Gout is a common form of inflammatory arthritis caused by too much uric acid in the body. It typically affects the big toe, causing severe pain, stiffness, redness and swelling. Since uric acid is created from the breakdown of purine — a naturally occurring body compound which is also present in certain foods — diet has a role in the management of this condition.
However, gout sufferers don't simply consume too much purine, their bodies make and retain too much uric acid — and medications tend to be more effective at treating these problems. Consequently, diet modifications cannot promise to eliminate gout flare-ups, but may reduce the severity and frequency of gout attacks.
Limit High Purine Foods
Too much purine in the diet can increase the risk of gout flare-ups, particularly in people with a history of gout. One study which compared the recent diets of gout sufferers found those with the highest purine intake had 5 times the risk of gout flare-ups. This same study linked animal sources of purine to a higher risk of gout attacks.
So to reduce the risk of gout flare-ups, consider the recommendations from the American College of Rheumotology (ACR), which call for the avoidance of high purine organ meats such as sweetbreads, liver and kidney, and the restriction of beef, lamb, pork and high purine seafood, including sardines and shellfish.
The Academy of Nutrition and Dietetics (AND) clarifies this restriction, recommending that meat, poultry and fish be limited to 4 to 6 ounces daily. Although purines are found in many plants foods, such as legumes, spinach and mushrooms, these foods are not linked to a higher risk of gout and are not restricted in the ACR or AND recommendations.
Make Wise Beverage Choices
Drinking plenty of fluids is essential, since dehydration can trigger gout flare-ups. According to AND, people with gout should drink 8 to 16 cups of fluid daily, with half of this water, unless fluid intake is restricted in order to manage another health condition.
ACR guidelines recommend a limitation of alcohol — no more than 2 drinks daily for men and 1 daily drink for women — as well as abstinence from alcohol during an acute attack, since alcohol not only contains purines, but decreases the body's ability to get rid of uric acid. Of note, beer has been linked to a higher gout risk compared to wine.
ACR also recommends avoidance of fructose-sweetened sodas, juices and energy drinks, due to research that high fructose corn syrup is associated with an increased risk of gout. Specific fluids that have been shown to reduce the risk of gout include moderate amounts of coffee and nonfat or low-fat milk.
Follow a Healthful Pattern
Vegetables, cherries, high vitamin C foods such as citrus, and plant oils, including olive, sunflower and soy have all been associated with a lower risk of gout.
Since this gout-specific research has not been completed on all common foods, and because an emerging theme is that most plant foods are protective, a more comprehensive gout-prevention strategy may be to emphasize a plant-based pattern of eating, rather than a focus on individual foods.
In fact, the Dietary Approaches to Stop Hypertension (DASH) diet, a commonly prescribed diet pattern that provides this emphasis, has been associated with a lower risk of gout. This diet pattern includes a strong emphasis on fruits and vegetables, daily inclusion of legumes, nuts, seeds, whole grains and low-fat dairy products, limited portions of meat, chicken and fish, and a low intake of sodium and sweetened beverages.
You are more likely to suffer from gout if you take medications that can cause dehydration, or if you have heart failure, high blood pressure, diabetes, obesity or kidney disease. Proper management of these conditions can help curtail the risk of gout attacks.
Medications which block uric acid production or enhance the removal of uric acid from the body are the mainstay of gout therapy, and in most people, more effective than diet changes alone.
However, diet can be an effective complement to drug therapy and particularly valuable in persons who are not using these drugs. See your doctor if you have a history of gout and need individualized advice on how to prevent flare-ups, or if you think you are having a gout attack, which is characterized by intense pain, swelling or stiffness in the big toe, or in the ankles, knees, wrists, fingers or elbows.
Reviewed by Kay Peck, MPH RD
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Gout
- BMJ: The Dietary Approaches to Stop Hypertension (DASH) Diet, Western Diet, and Risk of Gout in Men: Prospective Cohort Study
- BMJ Open: Fructose Intake and Risk of Gout and Hyperuricemia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
- Centers for Disease Control and Prevention: Gout
- Arthritis and Rheumatism: Cherry Consumption and the Risk of Recurrent Gout Attacks
- Annals of Rheumatic Disease: Purine-Rich Foods Intake and Recurrent Gout Attacks
- Arthritis Care and Research: 2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia
- Journal of Advanced Research: Gout: An Old Disease in New Perspective – A Review
- Journal of the American Academy of Nutrition and Dietetics:Gout: Is a Purine-Restricted Diet Still Recommended?
- Arthritis and Rheumatology: Coffee Consumption and Risk of Incident Gout in Men: A Prospective Study
- Academy of Nutrition and Dietetics: A Low Purine Diet: Relief from Gout and Kidney Stones