Should patients with gout avoid nuts?

Nuts Do Not Need to Be Avoided in Gout Management

For patients with gout, nuts do not need to be specifically avoided as they are not identified as high-risk foods in current gout management guidelines. 1, 2 The 2020 American College of Rheumatology guidelines for gout management focus on limiting purine-rich foods, alcohol, and high-fructose corn syrup, but do not specifically mention nuts as foods to be restricted.

Dietary Recommendations for Gout Management

The American College of Rheumatology conditionally recommends:

1. Limiting purine intake - Focus on avoiding:

   • Organ meats
   • Red meat (limit to 5-7 servings per week)
   • Seafood
   • Yeast supplements 1, 2

2. Limiting alcohol intake, especially beer 1, 2

3. Limiting high-fructose corn syrup consumption 1, 2

4. Weight loss for overweight/obese patients 1

   • A 5kg weight loss can lower serum uric acid by approximately 1.1 mg/dl 2
   • BMI decrease >5% is associated with 40% lower odds of recurrent flare 1, 2

Why Nuts Are Not a Concern in Gout

Nuts are not specifically mentioned in the major gout management guidelines as foods to avoid 1, 2. This is because:

1. Nuts are not particularly high in purines compared to organ meats, seafood, and red meat
2. The focus of dietary management is on foods with established high purine content and strong associations with gout flares
3. Nuts have beneficial nutritional properties (healthy fats, protein, fiber) that may support overall health

Recommended Dietary Approach

Instead of avoiding nuts, patients with gout should:

• Increase consumption of:

  • Low-fat dairy products
  • Vegetables
  • Adequate water (>2L/day) 2

• Avoid or limit:

  • Purine-rich foods (organ meats, seafood)
  • Alcoholic beverages, especially beer
  • Sugar-sweetened beverages with high-fructose corn syrup 1, 2, 3

Important Clinical Considerations

1. Dietary modifications alone are insufficient - The American College of Rheumatology emphasizes that dietary changes should be implemented alongside appropriate medical therapy, as diet alone typically yields only small changes in serum uric acid 2

2. Medication remains the cornerstone of treatment:

   • Acute flares: NSAIDs, colchicine, or glucocorticoids 1
   • Long-term management: Urate-lowering therapy (allopurinol, febuxostat) 2

3. Target serum uric acid levels:

   • <6 mg/dL for most patients
   • <5 mg/dL for severe gout (tophi, chronic arthropathy, frequent attacks) 2

Common Pitfalls to Avoid

1. Overemphasizing dietary restrictions without adequate medication management
2. Focusing on foods not strongly associated with gout (like nuts) while ignoring high-impact dietary factors like alcohol and high-purine foods
3. Failing to address weight management in overweight/obese patients with gout
4. Discontinuing urate-lowering therapy during acute attacks
5. Not providing adequate prophylaxis when initiating urate-lowering therapy 2

In summary, while dietary management is important in gout, nuts are not specifically identified as foods to avoid. Patients should focus on limiting established high-risk foods and beverages while maintaining appropriate medical therapy.