Dietary Recommendations for Patients with a History of Gout
For patients with a history of gout, a diet that limits alcohol, reduces purine-rich foods, avoids fructose, and promotes weight loss if overweight is strongly recommended to reduce the risk of flares and complications. 1
Key Dietary Modifications
1. Alcohol Restriction
- Avoid or strictly limit alcohol consumption - especially beer and spirits
- Alcohol increases uric acid production through adenine nucleotide degradation and decreases excretion through lactate production 2
- 88% of clinical guidelines recommend alcohol restriction as a primary dietary intervention 1
2. Weight Management
- Lose weight if BMI ≥30 kg/m² through gradual, sustainable methods
- Avoid crash diets, starvation, or excessive exercise which can paradoxically increase uric acid levels 2
- Weight loss has shown beneficial effects for overweight and obese gout patients, though evidence quality is low to moderate 1
3. Purine Intake Reduction
- Limit high-purine foods (>200 mg/100g) including:
- Moderate intake of medium-purine foods:
- Red meat
- Some seafood
- Certain vegetables (spinach, asparagus, mushrooms)
4. Fructose and Sugar Reduction
- Limit consumption of:
- Sugar-sweetened beverages
- Fruit juices
- Foods with high-fructose corn syrup
- Fructose metabolism increases uric acid production and decreases excretion 2
- 65% of guidelines recommend reducing fructose intake 1
5. Beneficial Foods to Include
- Increase low-fat dairy products which are associated with lower gout risk 2
- Consider Mediterranean diet pattern which may help prevent hyperuricemia 2
- Increase water intake to maintain good hydration and promote uric acid excretion
6. Potentially Beneficial Supplements
- Consider vitamin C supplementation which may lower serum uric acid levels 2
- Regular coffee consumption may be protective against gout 2
Implementation Considerations
Practical Approach
- Focus on overall dietary pattern rather than individual foods
- Prioritize purine content per portion rather than just per weight 4
- Aim for balanced nutrition while limiting high-risk foods
Common Pitfalls to Avoid
- Overly restrictive diets can lead to poor adherence and nutritional deficiencies
- Rapid weight loss can trigger gout flares through increased uric acid release
- Dehydration can concentrate uric acid and trigger attacks
- Focusing only on purines while ignoring other metabolic factors like fructose intake
Special Considerations
- Some purine-rich foods like fatty fish contain beneficial omega-3 fatty acids important for cardiovascular health 1
- Balance gout management with management of common comorbidities (hypertension, diabetes, cardiovascular disease)
Evidence Quality Assessment
The majority of dietary recommendations for gout are based on low to moderate quality evidence 1. Most guidelines recommend similar interventions despite limited high-quality research supporting specific dietary modifications. The strongest evidence supports weight loss for overweight patients, alcohol restriction, and limiting purine-rich foods 1, 5.