What Role Does Diet Play in Gout Management?
Changing your diet alone isn’t enough to stop gout attacks.
You’ve experienced the horrible pain of a gout attack. And you don’t want it to happen again. The doctor says you need to get your serum uric acid (SUA) level below 6 mg/dL. She says you should change your diet and take urate-lowering medicine to achieve that goal. But how much does food really matter and what diet should you follow?
The Role of Purines and Uric Acid
Too much uric acid in your body causes gout. Most of your uric acid (about two-thirds) is produced by your body naturally. The rest comes from your diet, often in the form of purines. Purines are substances in animal and plant foods that your body converts to uric acid. If you can’t flush the uric acid out through your kidneys, it can build up in the bloodstream and be deposited as needle-shaped crystals in your joints. These crystals cause the severe inflammation and intense pain of a gout attack.
People who follow even the strictest low-purine diet will reduce their uric acid levels by only a small amount. Larry Edwards, MD, vice chairman and professor, department of medicine at the University of Florida in Gainesville says, “You can lower your uric acid a little bit – by no more than 1 mg/dL – but that’s not going to get most people who have clinical symptoms of gout into the range that they’re going to stop having flares.”
Randall N. Beyl, Jr, MD, a rheumatologist in Albertville, Alabama agrees “when my patients hit SUA numbers in the double digits, I’m telling them it’s not if they’ll have gout in the future it’s when they’ll have an attack. Even on the best diet possible, we’re never going to control the disease with diet alone.”
For a person not taking urate-lowing medicine, a more restricted diet can decrease the number of food trigger flares they have. Dr. Edwards says, “If patients cut back on beer binges and shrimp boils, it will cut down on the number of flares they have, but it’s not going to cure their gout.”
“Once they’ve been on a urate-lowering drug for a while and reach the target SUA of <6 mg/dL, then dietary indiscretions are not as big a problem,” Dr. Edwards explains. “They won’t have to be so restrictive with their food once the disease is controlled pharmacologically.”
Diet or Genetics?
“The causes of gout, by and large, are not dietary,” says Dr. Edwards. “That’s one of the great myths about this disease, and it’s part of the reason patients are embarrassed to talk about their gout.” Gout is a metabolic disease with primarily genetic origins, he explains.
Many things contribute to whether you develop gout and have ongoing attacks. Some you can change, most you can’t. Factors you can’t change include:
- Race: African Americans are more prone to gout than whites.
- Age: Your risk of gout gets higher with age.
- Sex: Younger men are four times more likely to develop gout than women; and after the age of 65, men are three times more likely to develop gout than women.
- Genes: Some people are predisposed to have higher uric acid levels and a lower ability to eliminate uric acid.
But you do have control over your weight. Being overweight is a big risk factor for developing gout and metabolic syndrome (METs). The combination of high blood pressure, high cholesterol, high blood sugar and obesity (METs) is linked to high serum urate and gout.
Even though a low-purine diet alone won’t cure you of gout, eating well and reaching a healthy weight will decrease your overall risk of gout and the complications of metabolic syndrome. Dr. Beyl says, “Of all modalities we know in terms of diet, weight loss is proven to be the most effective to help prevent gout flares and help lower uric acid numbers.”
Dr. Edwards recommends patients not be overly focused on a low-purine diet, “These terribly restrictive diets just burn the patients out.” He says a weight reduction diet for people who are overweight is important and following a Mediterranean diet probably has the most impact on uric acid levels and general health.
Dr. Beyl agrees that patients should focus on foods that will benefit their overall health and lower their risk of metabolic syndrome: plant-based proteins, vegetables, fruits and nuts. He does suggest patients limit intake of foods that increase uric acid levels -- like red meat, beer, liquor, and high fructose corn syrup. “Being careful but not overly restrictive with your diet will help your gout medicine be more effective and prevent flares,” Dr. Beyl says.