What should be avoided in diet and lifestyle if serum uric acid is elevated?

Dietary and Lifestyle Modifications for High Serum Uric Acid

For patients with elevated serum uric acid levels, avoid alcohol (especially beer), sugar-sweetened beverages, high-purine foods (organ meats, seafood, red meat), and maintain a healthy weight through gradual weight loss if overweight. 1

Foods to Avoid

High-Purine Foods

• Organ meats: Completely avoid liver, kidney, and other organ meats 1, 2
• Seafood: Limit consumption, particularly shellfish and fish milt 1, 2
• Red meat: Restrict to no more than 5-7 servings per week 1
• Yeast supplements: Avoid completely 1

Beverages to Avoid

• Alcohol: Limit or avoid all alcoholic beverages, with special emphasis on avoiding beer 1
  • Consuming more than 1-2 alcoholic beverages in a 24-hour period increases gout flare risk by 40% 1
• Sugar-sweetened beverages: Eliminate from diet 1, 3
  • Research shows that sugar-sweetened soft drinks significantly increase serum uric acid levels and hyperuricemia risk 3
• Fruit juices: Limit or avoid, especially those containing high-fructose corn syrup 1
• High-fructose corn syrup: Reduce consumption in all forms 1

Foods to Increase

• Low-fat dairy products: Increase consumption of milk and yogurt 1, 4
  • Studies show that consuming milk at least once daily and yogurt every other day is associated with lower serum uric acid levels 4
• Water: Maintain adequate fluid intake (>2L/day) 1
• Cherries: May help reduce frequency of acute gout attacks 1
• Vegetable protein: Consider increasing intake as an alternative to animal protein 5

Lifestyle Modifications

Weight Management

• Weight loss: Aim for gradual weight loss if overweight or obese 6, 1
  • Target a 5kg weight loss, which can lower serum uric acid by approximately 1.1 mg/dl 1
  • Avoid rapid weight fluctuations, as BMI increases >5% are associated with 60% higher odds of gout flares 1

Physical Activity

• Regular exercise: Maintain consistent physical activity 1
• Avoid strenuous exercise: Particularly during acute flares or if it triggers symptoms 1

Medication Considerations

• Diuretics: When possible, substitute diuretics with alternative medications 1
• Hypertension management: Consider losartan which has uricosuric effects 1
• Hyperlipidemia treatment: Consider fenofibrate which has modest uricosuric effects 1

Monitoring and Management

• Target serum uric acid level: Maintain below 6 mg/dL (360 μmol/L) for most patients 1
• For severe cases: Target below 5 mg/dL (300 μmol/L) until resolution 1
• Regular monitoring: Check serum uric acid levels periodically to ensure targets are maintained 1

Important Caveats

• The purine content of foods varies significantly - it's not just about total purines but also the specific types of purines (adenine, guanine, hypoxanthine) 2, 7
• Diet soft drinks do not appear to affect serum uric acid levels and are not associated with hyperuricemia 3
• While dietary modifications are important, they typically produce modest effects compared to medication. For patients with established gout, dietary changes alone may be insufficient 1
• Total protein intake is not strongly associated with serum uric acid levels - it's the specific sources of protein that matter 4

Following these dietary and lifestyle recommendations can help manage serum uric acid levels and reduce the risk of gout flares and other complications associated with hyperuricemia.