Fish in a diet for gout patients – the prizes and the pitfallsFish oil supplements should be in a diet for gout patients, as described on the fish oil supplements page. The omega -3 and omega -6 fats are also called essential fatty acids. The word essential is used because, well, they are. Your body does not make them. You can get them from fish oil supplements and the other foods we explained on that page, and on the omega -6 page. Food and gout is a subject that interests all gout sufferers so we have to consider fish and gout too, not just the fish oil supplements. Fish high in omega -3 oils (fatty acids) should be eaten because their omega -3 oils are natural. This is quite a long discussion because it's an important diet for gout patients' topic, as we hope you will see. The question is.... how much fish should be in a diet for gout patients, and which fish are best? Many accounts of the value of omega -3 say "get it from cold water fish" and leave it at that. However many cold water fish are not very high in omega -3 fats. Some popular examples are: plaice, cod, sole, red snapper, flounder, haddock and halibut. These are not worth eating if you're looking for natural omega -3. But if you are lucky enough to be able to buy halibut caught in Alaskan waters...it does contain useful amounts of EPA and DHA and it is only moderately high in purines. To learn more about whether fish are a good food to eat for gout, we need to know how much of the omega -3 fatty acids are in different kinds of fish. Remember there are three omega -3 fatty acids – EPA, DHA, and alpha linolenic acid (ALA), but EPA and DHA, the ones found in fish, are much better than ALA. Click this link to view a very useful list of the amounts of omega -3 fatty acids in various fish, which can help you plan the right fish to eat. Depending on where you live some of these fish will be unknown to you but many should be familiar. So far so good. Fish are one of the good foods for gout because of their omega -3. But then let's now consider purines. When we do so, it becomes more difficult to reach a definite conclusion about which fish, and how much, to eat, but we shall reach a general conclusion about how much to include in a diet for gout patients. PURINES TABLE Consider the purines tables in this link. This table shows the amount of uric acid produced by 100 grams of a food.On this table there are four columns of numbers. Use the first three (left to right) columns and mainly the first left column. First left is the average amount of uric acid produced per 100 grams of a food. Purines themselves – there are four – produce different amounts of uric acid and the amount of each of the four purines in different foods is not the same. So the total amount of purines in foods differs. Second left (when numbered) is the minimum uric acid amount found in the testing, third is the maximum uric acid amount (when numbered) found in the testing. The difference between the minimum and maximum is sometimes quite significant which tells you to use this as an approximate guide only. Ignore the last column. FISH HIGH IN OMEGA-3 AND WHICH ARE NOT HIGH PURINE? Most fish are high or medium in purines. The tables for moderate in uric acid are quite a wide range, between 100 – 400 mg uric acid produced per 100 grams. It is probably better to assume that those fish which will be safer are those that produce up to 170 mg of uric acid per 100 grams of fish. Viewed this way, fish which are quite useful for omega -3, and are under 170 mg of uric acid produced are mackerel, salmon, certain kinds of mussels and certain kinds of shrimps. Mackerel, many types of which are high in omega -3,are shown to produce less than 170 grams of uric acid/100 grams, which appears to make them excellent. However, other purines' tables describe mackerel as high in purines. Two others worth mentioning are oysters and real caviar. Oysters are fairly high in omega -3 and low medium in purines. However, they are in the top ten for EPA/DHA. And these days oysters are expensive in many countries. Real caviar (black and red) is also worth a special mention. It is not shown in the linked table above to the omega -3 fish, but it is very high in omega 3 and medium purine. It is also expensive of course. There aren't any other high omega fish that are not also medium or high purine. Other purine tables There are other purine tables that show the amounts of purines, measured as mg of purines, per 100 grams of a food or beverage. Not the same as the amount of uric acid they produce, but still a useful guide. A good nutrition book you can buy from online bookshops, and which has a good list of the purines in foods, is Bowes & Church's Food Values Of Portions Commonly Used. It's a useful food reference guide for gout and will answer a lot of queries that flash through your mind about purines in your favourite foods. It will help you to select more low purine foods than you might think possible. Here is a link to this guide at amazon.com, or visit amazon in your country, if there is one. There are other online sellers.
Don't expect these tables, nor the omega -3 tables linked to above, to be absolutely precise. There are simply too many different variables at different testings. Among these are that amounts of purines are usually shown from raw food, and purine amounts can change when food is cooked. In other words this is fairly scientific, but not exactly. And that goes for virtually all nutrition measurements too. Remember too that purines from foods, like cholesterol in foods, only partially affect the amount of uric acid you produce. Most are produced in the liver. How often should you eat fish and with what? Since the benefits of high omega -3 fish make them a food to eat for gout, it's reasonable to say that eating fish that are not the highest in purines (for example between 100 – 400 mg uric acid produced per 100 grams of fish, and safer if the number is under 170 grams) twice a week is a good idea, especially if the rest of the meal is low purine which it will be if it's vegetables or a salad. The purines in vegetables and salad foods do not have much effect on uric acid levels. Despite their huge omega -3 benefit, you may have to be careful of salmon and mackerel If you think your uric acid levels are not falling because of fish in your diet, then reduce your intake. You know what you like, and some fish should be eaten. Study the tables we have linked to. And if you understand ounces better than grams note that 100 grams is about 3 ½ ounces, a small serving size. Other seafood reported to be medium/high purine, which are not listed in the purine table on the link are: scallops, unsmoked eels, other fish roes, clams, and tiny fish such as sprats and whitebait. A STUDY FOUND INCREASED RISK FROM FISH One study that found a risk of gout from eating fish was done a few years ago on men who had developed gout. It analysed the diets of 730 men who were thought to have developed gout. The researchers weren't completely sure that all 730 men did have gout, but we can assume most did – and this is a large number. In this study, those who ate the least fish certainly had the least risk. (The statistical number was less than 0.15 servings per day). But there was not much risk difference in groups who ate more than those in the least group. (The statistical number range was servings per day of 0.15 up to 0.56). Nevertheless, in this statistical range, the risk was definitely greater than those in the least group. And the risk was highest in those who ate the most. However, in the gout sufferers diet study that was quite successful against gout, the participants were recommended to eat fish at least four times a week for their polyunsaturated oils (omega -3 oils are polyunsaturated). This could be considered quite a high consumption of fish. However, we don't know what fish they ate, but we do know that the diet ignored purines. And it's important to say that insulin resistance was almost certainly their cause of gout, not excessive purine consumption over a number of years. The diet was quite successful in reducing gout attacks and in improving markers of heart health and insulin resistance. Perhaps the anti inflammatory, heart benefit and anti insulin resistance action of the omega -3 fish, was more effective than the potential rise in uric acid from the purines, but that's a guess.
Remember the fish oil dietary supplements don't contain purines.
Another point you may have to consider is that the amounts of omega -3 and purines in the types of fish eaten many countries are difficult to discover, probably because the research has never been done. Try to research this further if you live in one of these countries. Local rheumatologists may know and have anecdotal reports from other gout patients. And you may find that certain fish cause a personal rise in uric acid levels, and even gout attacks so be alert! The bottom line about fish in a diet for gout patients? Omega -3 fish are one of the good foods for gout, but you have to be careful.
HIGHLY REFINED FISH OILS www.zonediet.com is the website of Dr.Barry Sears, author of the best selling diet books "The Zone," "The Anti-Inflammation Zone," and others. Dr. Sears has developed a range of high quality, and the most highly refined omega -3 oils, (to really remove impurities), based on his 25 years research into omega-3 fatty acids and other nutrients. www.zonediet.com ship within the U.S. and Internationally. Visit the website for more details. To purchase these products click on the advertisement below. Clicking doesn't commit you. It takes you to the product page at the Zone diet's website.
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