What are purines, and how do they cause gout?

Gout is not really complex (if you look at it from the attack perspective). A buildup of organic crystals in the joint fluid is interpreted by your body as a virus attack, and the body triggers the same response as it would if you actually had a virus infection - an inflammation. The inflammation response is the immune system deploying white blood cells and increasing the blood flow in the affected body part, which makes it swell up - and this causes the pain. I have written more about the inflammation on another page, and what you can do if you have a gout attack in yet another.

RAW MATERIAL FOR URIC ACID

It is uric acid that causes the gout pain. So why is everyone talking about a diet low in purines?
It is very simple: The raw material fot uric acid is purines. And the raw material for purines is genetic material from dead cells. Uric acid is not a simple molecule like acetic acid, it is a complex protein made up of several amino acids.
Actually, there are several intermediate steps between purines and uric acid, which involve the creation of enzymes from the purines, and those enzymes being used in the breakdown of sugars and the energy production in the body, but no need to go into that now. One thing to remember though is that we are talking about very small volumes of uric acid - less than a hundredth of an ounce. This is because the enzymes and the uric acid are continously being replaced as soon as they are used up.

ADDING PURINES BY RECYCLING CELLS

Purines are produced in your body when you recycle cells. That is, your body makes it from dead cells. Then it turns them to antioxidants which are used in the energy production in your body. When your body is done with the purines, it turns them into uric acid in the liver, and then the uric acid is flushed by your kidneys. In theory. Uric acid is also a strong antioxidant and it does its best to mop up the free radicals that abound in the body. Not all of them are bad but the uric acid (and other antioxidants) do their best to keep the balance in the body.

Japanese beer-like drink from Asahi, made from soy beans and with zero purines, as well as zero calories and zero alcohol. Not zero taste though.

You can also get purines through what you eat or drink. Since they are used in energy production your body takes them up very easily. The problem if you have gout is that your body produces purines and then you are adding more through your diet. It becomes impossible to get rid of gout since the purines broken down to uric acid are constantly replenished.

I have been trying to understand something which is crucial to understand when it comes to gout: Why your body digests all those extra purines which you get in your food, unless you go on a purine-free diet. If you eat more fat than you can metabolize, the ectra fat gets execreted through your poop. Carbohydrates get digested and either used as energy in your cells or stored as fat (if they are not needed right now).

KNOWING YOUR BASELINE

Your body produces a baseline of uric acid, typically between 5 and 8 mg/dL. But then, you have to add your purine intake on top of that. If your baseline is low you can control your gout by diet. If it is high, your body is not balanced and you need allopurinol to keep it down. Typically, the purine addition from what you eat to your uric acid levels is between 10 and 30 % of the total. 30% of 6.8 is 2.4, so if you already am on 6.8, eating a purine-rich diet will raise you above 9.2, which is high. If your uric acid level is around 10, you will be adding 3 mg/dL. And 13 mg/dL is high enough that you will almost certainly have a gout attack.
​If you want to control your gout, you not only want to measure the uric acid level in your blood (which goes up and down and can be 2 to 3 mg/dL higher than in the morning after lunch). You also want to know the baseline so you are sure how much you are adding through your food and drink.
If you want to establish the baseline for your uric acid level, you need to eat a purine-free diet for a few days. I have put together a special web page about that.

GOUT AND WEIGHT LOSS

Even if you were to start a water fast, eating absolutely nothing and not drinking anything but water (which has neither calories nor purines), your body would still produvce purines from recycling the cells that die in your body when you lose weight. These purines are then turned into uric acid when they have finished working in the energy production systems of the body.

Meat is a rich source of purines - because it contains lots of dead animal cells.

There are purines in all animal-based foods, and some vegetables. What is important to remember, however, is that the production in your body is a baseline, and then you top it up with what you eat.

PURINES ARE NOT PROTEINS

When the idea of managing your diet to manage your medical conditions became popular, the people designing the diets believed purines and proteins were simular. The gout diets became protein-poor. But this is not true.
While a traditional diet rich in protein will contain a lot of purines, all protein-rich products do not contain purines. Cheese, milk, whey, eggs and tofu consist mostly of proteins but contain very little purines. The reason becomes evident if you look at how they are made.

THE MAKINGS OF TOFU

Beans are the best protein source for vegetarians. But beans are the vegetable that is richest in purines - almost as much as some types of meat (but still lower). There is no way of removing the purines from beans - except one.
Tofu contains a lot less purines than whole beans. Grinding up the beans and dissolving them in water, then making the mix settle and capturing the tofu clearly makes most of the purines go into the lees. As a result, tofu is one of the safest protein sources for gout sufferers.

NOT DESTROYED BY COOKING

Purines are made to be resilient, like the DNA they are made from. Purines are resistant to cooking at normal temperatures. DNA degrades at temperatures above 220 degrees centigrade, so ordinary bread does not retain any DNA from the yeast in it (and hence no purines). But ordinary cooking does not destroy the purines.

EGGS WITHOUT CELLS

Eggs are proteins in a shell, with a yolk that contains everything else you need to make chickens. When the danger for gout-sufferers was considered proteins, eggs were a major danger.
But since the problem is in the cell core, and eggs only have one in a big shell, they are a better part of a gout diet than most other animal foods - except for cheese and milk products, which do not contain any genetic materials at all.

PLANTS TO AVOID

It is animal products and seafood which contain the most purines, followed by beer (since beer essentially is a solution of dead yeast cells in water). Some plants also have high levels of purines, like beans and shiitake mushrooms. You can read more about it on the forbidden foods page. Asparagus and spinach are also among the purine-rich vegetables, but differently from beans, you can not make tofu from them.