Eat Right to Control Gout

Learn what to eat for this inflammatory form of arthritis and your overall health.

For years, people who had or were at risk of developing gout were told to avoid alcohol, sugary drinks, red meat and some types of fish. The advice made sense because these foods are high in purines, compounds the body converts into uric acid, a leading cause of gout in some people. Yet low-purine diets aren’t all that effective, and people have trouble sticking to them. Plus, telling people to limit protein often means they fill up on carbs and processed foods, leading to weight gain and greater gout risk.

Metabolic Syndrome

Also driving the reappraisal of gout diet advice is a new way of looking at gout itself. Highly regarded experts like Hyon Choi, MD, a professor at Harvard Medical School, believe high uric acid is part of metabolic syndrome — a group of conditions that occur together and increase your risk of heart disease, stroke and type 2 diabetes. The conditions include high blood pressure, high blood sugar, high cholesterol and belly fat. 

It’s not hard to see how gout fits into this picture. People who have gout are two to three times more likely to have heart disease than those who don’t. About three-fourths have high blood pressure, which can lead to stroke. High blood sugar is a particular problem; when blood sugar can’t get into cells — called insulin resistance — uric acid rises because the kidneys have a harder time excreting it. And obesity and belly fat are both associated with a more than doubled risk of gout.  

Overall, more than 70% of people with gout have metabolic syndrome compared to 22% of the general population. Still, not everyone agrees that gout is part of metabolic syndrome or that metabolic syndrome causes it. They do agree that an ideal gout treatment should not only lower inflammation and uric acid but also promote heart health and reduce diabetes risk. No drug can do that, but two popular eating patterns — the Mediterranean and DASH (dietary approaches to stop hypertension) diets — can.

Diets that Do It All

Although they’re called diets, the Mediterranean and DASH eating plans aren’t weight-loss schemes, and neither one involves counting calories. They’re the way you should eat all the time for good health and are more accurately called eating plans or eating patterns. Both are mostly plant-based, with an emphasis on fruits, vegetables, nuts, legumes (beans, peas and lentils) and healthy fats. They provide many of the same benefits and are endorsed by the American Heart Association and the Dietary Guidelines for Americans 2020-2025. Still, there are a few key differences:
  • The DASH diet was originally developed to manage high blood pressure. It has two versions — low-sodium (2,300 mg a day, about the amount in a teaspoon of salt) and lower sodium (1,500 mg a day). Both have been shown to significantly lower blood pressure as well as LDL cholesterol — the kind you don’t want. The DASH diet also reduces the risk of heart disease and is associated with a 32% reduction in gout.
  • The Mediterranean diet is based on traditional eating patterns in some Mediterranean countries. For decades, researchers noted that people in these regions rarely had heart disease or cancer and reasoned that what they ate — fruits, vegetables, nuts, seeds, occasional yogurt and fatty fish like sardines and hefty amounts of extra-virgin olive oil — might be at least partly responsible. In randomized trials, the Mediterranean diet cut the risk of type 2 diabetes in half and the risk of heart disease by nearly 75%. It can also help you lose weight and keep it off while lowering uric acid levels.
  • DASH has less sodium and fat and is slightly more flexible than the Mediterranean diet. It’s built around fruits, veggies, nuts, legumes and whole grains, but also allows chicken, low-fat dairy and eggs, which are more limited in the Mediterranean eating pattern. In both plans, red meat, sweets, processed foods and refined carbs like white bread and high-fructose corn syrup are discouraged.
The Healthy Eating Pyramid

Dr. Choi and colleagues developed a gout “healthy eating pyramid” that combines parts of the DASH and Mediterranean diets. The base of the pyramid contains foods you can eat at every meal — whole grains (from DASH) and healthy fats like olive oil; but not butter, seed oils or trans fats (from the Mediterranean diet). The second tier is rich in vegetables with moderate amounts of fruit, especially cherries, which are known to reduce uric acid and prevent gout flares. The third tier contains nuts and legumes and the fourth is a small amount — one or two servings — of dairy products. Next are even smaller amounts of fish, poultry and eggs — eaten no more than once or twice a week. Meat, desserts and refined carbs top the pyramid, so they’re out of reach.

The pyramid gives a general idea of which foods are best to control gout and protect against heart and metabolic disease. But Dr. Choi thinks gout patients can also benefit from an individualized eating plan based on their other risk factors. For example, he recommends the DASH diet and exercise for people with high blood pressure or high cholesterol. The Mediterranean diet plus exercise may be better for those with type 2 diabetes, heart disease or chronic kidney disease.

He also stresses that most people have mild gout that can easily be controlled with diet. If you’ve had a single attack, healthy food and exercise should be all you need. If you have repeated flares or severe disease, you will likely need medication to manage your symptoms. A healthy eating plan is still important to help prevent heart disease, type 2 diabetes and future gout attacks.