What diet is recommended to lower gout flare?

Recommended Diet to Lower Gout Flares

Limiting alcohol intake, reducing purine-rich foods, avoiding high-fructose corn syrup, and weight loss for overweight/obese individuals are the key dietary modifications recommended to reduce gout flares. 1, 2

Core Dietary Recommendations

Foods and Beverages to Limit or Avoid

• Purine-rich foods:

  • High purine content (>300 mg/100g): Organ meats, fish milt, anchovies, dried yeast 2
  • Moderate purine content: Red meat and seafood (associated with 51% higher risk of gout) 2

• Alcoholic beverages:

  • Beer has the strongest association with gout flares (49% increased risk per serving) 2
  • Each alcoholic drink within 24 hours increases gout flare risk by 40%, with a dose-response relationship 1
  • Heavy drinkers (≥30 units/week) have more frequent flares even when on urate-lowering therapy 1

• Fructose-containing items:

  • Sugar-sweetened beverages with high-fructose corn syrup 1, 2
  • Sweet fruits and fruit juices (especially orange and apple juice) 2
  • Each gram of fructose per kg body weight can increase serum uric acid by 1-2 mg/dl 1

Foods to Increase

• Low-fat dairy products:

  • Skimmed milk and low-calorie yogurt are inversely associated with serum uric acid levels 2
  • Recommended as part of gout management 2

• Cherries:

  • Associated with reduced frequency of acute gout attacks 2

• Coffee:

  • Associated with lower uric acid levels 2

Weight Management

• Weight loss is conditionally recommended for overweight/obese patients with gout 1
• A 5 kg weight loss can result in a mean serum uric acid reduction of 1.1 mg/dl 1
• BMI reduction of >5% is associated with 40% lower odds of recurrent gout flares 1
• Avoid starvation diets and dehydration, which can paradoxically increase uric acid levels 3

Recommended Dietary Approaches

• Mediterranean diet is beneficial for gout patients 2, 3
• DASH diet (Dietary Approaches to Stop Hypertension) may help lower uric acid levels 4

Supplements to Consider

• Vitamin C supplementation may reduce serum urate levels by approximately 0.35 mg/dl 2
• However, the 2020 ACR guideline conditionally recommends against vitamin C supplementation due to limited evidence 1

Exercise Recommendations

• Regular, moderate exercise is beneficial for gout management 2
• Avoid strenuous exercise during acute flares 2
• Strenuous exercise can temporarily raise uric acid levels through adenine nucleotide degradation 3

Common Pitfalls to Avoid

1. Focusing only on diet while neglecting medication: Diet alone typically has modest effects on serum urate levels and should complement, not replace, urate-lowering therapy 5

2. Excessive dietary restriction: Overly restrictive diets can reduce quality of life and adherence 1

3. Dehydration: Inadequate fluid intake can increase uric acid concentration 3

4. Rapid weight loss: Crash diets can paradoxically trigger gout flares 3

5. Focusing solely on purine restriction: This may lead to increased consumption of unhealthy carbohydrates and fats, potentially worsening metabolic syndrome 4

Quality of Evidence

It's important to note that most dietary recommendations for gout are based on low or very low quality evidence 1. The 2020 American College of Rheumatology guideline conditionally recommends limiting alcohol intake, purine intake, high-fructose corn syrup, and weight loss for overweight/obese patients, all based on low or very low quality evidence 1.

Despite the limited quality of evidence, these dietary modifications represent the best current approach to nutritional management of gout, with the strongest evidence supporting alcohol limitation and weight loss for overweight individuals.