Why the Mediterranean Diet is Good for Gout Health

Mediterranean diet
Image: G.steph.rocket, CC BY-SA 4.0 via Wikimedia Commons

The Mediterranean diet is considered to be one of the healthiest diets, but is it good for your gout?  Read on to discover what the Mediterranean diet is, its numerous health benefits and why, although it’s good for your gout, there are some issues you need to be aware of.

“Mediterranean diet” seems to imply that the different peoples living around the Mediterranean basin have a common diet. This clearly isn’t the case.

Each region has it’s own unique dishes, ingredients and flavors which have been shaped by geography, bio-diversity, cultural traditions, religious beliefs, socio-economic factors, and so on.

But there’s a lot in common too.

Some of this can be attributed to legacies of empire, for example, the Roman, Byzantine, and Ottoman Empires.

And Moors from North Africa occupied much of the Iberian Peninsula for centuries.

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Each invader brought with it it’s own culture, lifestyle, diet, and way of eating, that gradually influenced, but not necessarily replaced, those of the occupied peoples.

Furthermore, Spain and Portugal imported many exotic foods from their New World territories that were then traded throughout the Mediterranean (and beyond).

Typical of these New World foods are maize, potatoes, sweet potatoes, avocados, peppers, tomatoes, pineapples, sunflower, chocolate, and vanilla.

So what exactly is the Mediterranean diet and why do so many experts and national health agencies recommend it as one of the healthiest diets?

The Mediterranean Diet

The concept of a “Mediterranean diet” may have been first articulated by American physiologist Ancel Keys and his research chemist wife, Margaret, in their 1959 book “EatWell, Stay Well”.

They later updated and republished it in 1975 as “How to Eat Well and Stay Well the Mediterranean Way”.

During their research they discovered that cholesterol levels were much lower, and heart attacks less common, in countries like Italy, Spain, and Greece, compared to the United States.

They hypothesized that high cholesterol was a major factor in coronary heart disease and that the Mediterranean diet, which was lower in red meat and saturated fats, was the reason why heart attacks were less common around the Mediterranean basin.

Fast forward to today and it’s now known that issues such as high blood pressure, smoking, obesity, diabetes, and physical inactivity, are also high risk factors for cardiovascular disease (CVD).

Fortunately, a Mediterranean-style diet can have a positive effect, not only on cholesterol, but also on other CVD risk factors.

Even better, recent studies link such a diet with a range of positive health outcomes, not just cardiovascular health.

For example, as well as CVD, studies associate the Mediterranean diet with a decreased risk of metabolic syndrome, stroke, type 2 diabetes and cancer. Weight loss has also been noted.

And several observational studies link it to a reduction in all-cause mortality; meaning a longer lifespan.

[Note: The Mediterranean diet shouldn’t be confused with the “Dash Diet” (Dietary Approaches to Stop Hypertension) which, although similar, was designed by a panel of experts to specifically tackle high blood pressure.]

Dietary Guidelines

The Mediterranean diet emphasizes plant-based protein, such as vegetables, lentils, beans, nuts, and whole grains, as well as protein from eggs, milk, yogurt, and cheese.

There’s also moderate amounts of meat-based protein but it favors poultry and fish over red meat which is higher in saturated fat.

And healthier monounsaturated and polyunsaturated fats found in the likes of olive oil, fish and nuts are also emphasized. Olive oil is the main source of fat in the diet.

It’s low in cholesterol-raising refined grains, sugars and saturated fats.

Although it’s high in carbohydrates, it’s mostly complex carbs from healthier unrefined, fiber-rich foodstuffs.

The diet is nicely illustrated in the Mediterranean Diet Pyramid, which was developed by the Oldways Preservation Trust, the Harvard School of Public Health, and the World Health Organization…

Mediterranean Diet Pyramid
Image: Oldways’ Mediterranean Diet Pyramid

Working upwards…

Studies have shown that the diet isn’t just about the food, it’s also about a healthy lifestyle, for example, enjoying meals with others, having strong social networks, physical activity, and so on.

Every meal includes plant-based foods, such as olive oil (extra virgin is best), olives, vegetables, fruits, legumes, nuts, whole grains, herbs, and spices.

Seafood, especially oily fish, is encouraged at a rate of twice a week.

Moderate portions of poultry, eggs, and dairy are consumed daily or weekly.

Red meat is consumed only occasionally; modest portions once or twice a month.

Sugary stuff, refined products and processed foods are avoided or consumed very sparingly.

A daily glass (women) or two (men) of antioxidant-rich red wine is allowed, unless there’s a reason why it needs to be avoided.

Plenty of water — 8 x 8 ounce glasses per day — to stay hydrated.

The Mediterranean Diet and Gout

Gout is a form of inflammatory arthritis whose root cause is abnormally high uric acid levels in the blood, a condition called “hyperuricemia”.

Gout attacks (aka “gout flares”) occur when tiny monosodium urate crystals are formed out of the uric acid and collect in the joints and tendons. The big toe is the most common site but any joint may be affected.

Typical symptoms of gout attacks are inflammation, swelling, shiny red skin, warm to the touch, stiffness, and agonizing pain. The inflammation is systemic in nature so that some people may also experience fatigue, fever and chills.

Uric acid is the end product of purine metabolism, which purines are natural chemical compounds that occur in the cells of all living things, including our food sources. So the more purines ingested in food the more uric acid is produced in the body.

Healthcare professionals usually advise a low-purine diet which avoids high-purine foods, such as organ meats and wild game; limits moderately-high purine foods, like red meat and poultry; and encourages lots of low-purine foods, such as vegetables, fruits, nuts, seeds, whole grains, and low-fat dairy.

And sugar, especially high fructose corn syrup in processed foods and beverages, is also associated with high levels of uric acid. So processed foods and sugary soft drinks and sodas are to be avoided or severely limited.

But a gout diet still needs to be nutritious. What are the alternative sources of nutrition when meat, poultry, and seafood, are either avoided or limited?

A healthy low-purine gout diet looks like this:

Most protein comes from vegetables, beans, nuts, and seeds, as well as eggs and low-fat dairy products. Some animal protein from modest amounts of lean meat, poultry, and seafood.

Complex carbs from vegetables, fruits, whole grains, and low-fat natural yogurt and milk.

Essential fatty acids from vegetables, eggs, olive oil, whole grains, seeds, and nuts, with limited amounts of certain types of oily fish.

Fiber from vegetables, fresh and dried fruit, beans, peas, nuts, seeds, and whole grains.

Vitamins and minerals from vegetables, fruits, dried fruits, beans, nuts, seeds, olives, olive oil, low-fat dairy, eggs, and whole grains, with moderate amounts of lean meat, poultry, and seafood.

This is very similar to the Mediterranean diet:

  • Vegetables, fruits, beans, nuts, whole grains, legumes, herbs, and olive oil on a daily basis.
  • Moderate servings of poultry, eggs, and low-fat dairy, daily to weekly.
  • Moderate servings of seafood, especially oily fish, at least twice a week.
  • Modest amounts of red meat perhaps once or twice a month.
  • Sweets and processed meats hardly ever, if at all.

So it’s clear that the Mediterranean diet aligns with the purine-restricted gout diet that emphasizes plant-based foods and strictly limits animal protein, saturated fats, and sugar.

And this has been backed by a number of studies, such as “The role of the Mediterranean diet in hyperuricemia and gout” review which associated the Mediterranean diet with reduced uric acid levels.

However, whilst the Mediterranean diet is undoubtedly a gout-friendly one, there are some issues to be aware of…

Potential Problems with the Diet

There may be some issues with the diet, not so much the diet itself, but rather the way in which it is interpreted and consumed.

For example, there’s a risk of weight gain through consuming too much (albeit good) fats and too much red wine. Being overweight is a known risk factor for gout as is too much alcohol consumption, although red wine may be the least risky of alcoholic beverages.

And there may be a lack of certain nutrients, for example, insufficient iron from reduced red meat consumption, and not enough calcium through reduced dairy.

Of course, what’s eaten around the Mediterranean today isn’t exactly the same as it was when the Keys carried out their initial research; similar, but not necessarily the same.

Back then many regions around the Mediterranean basin were relatively poor. Of necessity, meals were perhaps more frugal, but highly nutritious nevertheless.

However, the standard of living has improved markedly over the past 50 years as has the availability of relatively cheap foods, including meat, meat products, convenience foods, and unhealthy saturated fats and sugars.

So it might not be a good idea to base your “Mediterranean diet” solely on what you might experience on your travels in the region today.

Stick to the classical Mediterranean diet model (the pyramid) which is based on the traditional diets of countries bordering the Mediterranean Sea.

People with gout need to be extra careful though…

The Mediterranean diet allows moderate amounts of seafood at least twice a week. However, people with gout have to avoid high-purine seafood, such as anchovies, sardines, clams, shrimp, prawns, and langoustines.

A modest serving of moderately-high purine seafood, such as cod, haddock, hake, octopus, lobster, salmon, and sea bass, twice a week, is fine though.

A gout-friendly diet also avoids organ meats and game. So stay clear of those.

Infrequent, modest amounts of lean red meat (as in the Mediterranean diet pyramid) are okay.