In this video Dr. David Perlmutter examines whether vegetables that are high in purines—such as broccoli, cauliflower, leeks, mushrooms, spinach, artichokes, Brussels sprouts, and others—should be avoided by people trying to control uric acid or who have gout. He reviews two large epidemiological studies: a cross‑sectional study of about 2,000 adults that used food‑frequency questionnaires and plasma urate measurements, and a much larger cohort of roughly 47,000 participants. Both studies found that higher consumption of purine‑rich vegetables was associated with lower plasma uric acid levels and no increased risk of gout. Perlmutter explains that, despite containing purines, these vegetables also provide dietary fiber, bioflavonoids that inhibit xanthine oxidase, and modest vitamin C, all of which help lower uric acid production or promote its excretion. He concludes that restricting these vegetables is unnecessary and that they should be encouraged in the diet of anyone—especially those with elevated uric acid or gout. The video ends with a practical recommendation to include these vegetables as part of a uric‑acid‑friendly diet.
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Hello everyone, I'm Dr. David Perlmutter. You know, in our efforts to keep uric acid under control, the recommendations are, of course, be careful about the type of alcohol that you consume, be on a diet that really limits your consumption of fructose, and we've also talked about purines, these breakdown products of DNA and RNA that can raise uric acid as well. We find high levels of purines in certain foods like organ meats, kidney and liver, and certainly in small fish like anchovies and sardines, but there are high levels of purines, or there are some vegetables that are described as being high in purines, and they have familiar names. Things like cauliflower, broccoli, bok choy, and mushrooms, for example, have high levels of purines, and you might find online, for example, in some of the forums related to gout, that there are recommendations that gout sufferers, that's a disease characterized by generally high levels of uric acid, should avoid purine-rich vegetables. And gee, that's taking a lot of seemingly good food off the table, especially things like broccoli, the cruciferous vegetables. Is that really a good idea? Let's take a look. Let's unpack that a little bit and see what the science tells us. So again, the question is, should we consume high purine vegetables, vegetables like broccoli? I mean, all these years we've been told, gosh, broccoli is a superfood, we want to increase available sulforaphane in the body, any number of things that we were told is good about broccoli. And it turns out that it's really valuable to look at this. If broccoli is high in purines and other vegetables are high in purines like artichokes, leeks, Brussels sprouts, mushrooms, and spinach. What does that tell us in terms of dishes like this, which I have to admit looks really, really good? So are we to abandon high purine vegetables because of their propensity, possibly because of the high purines, to increase uric acid? Does that stand the test of science? And in fact, it's been looked at quite extensively. This is one— a study that is entitled The Association of Dietary Intake of Purine-Rich Vegetables, like broccoli, like mushrooms, Sugar-Sweetened Beverages, and Dairy with Plasma Urate in a Cross-Sectional Study. And what these individuals who did the study looked at, they had just over 2,000 participants, about 44% female, so the rest male, and they gave them a food frequency questionnaire so that they could determine what they were eating, and they also measured their plasma uric acid levels. So what are you eating and what is your uric acid level? And what did they find? Well, they looked at both men and women and they stratified these individuals based upon, in this case, they did a lot of evaluation of these people, but they looked at them in terms of their intake of what are called purine-rich vegetables. vegetables and correlated that or compared that to their uric acid levels. Now, women in green, men in blue. What you see is moving from left to right, looking at the green bars, the women, that the higher levels of eating purine-rich vegetables on the right side, quartile number 4, these are the people, these are the women who have— That's right. The greatest level of purines from vegetables consumption, look at their uric acid level. It's in fact the lowest. Men have in general a higher uric acid level, but nonetheless, those men who ate the most of those purine-rich vegetables that I just mentioned, the broccoli, the cauliflower, the leeks, the mushrooms, et cetera, these men had in fact the lowest uric acid levels. So what did we learn? We learned that the findings of this study are in agreement with another study in which they evaluated 47,150 people and did not find an association between eating these vegetables and risk of gout, which is a disease characterized in general by a high uric acid level. Further, they stated, our results reinforce concerns about the validity of recommendations to restrict intake of purine-rich vegetables such as asparagus, cauliflower, beans, lentils, and spinach in gout patients. What they're saying is that their results would indicate that in fact gout patients should be eating these higher purine vegetables. It turns out they're good for you. They're good for you according to their recommendation if you have gout, and I am certainly going to indicate that they're good for you whether you have gout or not, but if your uric acid level is elevated, these are good choices as it relates to the foods that we consume. So what we've learned then is that though these vegetables seem to have higher levels of purines, they don't tend to be associated with higher levels of uric acid, and certainly they don't tend to be associated when they are consumed with higher risk for gout. Why might that be? Yeah, they contain purines, and purines are broken down to uric acid, but they contain other things That help to lower uric acid, things like dietary fiber, various bioflavonoids that can inhibit the enzyme that makes uric acid called xanthine oxidase, maybe a little vitamin C that may aid in reducing or aiding in the excretion of uric acid and hence helping to keep the uric acid level lower than it otherwise would be. So the end of the day recommendation is that these are good vegetables for us, like them or not, they're good for you. Even if you're trying to gain control over an elevated uric acid. Good information. Hope you enjoyed it. I enjoyed spending time with you, and I'll be back soon. I'm Dr. David Perlmutter. Bye for now.
