North Indian Diet plan for High Uric acid levels and Gout


Dietary Guidelines- The objective of planning a diet for a patient  with High Uric Acid is to meet his daily requirements while keeping low in purine rich foods. Uric acid is produced due to the breakdown of purines. In some people, the kidney does not efficiently excrete uric acid. Hence, this excess uric acid in the blood is deposited as crystal near the joints causing Gout.

How does food influence uric acid In Gout patients?
Trigger foods are generally high in purines, a chemical found naturally in foods. This isn't a concern for healthy men and women, as they efficiently remove excess uric acid in the body. However, people with gout can not effectively remove excess uric acid. Therefore, a high-purine diet can let uric acid accumulate and cause a gout attack.

Fortunately, research shows that restricting high-purine foods can help lessen gout attacks. Foods that commonly trigger gout attacks include organ meats, red meats, fish, beer and alcohol. They have a moderate-to-high quantity of purines. However, research demonstrates that high-purine vegetables don't trigger gout attacks. And interestingly, sugar based drinks can increase the risk of gout and gout attacks, although they're not purine-rich.
An ideal plan for this High Uric Acid diet should have specifications as stated below: 

Cereals-   Most of the cereals is moderately rich in Purines and hence should be limited to one cereal per meal.
Proteins-  Meeting the protein requirements for these patients is a challenge, as most protein food are high in purines. Avoiding legumes, meat, poultry, fish and dairy is necessary. However, we can use proteins like egg white, low fat milk and its products and a few nuts to meet the daily target.
Fats-     20% of daily calories should come from fats. However avoid saturated fats from animal source.
Fruits-  Fruits rich in Vitamin C should be focused on. Other than that cherries and other berries are proven to reduce uric acid levels.
Vegetables-  Using plenty of vegetables is recommended. However avoid high purine vegetables like spinach, asparagus, cauliflower and mushroom.
Sugar-  The prevalence of diabetes and obesity is very high in patients who have high Uric acid levels. Hence, sugar intake should be as minimal as possible.
Salt-  When the serum uric acid levels are high it is better to use minimal salt as uric acid combines with sodium to form crystals. There is also a high chance of hypertension when uric acid levels are high.I would suggest sprinkling a little salt on the food after it’s cooked. 
By this method we can always keep a check on our salt intake.
Water- One should drink minimum 3 liter of water daily to flush out excess uric acid. 
Alcohol- Alcohol consumption increases uric acid in the blood and should be avoided completely.

This is sample uric acid diet with 1300kcal, ideal for a person with high uric acid levels and looking for weight maintenance.

Breakfast- Cabbage Parathas with Apple Chutney



Energy- 350kcal, Proteins- 6.1g, Carbohydrates-42 g, Fats-4 g
A good Breakfast is a key to good health. I have chosen cabbage for breakfast as its vegetable with negligible purine content. To add to its benefits, we have chosen a dip that contains apple cider vinegar. This super food for patients with gout issue is a challenge to consume raw due to its extreme sour taste. However combining it with sweet apples makes its delicious to consume.

Snacks- Strawberry Choco Lassi




Energy- 150 kcalProteins- 6g, Carbohydrates-10g, Fats-5g

Our breakfast was perfect but the only nutrient that was lacking was proteins. Well, this hung curd recipe will provide us with the morning dose of proteins. Along with it we shall combine two yummy ingredients that have proven to lower Uric acid level. Yes, its dark chocolate and strawberry. We shall grate a piece of dark chocolate on the top so that our lassi doesn’t get bitter.

Lunch- Punjab egg curry + Jeera rice



Energy- 360kcalProteins- 6.6g Carbohydrates-66, Fats-6g
As meats are not preferred by these patients, a non-vegetarian gut remains unsatisfied. However, most people forget that they can consume egg whites for a palatable taste and for protein intake too. We shall also concentrate on one carbohydrate source in one meal as obesity and uric acid are very closely related. Hence I have selected rice for lunch, and avoided it in dinner so that one can metabolize it throughout the day. I have tried to create a balanced uric acid diet so that you can digest this during the day.

Snacks- Cherry Lime Margarita



Energy- 30kcal, Proteins- 1g, Carbohydrates-10g, Fats-0 
Researches show that daily consumption of a bowl of cherries can reduce uric acid levels. A combination with lemon juice adds to its Vitamin C content. On the whole this recipe is a boon for patient with gout problem. This recipe will also help to reach the daily water intake target.

Dinner: Low fat Paneer Burji  ( Cottage Cheese Scramble ) + Ajwain Paratha ( Caraway Tortilla) 



Energy- 350kcal Proteins- 10g Carbohydrates-42g, Fats-4 g
This meal would be delicious to taste and at same time provide numerous benefits. Firstly low fat cottage cheese will give the necessary proteins to meet the recommended intake. In Ayurveda  Ajwain is recommended  to reduce uric acids levels and helps with gout. Therefore this meal would be a perfect combination of good proteins, carbohydrate and loads of antioxidants.

Bedtime- Badam Milk ( Almond Milk) + Almonds



Energy- 60kcal   Proteins- 3 g Carbohydrates-7g, Fats-2.5 g
This milk is extracted from almonds. It is purine free and hence can be consumed daily to meet the protein requirements.


References:
1. https://www.nejm.org/doi/full/10.1056/NEJMoa035700
Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men
Hyon K. Choi, M.D., Dr.P.H., Karen Atkinson, M.D., M.P.H., Elizabeth W. Karlson, M.D., Walter Willett, M.D., Dr.P.H., and Gary Curhan, M.D., Sc.D.
March 11, 2004  N Engl J Med 2004; 350:1093-1103     DOI: 10.1056/NEJMoa035700

2. J Hum Nutr Diet. 2009 Feb;22(1):3-11. doi: 10.1111/j.1365-277X.2008.00928.x.
The role of diet in the management of gout: a comparison of knowledge and attitudes to current evidence.
Shulten P1, Thomas J, Miller M, Smith M, Ahern M.

3. Ann Rheum Dis. 2012 Sep; 71(9): 1448–1453.
Published online 2012 May 30. doi: 10.1136/annrheumdis-2011-201215
Purine-rich foods intake and recurrent gout attacks
Yuqing Zhang, Clara Chen, Hyon Choi, Christine Chaisson, David Hunter, Jingbo Niu,1 and Tuhina Neogi

4. Gout.    Richette P, Bardin T.        PMID: 19692116 DOI: 10.1016/S0140-6736(09)60883-7
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