Is whole grain bread really better than white bread in your gout diet? Or is it just another gout myth? Should you avoid bread altogether? Let’s find out…
Gout is an extremely painful form of inflammatory arthritis caused by higher-than-normal levels of uric acid in the blood out of which microscopic needle-like crystals of monosodium urate can accumulate in the joints and associated tissue.
Uric acid is a waste product of purine metabolism, which purines exist in our body’s cells and in the cells of the food we eat. Since food accounts for some 30% of the uric acid produced in our body us gout sufferers need to keep a careful watch on which foods we eat.
Bread and Gout
In case different breads affect gout in different ways, let’s take a quick look at how they’re made…
White bread is made from wheat kernels that have been processed (refined) to remove the bran and germ, leaving only the endosperm.
Wheat bread — without “whole” in front — is made using refined wheat flour which is the flour used in white bread. So it’s just another name for white bread.
Whole wheat bread is an entirely a different matter: it’s made from whole wheat kernels that contain the bran, germ, and endosperm.
Whole grain bread is also made up of whole kernels but, as well as whole wheat, whole grain bread also includes other whole grains, such as whole barley and whole oats, etc.
Whole meal bread is made from whole grains that have been milled to a fine “meal” or flour without removing the bran and germ.
Multigrain bread is just bread that’s been made from different types of grain. However, there’s no guarantee that any of the grains are whole, so you’ll need to check the ingredients label.
Note: To make things simpler going forward I’ll refer to whole wheat, whole grain, and whole meal breads, collectively, as “whole grain breads” or “whole grains”.
Whole Grain Bread vs. White Bread — Which is Healthier?
Whole grain breads have a higher nutritional value than white bread since they retain their bran, germ, and endosperm. White bread has had the bran and germ removed.
Whole grains are high in dietary fiber, protein, B vitamins, vitamin E, and minerals, such as calcium, iron, magnesium and selenium, etc. They also contain omega-3 fatty acids and, of course, carbohydrates.
Such nutrients can translate into healthy outcomes when consumed as part of a well-balanced diet. For example, studies show that replacing reﬁned grains with whole grains lowers the risk of many diseases, such as heart disease, stroke, diabetes, asthma, even colorectal cancer. They may also help to strengthen the immune system, lower blood pressure, and help in weight control.
So, in terms of their overall health benefits, whole grain breads are a better option than white bread. For example, you’d have to eat something like eight slices of white bread to get the same amount of dietary fiber — essential for digestive and cardiovascular health — as in a single slice of whole grain bread.
But we’re particularly interested in gout health aren’t we?…
Impact of Bread on Gout
Let’s first take a look at their purine content…
White bread is rated as being low in purines so, as far as its purine content goes, is safe with gout.
Whole grain breads are a bit higher in purines, but still safe when eaten in moderation.
Now let’s consider their sugar content…
Sugar, especially fructose and high fructose corn syrup (HFCS), has been associated with a higher risk of gout, so that gout sufferers are advised to severely limit its consumption.
It’s no surprise to discover that high fructose corn syrup is often added to white bread, during manufacture, to help improve its flavor.
What is surprising, though, is that some whole grain breads may also contain HFCS: not nearly as often as in white bread, but it can happen. So check the ingredients list.
There’s one final issue we need to consider and that’s glycemic index…
A food’s glycemic index indicates how slowly or quickly that food increases blood glucose levels. This is important for us gout suffers because, according to a 2016 study published in the National Library of Medicine, a food’s glycemic index (GI) has a positive correlation with uric acid. The study concluded that a lower GI was associated with lower uric acid.
For reference, glucose has a GI of 100, so that anything over 70 is considered “high”, 56-69 “medium”, and 55 or less “low”.
As a general rule of thumb, the more processed a food is the more likely it is to have a higher GI.
Well, it turns out that both white bread (75) and whole wheat/meal bread (74) have high GIs. Source: Harvard Health Publishing, Harvard Medical School. I have to say I was surprised at this as I was always led to believe that whole grain breads had a much lower GI than refined.
As far as their respective GIs are concerned, then, it seems that both may be considered problematic for gout sufferers if consumed to excess. Less so when eaten in moderation of course.
Whole Grain Bread vs. White Bread — Which is Safer with Gout?
There’s not that much difference between white and whole grain breads when it comes to their purine content and their glycemic indices. However, white bread is more likely to have had sugars added during processing and has much less nutritional value than whole grain bread.
So, on balance, the better bread for your gout diet is the much healthier whole grain, but only in limited amounts, say one or two slices per day.
But you have to ensure that you’re consuming 100% whole grain bread: Some products may have a “Whole Grain” stamp on the packaging but this doesn’t necessarily guarantee that it’s 100% whole grain.
Here’s how to check whether or not a bread sold as “Whole Grain” really has been made from 100% whole grains…
The first thing to realize is that, by law (and often by custom and practice), ingredients on packaging have to be listed in descending order of weight. This means that the main ingredient is listed first. The next thing to understand is that whole grains are rich in fiber whilst refined grains have very little or none.
So look for “whole grain”, “whole meal”, or “whole wheat”, at the top of the list of ingredients. “Whole” is important. Then make sure that the amount of dietary fiber indicated in “Nutrition Facts” is greater than 10% of Percent Daily Value (%DV). If both are true then you can be pretty sure it’s whole grain.
But, of course, you’re also interested to see if it contains added sugars, like high fructose corn syrup (HFCS), so check for that too. Tip: assume anything ending in “…ose” is a sugar.
Finally, some people are gluten intolerant and have to avoid the gluten found in bread made from wheat, spelt, rye, or barley, as well as a whole host of other commercial products. So if you suffer from celiac disease or non-celiac gluten sensitivity then you’ll likely have been advised by your doctor to avoid breads, whole grain or otherwise, that contain gluten.