Gluten is found, not just in wheat, but also hidden away in more foods than you might realize. And since diet is a key tool for managing your gout it’s important to understand how your body reacts to this natural protein.
Gluten and Gout
Gluten is a natural protein found, not just in wheat, but also in other cereals such as barley, rye and triticale (a wheat/rye cross). It’s the ingredient that gives dough its elasticity and helps it rise and keep its shape.
Simply put, gluten is the glue that holds baked goods and pasta together. More technically, gluten is the composite of a gliadin and a glutenin which is combined with starch in the endosperm of various grass-related grains.
Gluten itself offers no particular nutritional benefits but the whole grains that contain gluten are themselves rich in vitamins, minerals, iron, and fiber. Studies have shown that many whole grain foods may help lower the risk of heart disease, type-2 diabetes and some forms of cancer when used as part of a healthy diet.
However, there are some people who have to avoid gluten, such as those with celiac disease or non-celiac gluten sensitivity. But it can be difficult for them because gluten isn’t always “on show” and can be hidden in many processed foods we consume today. For example, all wheat based flours contain gluten, so anything made with flour from wheat, rye, barley or triticale will all contain gluten.
And it doesn’t end with flour: gluten is also added to a surprising number of processed foods we use today, such as bread, cookies, pastries, noodles and pasta. It’s also hidden in things like tinned products, soups, deli meats, sauces, salad dressings, marinades, spices, flavorings, cheese, dairy products, beer, and is often disguised as hydrolyzed vegetable protein (HVP) and modified starch. It can even be found in make-up and medicines!
So, seeing as how gluten is so prevalent, it’s important for us gout sufferers to understand how gluten may affect our gout…
Gout is a very painful form of inflammatory arthritis caused by high levels of uric acid circulating in the bloodstream, a condition called hyperuricemia.
Uric acid is the end product of purine metabolism, which purines are natural chemical compounds found in the cells of all living things, including humans, animals and plants.
A gout flare (attack) happens when minute, needle-shaped, crystals of monosodium urate precipitate out of the acid and settle in a joint. The body’s innate immune system recognizes these crystals as potentially harmful and triggers a pro-inflammatory response at the affected site, giving rise to the symptoms of a painful gout attack.
Around 30% of the uric acid produced in our body comes from the food we eat so people with gout have to be mindful of everything they eat (and drink).
Can Eating Gluten Cause Gout?
We already know that those suffering with celiac disease or non-celiac gluten sensitivity (sometimes referred to as gluten intolerance) have to avoid gluten. So if we can understand how gluten causes those two conditions we may be better able to understand how gluten affects gout sufferers, if at all.
Let’s take a quick look at both conditions…
Celiac disease, also known as gluten sensitive enteropathy and celiac sprue, is a well-established autoimmune disorder affecting the small intestine. It’s reckoned that around 1% of Western societies suffer from the disease.
Celiac disease is caused by the immune system in the body reacting adversely to gluten. When gluten enters the body of a celiac the body’s own immune system not only attacks the offending substance but also attacks other tissues in the body. This autoimmune response produces inflammation that damages the villi (small finger-like projections) in the lining of the gut which stops it from properly absorbing nutrients and vitamins from food. Eventually the gut can become permeated or “leaky.”
It’s believed that, as the body’s immune system is constantly responding to gluten, its pro-inflammatory response becomes systemic and thus can affect other areas of the body, notwithstanding gluten entering the bloodstream via a leaky gut. Some common symptoms are:
- abdominal pain
- bloating and gas
- unexpected weight loss
- nausea and vomiting
- joint pain
- tingling feeling in feet and hands
- depression and anxiety
Celiac disease is genetic, so if someone in the family already suffers from the disease it is likely that others will too. If a close family member, such as a parent or sibling has celiac disease then the chances of developing the disease are 1 in 10.
It affects males and females of all ages and races who have the specific hereditary genes that predispose them to the disease. And according to Dr. Sheila Crowe, a professor in the Department of Medicine at the University of Virginia, it’s virtually impossible to get celiac disease without these particular genes.
It can be triggered, or become active, for the first time in someone who has had surgery, is pregnant, has given birth, has had a viral infection, or has severe emotional stress.
It is important to get tested as, left untreated, celiac disease can lead to osteoporosis, anemia, low-bone density, iron deficiency, and can also increase the risk of lymphoma. Once on a gluten-free diet, where the body doesn’t continually attack itself, the body is able to begin to heal.
In very rare cases, where the disease has been present for a long time untreated, the patient can suffer from refractory disease where a gluten-free diet gives no improvement, as the intestine is so badly damaged it’s unable to heal enough to absorb nutrients. This can only be treated with medications, so it’s very important to be tested early if there is any reason you think you may have celiac disease.
There is no known cure for celiac disease at present. The only treatment available is a gluten-free diet.
Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity is controversial in that not all experts agree on its cause or even if it actually exists. Having said that, some do believe that there’s now enough evidence to establish it as a real condition, completely separate from celiac disease and wheat allergy.
Non-celiac gluten sensitivity gives all the symptoms of celiac disease to the sufferer, but is affected by a different immune system reaction. The antibodies that attack the gluten do not turn on the body tissue and damage the intestinal wall.
Some experts believe that the mechanism that triggers non-celiac gluten sensitivity is an innate immune response. This is the body’s very basic, first-line response to foreign invaders. It isn’t antigen-specific and not capable of “memorizing” antigens and how to deal with them. And it doesn’t attack the body’s own tissue. So it isn’t the same as an allergic immune response (e.g., wheat allergy) or an autoimmune response (e.g., celiac disease).
Unlike in celiac disease, there is no current test for non-celiac gluten sensitivity. If a person suffers when consuming gluten, yet tests show they don’t have celiac disease, they may still be sensitive to gluten and would benefit from a gluten-free diet. And although their immune system is not attacking itself — so there’s no damage to the intestinal wall — it will still make them very sick and this could show in a number of other illnesses, not just an upset tummy.
Since there isn’t a test for non-celiac gluten sensitivity the number of people with the condition is very hard to quantify. Numbers can only be speculative, with estimates ranging from 1% to 6% of Western populations. Some believe it could be very much higher.
As with celiac disease there is no known cure for non-celiac gluten sensitivity. The only treatment is a gluten-free diet.
Does Gluten Cause Gout?
As noted earlier, due to systemic inflammation, not all symptoms are related to the digestive system, for example things like joint pain are fairly common.
So, since gout is an inflammatory disease of the joints, could the presence of gluten produce a similar response in gout sufferers? And, if so, how?
First, we need to separate out those with celiac disease or non-celiac gluten sensitivity as their joint pain is due to systemic inflammation alone. But this isn’t gout, which is caused by the body’s pro-inflammatory response to uric acid crystals physically being present in the joints. And they have to avoid gluten in any case so the gluten/gout issue in these groups is moot.
But well-designed studies into gluten in otherwise healthy humans are lacking. Most are in vitro (“test tube”) and animal experiments and where there are actual human studies most of those involve celiac patients.
For example, according to a 2017 study by Agnieszka Piatek-Guziewicz and colleagues, celiac patients had significantly higher uric acid concentrations than controls. So, based on those higher uric acid levels, celiac patients may have a higher risk of gout than non-gluten-intolerant patients. However, the authors didn’t make this claim as they weren’t tracking incidences of gout in the study group.
This still may be a reasonable assumption, though, since there is some evidence that celiac patients tend to have higher rates of rheumatoid and other arthritides. It should be noted, however, that although gout is a form of arthritis it isn’t an autoimmune condition, unlike rheumatoid arthritis.
But what about those who don’t have celiac disease or gluten sensitivity?
Unfortunately, I couldn’t find any studies that specifically researched the effects of gluten on gout patients without celiac disease or gluten sensitivity. So there’s nothing out there, at least that I can find, that associates gluten with a higher or lower risk of gout in non-gluten-compromised adults.
So where does that leave us?
Well, whilst the apparent lack of specific research on the effect of gluten in gout patients is unfortunate, there’s another way we may approach this: many foods that contain gluten can increase the risk of gout by other, well established, means….
For example, many, if not most, processed foods with gluten are also high in added sugar, fat and calories which can lead to weight gain: a high risk factor for gout. Sugar (fructose) in foods can also increase uric acid and so compound the risk of gout.
In addition, gluten foods, like white bread, pasta, and white rice are high on the glycemic index (GI) which indicates that they produce a rapid rise in blood sugar when ingested. Studies have shown a positive correlation between GI and uric acid.
Many gluten-containing foods are also pro-inflammatory and inflammation is a contributory factor in gout.
Lots of gluten foods are acidic and a study by Aya Kanbara and colleagues showed that acidic diets are associated with increased blood uric acid and decreased uric acid excretion.
Furthermore, it’s known that both celiac disease and gluten sensitivity can be “silent” or asymptomatic, meaning that some sufferers don’t display any obvious symptoms. So it may be that some gout sufferers are gluten intolerant or have celiac disease without even knowing it. In that case gluten may increase their risk of recurrent gout and it wouldn’t be obvious that intolerance could be the trigger.
So, even in the absence of specific studies on gluten and gout, it’s pretty clear that people with gout are best to avoid or, at the very least, reduce the amount of gluten-containing foods in their diet.
Included in the lists below are products that may not contain gluten but the possibility that they do is high. Anything in the list in normal type does contain gluten, anything in these lists that are starred* may or may not contain gluten, so please read their labels.
Grains and Alternatives
- Bulgar wheat
- Durum wheat
- Emmer wheat
Bread, Cakes, and Biscuits Made From Wheat, Rye, or Barley Flour
- All biscuits
- Pizza bases
- Wheat based breakfast cereals
*Check labels on cereals based on these and those that contain barley malt extract
Pasta and Noodles
- Canned, dried and fresh wheat noodles and pasta
Meat and Poultry
- Meat and poultry cooked in batter or breadcrumbs
- Breaded ham
- Any meat or poultry marinated or in a sauce*
- Meat pastes*
- Marinated tofu*
- Soya mince*
- Vegetable and bean burgers*
Fish and Shellfish
- Fish or shellfish in batter or breadcrumbs
- Fish cakes
- Fish fingers
- Fish pastes*
- Fish pâtés*
- Fish in sauce*
Cheese and Eggs
- Scotch eggs
- Some soft, spreadable cheeses*
Milk and Milk Products
- Yoghurt with muesli or whole grains
- Coffee and tea whiteners*
- Fruit and flavored yoghurt*
- Fromage frais*
- Soya desserts*
- Rice milk*
- Soya milk*
Fats and Oils
Fruits and Vegetables
- Vegetables and fruit in batter, breadcrumbs or dusted with flour
- Fruit pie fillings*
- Processed vegetable products (such as cauliflower cheese)*
- Potatoes in batter, breadcrumbs or dusted with flour
- Potato croquettes
- Oven, deep fried, microwave and frozen chips*
- Instant mash*
- Potato waffles*
- Ready to roast potatoes*
Nuts, Seeds, and Pulses
- Dry roasted nuts*
- Pulses in flavored sauce (such as baked beans)*
- Snacks made from wheat, rye, barley
- Flavored popcorn, potato and vegetable crisps*
- Flavored rice cakes and rice crackers*
Preserves and Spreads
- Lemon curd*
- Peanut and other nut butters*
Soups, Sauces, Pickles, and Seasonings
- Chinese soy sauce
- Blended seasonings*
- Brown sauce*
- Canned or packet soups*
- Curry powder*
- Gravy granules*
- Mustard products (such as English mustard)*
- Packed and jarred sauces and mixes*
- Salad cream*
- Stock cubes*
- Tamari (Japanese soy sauce)*
- Tomato sauce*
Confectionery and Desserts
- Ice cream cones and wafers
- Liquorice sweets
- Puddings made using semolina or wheat flour
- Ice cream*
- Tapioca pudding*
- Barley waters and squash
- Malted milk drinks
- Cloudy fizzy drinks*
- Drinking chocolate*
- Batter mixes
- Stuffing mix
- Baking powder*
- Cake decorations*
- Ready to use icings*
Let’s Sum Up
Although the science is somewhat lacking on whether or not gluten, in and of itself, increases the risk of recurrent gout attacks, we do know that many of the foods containing it have properties that can.
The bottom line is that many foods and drinks containing gluten are pro-inflammatory, high in sugar and are acidic-forming when consumed; some can even have high purine concentrations. All of these are risk factors for people with gout.
Luckily, a low-purine, low-sugar, alkaline gout diet already excludes or minimizes many gluten-containing foods. Detailed listings of foods to avoid and foods to moderate can be found in my breakthrough guide: Gout Rescue.