What diet is recommended for individuals with hyperuricemia?

Dietary Recommendations for Hyperuricemia

For individuals with hyperuricemia, a diet that limits purine-rich foods (especially organ meats, red meat, and seafood), avoids alcohol (particularly beer) and high-fructose corn syrup beverages, while encouraging low-fat dairy consumption is strongly recommended. 1

Key Dietary Modifications

Foods to Limit or Avoid:

• Purine-rich foods:

  • Red meat (limit to 5-7 servings per week) 1
  • Organ meats (avoid completely) 1
  • Seafood, especially anchovy and cutlassfish (avoid) 1, 2
  • Fish milt (contains 375-560 mg/100g of purines) 2

• Beverages:

  • Alcohol (especially beer and spirits) 3, 1
  • Sugar-sweetened beverages with high-fructose corn syrup 3, 1
  • Fruit juices (especially those with high fructose content) 1

• Other high-purine items:

  • Dried yeast and yeast supplements 1, 2
  • Dried Chinese soup stock 2
  • Some bacterial supplements (Lactobacillus, Euglena) 2

Foods to Encourage:

• Low-fat or non-fat dairy products (milk, yogurt) 3, 1
• Cherries (may reduce frequency of acute attacks) 1
• Water (maintain adequate hydration >2L/day) 1
• Mediterranean diet components 4
• Coffee (may lower serum uric acid levels) 4

Quantitative Considerations

Patients with hyperuricemia should aim to consume less than 400 mg of dietary purines per day 2, 5. Foods containing very high amounts of purines (>300 mg/100g) should be particularly limited 2. For context:

• A typical serving (20-30g) of fish milt contains 75-168 mg of purines, representing 20-40% of the daily recommended limit 2
• Purine content varies significantly across food groups:
  • Noodles: 0.6-12.1 mg/100g
  • Bread: 4.4 mg/100g
  • Dairy: 0.0-1.4 mg/100g
  • Meat/fish: 19.0-385.4 mg/100g 2

Additional Lifestyle Modifications

• Weight management: Weight loss is recommended for overweight/obese patients with hyperuricemia, with a goal of 5kg reduction 1, 4

  • A BMI reduction >5% is associated with 40% lower odds of recurrent gout flares 1
  • Controlled weight management can lower serum urate similarly to strict low-purine diets 5

• Exercise: Regular moderate exercise is beneficial, but avoid strenuous exercise that may trigger flares through adenine nucleotide degradation 1, 4

• Hydration: Maintain adequate fluid intake to prevent dehydration, which can raise uric acid levels 4

• Supplements: Consider vitamin C supplementation, which may help lower serum uric acid levels 4

Important Caveats

1. Diet alone provides insufficient serum urate-lowering effects for many individuals with hyperuricemia, typically achieving only a 10-18% decrease in serum urate 3

2. For those with sustained hyperuricemia substantially above 7 mg/dL, dietary modifications alone are likely insufficient and should be combined with appropriate pharmacologic urate-lowering therapy 3, 1

3. Avoid starvation diets, as they can decrease uric acid excretion and potentially trigger gout flares 4

4. The impact of dietary factors on long-term clinical outcomes in hyperuricemia remains somewhat uncertain, with most having relatively small effects on serum urate levels compared to medication 6

By following these dietary recommendations as part of a comprehensive management approach, individuals with hyperuricemia can help reduce their serum uric acid levels and potentially decrease the risk of gout flares and other complications.