What Role Does Diet Play in Gout Management?

If you’ve experienced the horrible pain of a gout attack, you likely don’t want it to happen again. Your doctor may recommend getting your serum uric acid (SUA) level below 6 mg/dL by changing your diet and taking urate-lowering medicine. 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. Your body produces most of your uric acid naturally – about two-thirds of it. 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.”

For a person not taking urate-lowering 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 patients have been on a urate-lowering drug for a while and reach the target SUA of <6 mg/dL, they won’t have to be so restrictive with their food because the disease is controlled with medication.

Diet or Genetics?

Gout is a metabolic disease with primarily genetic origins, not dietary. 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 by preventing gout flares and helping lower uric acid numbers.

Gout Diet

Dr. Edwards recommends patients not be overly focused on a restrictive low-purine diet that burns them 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.

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. Being careful and limiting intake of foods that increase uric acid levels – like red meat, beer, liquor, and high fructose corn syrup – will also help gout medicine be more effective and prevent flares.

Discuss your gout with your doctor so you can better understand treatments that will work best for your specific needs.