Failsafe - best gout diet?

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“What do you think about diet for gout?” asked a relative at a recent family wedding in New Zealand. “My father had severe gout, and I am scared I might get it.” 

Given that his father was full Māori, this is a very important question. Gout is the most common inflammatory arthritis, can be insanely painful, is linked to the Western diet, is increasing worldwide and Māori people have one of the highest rates.

“In men aged 65 and over, gout is estimated to affect 17 percent of non-Māori- non-Pacific people, 37 percent of Māori and 47 percent of Pacific people” (NZ Govt stats, 2019)

Twenty-five years ago, we started supporting families doing the RPAH Elimination Diet after it worked so well for us. We were surprised by how many failsafers mentioned an improvement in gout, like this one:

  “My husband’s gout has improved since our family went failsafe. He’s not really on the diet but eats a lot of our failsafe food” – Michelle [1531]

High purines

Back then, the official gout diet was simply to limit high purine-containing foods and drinks: meat, seafood and alcohol, especially beer.

Low-dose salicylates

Next, medical journals reported that gout sufferers might have to avoid certain medications especially low-dose aspirin (salicylates), commercial sweetened drinks and fruit juices and more foods such as tomatoes (high in salicylates, though this isn’t recognised) – and gout was still increasing.

“Some people find that certain foods such as strawberries, oranges, tomatoes and nuts will trigger their gout even though they are not high in purines. Although there is no clear evidence to suggest why this happens, it is probably best to avoid them if you have had this experience.” –from UK Gout Society

High purine food additives

Then - without a label warning - high purine food additives became really common in the late 1990s and the rate of hospital admissions for gout in NZ doubled over the next 10 years.

“People suffering from gout, which requires the avoidance of purines, should avoid this substance [flavour enhancers E627, E631 and E635]” - Maurice Hanssen, Additive Code Breaker, 2002

Failsafe avoids …

Finally, it dawned on me – the diet we recommend (RPAH elimination diet) works so well because it avoids:

  • high amine & glutamate foods - strongly flavoured meat and seafood that are also high in purines
  • most alcohol -  gin, vodka and whisky are the only failsafe drinks. One gout study found beer drinkers increased their risk by 50% for every daily serving, while those who drank hard liquor increased their risk by 15% for each drink
  • MSG boosters E627, E631 and E635 (guanylates, inosinates and ribonucleotides) - not even mentioned in most gout diets
  • salicylate-containing drugs like aspirin and high-salicylate foods like tomatoes, strawberries, oranges, fruit juice and flavoured commercial soft drinks

Everyone is different. A trial of the RPAH elimination diet with challenges can help to identify individual gout triggers.

A reader story

[1531] RPAH diet works better for gout than prescribed medical low purine diet (June 2019)

My male partner  (47) has suffered from medically diagnosed gout for three years and has tried many things; prescribed medication, a low lectin diet (as per the Plant Paradox book by Stephen Grundy), the prescribed medical low purine diet to no avail. His gout was in his foot/ankle and when it flared he could not even stand the bedsheet touching his foot.

I had done the failsafe diet for my daughter 20 years ago with success and I encouraged him to try failsafe. He undertook the failsafe diet as per the RPAH regime (no dietician). We only challenged salicylates, amines and glutamates as we do not eat artificial additives. He is gluten free and only has A2 milk (prior to failsafe as these foods suit him better).When we undertook the challenges he passed the salicylate challenge and failed miserably with amines and glutamates; both bringing on gout. He avoids all amines and glutamates and he is now gout free. – Susan

More info

Gout and diet factsheet

Introduction to food intolerance