What dietary recommendations are suggested for managing gout?

From the Guidelines

To manage gout effectively, it is recommended to limit alcohol intake, lose weight if overweight, reduce fructose and purine intake, and emphasize low-fat dairy products and complex carbohydrates in the diet. This approach is based on the most recent and highest quality evidence available, including the 2020 American College of Rheumatology guideline for the management of gout 1.

Key Dietary Recommendations

• Limit consumption of high-purine foods such as organ meats, seafood, red meat, and wild game
• Avoid alcoholic beverages, particularly beer
• Minimize sugary drinks and foods with high-fructose corn syrup
• Emphasize low-fat dairy products and complex carbohydrates like whole grains
• Stay well-hydrated by drinking 8-10 glasses of water daily
• Maintain a healthy weight through gradual weight loss if overweight

Rationale

The rationale behind these recommendations is to reduce the amount of purines that get converted to uric acid in the body, while supporting kidney function to better eliminate excess uric acid, thereby preventing painful gout flares.

Evidence Base

The evidence base for these recommendations is largely based on observational studies and expert consensus, as noted in the 2018 review of nutritional recommendations for gout 1 and the 2020 American College of Rheumatology guideline 1. However, the 2020 guideline provides the most recent and comprehensive review of the evidence, and its recommendations should be prioritized in clinical practice.

Limitations

It is worth noting that the evidence base for dietary recommendations in gout is not always strong, and more research is needed to fully understand the effects of different dietary interventions on gout outcomes 1. However, based on the available evidence, the recommended dietary changes are likely to be beneficial for patients with gout, and may help to reduce the risk of gout flares and improve overall health.

From the Research

Dietary Recommendations for Managing Gout

Dietary management is a crucial aspect of controlling gout symptoms. The following recommendations are suggested:

• Reduce or avoid purine-rich foods, such as organ meats and seafood, as they can increase uric acid levels in the blood 2, 3, 4, 5
• Limit alcohol consumption, especially beer, as it can raise uric acid levels and trigger gout attacks 2, 6, 5
• Maintain a healthy weight through a combination of diet and exercise, as obesity can increase uric acid levels and gout risk 2, 6
• Encourage consumption of low-fat or nonfat dairy products, vegetables, and fruits, such as cherries, which may have antihyperuricaemic effects 2, 6, 5
• Moderate intake of sweet fruits and soft drinks containing fructose, as they may raise uric acid levels and increase gout risk 2, 6
• Consider adopting a Mediterranean diet, which may help prevent hyperuricemia and reduce gout risk 2
• Stay hydrated and avoid dehydration, which can trigger gout attacks 2

Specific Food Recommendations

The following foods are recommended to be limited or avoided:

• Organ meats, such as liver and kidney
• Seafood, such as shellfish and fish with high purine content
• Beer and other alcoholic beverages
• Foods high in fructose, such as sweet fruits and soft drinks The following foods are recommended to be encouraged:
• Low-fat or nonfat dairy products
• Vegetables
• Fruits, such as cherries
• Whole grains and other foods low in purines and high in fiber 4, 5