What dietary advice is recommended for a patient with gout?

Dietary Recommendations for Gout Management

For patients with gout, dietary modifications should focus on limiting alcohol (especially beer), reducing purine-rich foods, avoiding sugar-sweetened beverages, consuming low-fat dairy products, and maintaining healthy weight through caloric restriction if overweight. 1, 2

Foods to Limit or Avoid

• Alcohol consumption should be reduced, with particular emphasis on limiting beer and spirits, as they increase uric acid levels through adenine nucleotide degradation and lactate production 1, 2
• Complete alcohol abstinence is recommended during periods of active gout arthritis, especially when medical control is inadequate 2
• Purine-rich foods including organ meats and certain seafoods should be limited as they raise serum uric acid levels and increase gout risk 1, 2
• Sugar-sweetened beverages and energy drinks containing high-fructose corn syrup should be limited as they can raise uric acid levels through increased production and/or decreased excretion 1, 2
• Foods rich in fructose, including certain sweet fruits and fruit juices, should be moderated 2

Foods to Encourage

• Low-fat or non-fat dairy products are strongly encouraged as they are associated with lower risk of gout and may have antihyperuricemic effects 1, 2
• Cherries may help reduce serum urate levels and the frequency of gout attacks 1, 2
• A diet high in fresh fruits, vegetables, and unprocessed foods may help reduce the risk of gout 3

Weight Management

• Weight reduction through daily exercise and limiting excess calorie intake is recommended for overweight and obese patients with gout 1, 2
• Weight loss is widely acknowledged as beneficial for overweight gout patients, despite limited high-quality evidence 1

Balanced Diet Approach

• The Japanese dietary guidelines recommend consuming less than 400 mg of dietary purines per day for patients with gout or hyperuricemia 2
• Well-balanced diets following general dietary guidelines (Japanese diet, American My Plate Plan, Mediterranean diet, and DASH diet) typically provide around 300-400 mg of purines per day, which aligns with recommendations 4

Important Considerations and Pitfalls

• Diet and lifestyle measures alone typically provide only a 10-18% decrease in serum urate levels, which may be insufficient for patients with significantly elevated uric acid levels 2
• Eliminating all purine-rich foods, including those that may have cardiovascular benefits (such as fatty fish with omega-3 fatty acids), is not recommended 2
• Adherence to dietary recommendations tends to be even lower than medication adherence in gout patients 1
• For most patients with gout, dietary modifications should be combined with appropriate pharmacological urate-lowering therapy for optimal management 2
• Associated comorbidities like hyperlipidemia, hypertension, hyperglycemia, and obesity should be addressed as part of comprehensive gout management 1, 2

Evidence Quality Considerations

• Many nutritional recommendations for gout have limited high-quality evidence supporting their effectiveness, despite being commonly recommended 5
• The current nutritional recommendations for gout are generally based on low quality evidence 5
• Only two of 17 guidelines acknowledge that the current evidence is insufficient to make recommendations on dietary changes 5