-fibre starchy foods can help you feel full for longer, and it suggests a wholegrain lower-sugar cereal with semi-skimmed milk and fruit sliced over the top as a healthier breakfast.
Keep the sweet finish small and deliberate
Choose the sweet part of breakfast on purpose. Dates are a fructose-rich fruit: USDA FoodData Central lists 32.0 g of fructose per 100 g of Medjool dates and 19.6 g per 100 g of Deglet Noor dates. In a 12-year study of 46,393 men, fructose-rich fruits (apples and oranges) and fruit juice were linked with a higher risk of gout (Choi and Curhan, 2008). That study did not test dates, and none of the other studies here did either, so they give no evidence either way on dates and gout attacks.
The NHS 5 A Day page counts a 30 g portion of dried fruit, dates included, as one of your 5 A Day, and says it should be eaten at mealtimes, not as a snack between meals, to reduce the impact on teeth (NHS). So keep the dates in the breakfast bowl or at the end of the meal, and weigh one 30 g portion once so you know what it looks like.
Watch the drinks, not just the plate
In the same study of men, two or more sugar-sweetened soft drinks a day carried a relative risk of gout of 1.85 compared with less than one a month, and diet soft drinks were not linked with gout. A 22-year study of 78,906 women found 778 new cases of gout (Choi et al., 2010). Two or more servings a day of orange juice carried a relative risk of 2.42, against less than one serving a month. The authors added that the contribution of these drinks to gout across the population is likely modest, because gout is not common in women.
The NHS gout page says not to have lots of sugary drinks and snacks, and to drink plenty of fluids to avoid getting dehydrated. Its 5 A Day page limits fruit juice, vegetable juice and smoothies to a combined 150ml a day, drunk at mealtimes. A glass of plain water beside the breakfast bowl covers both points.
What this isn't
This is a breakfast routine, not a treatment for gout. The NHS says your doctor may give you a list of foods to include or limit, and that uric acid-lowering medicine should be taken regularly, even when you no longer have symptoms. It also lists eating a very large meal, along with drinking too much alcohol, among the things that can trigger an attack. Vitamin C is one place where sources differ. The NHS says to ask a GP about vitamin C supplements, while the ACR guideline conditionally recommends against adding them, after two small trials of 29 and 40 patients showed clinically insignificant changes in uric acid.
A better gout breakfast is mostly about choices you make the night before: a plant protein, a bowl that is ready, a weighed portion of dates and water in the glass.
For dates to keep in that overnight-oats jar, see our range at Kurma Nabi or get in touch via our Contact Us page. There is more about Kurma Nabi on our about page.
References
- NHS. Gout. https://www.nhs.uk/conditions/gout/
- NHS. 8 tips for healthy eating. https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eight-tips-for-healthy-eating/
- NHS. 5 A Day: what counts? https://www.nhs.uk/live-well/eat-well/5-a-day/5-a-day-what-counts/
- FitzGerald JD, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. PMID 32391934
- Zhang Y, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis. 2012;71(9):1448-53. PMID 22648933
- Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336(7639):309-12. PMID 18244959
- Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8. PMID 21068145
- USDA FoodData Central (SR Legacy). Dates, medjool, FDC 168191. https://fdc.nal.usda.gov/food-details/168191/nutrients
- USDA FoodData Central (SR Legacy). Dates, deglet noor, FDC 171726. https://fdc.nal.usda.gov/food-details/171726/nutrients