Is Juice Good for Gout?
Most juices are not beneficial for gout and should be limited, particularly those containing high-fructose corn syrup or added sugars, as they can raise seric urate levels and trigger gout flares. 1
Juices to Avoid or Limit
Fruit juices high in fructose should be reduced or eliminated from the diet of patients with gout, as fructose consumption increases serum urate concentration by 1-2 mg/dl within 2 hours of ingestion. 1 The 2020 American College of Rheumatology guidelines conditionally recommend limiting high-fructose corn syrup intake for all patients with gout, regardless of disease activity. 1
- Sugar-sweetened beverages and fruit juices containing high-fructose corn syrup raise uric acid levels through increased production and/or decreased excretion. 2
- Artificially sweetened carbonated beverages have also been associated with higher serum urate levels. 1
- Greater consumption of high-fructose corn syrup was associated with higher risk of incident gout in the Nurses' Health Study. 1
Cherry Juice: The Exception with Caveats
Cherry juice represents a special case, though the evidence remains insufficient for formal recommendations:
- The American College of Rheumatology acknowledges that cherries may help reduce serum urate levels and the frequency of gout attacks, but the certainty of evidence is low to very low and insufficient to make a formal recommendation. 1, 2
- One observational case cross-over study reported that cherry consumption was associated with reduced risk of recurrent gout attacks. 3
- However, a 2020 randomized controlled trial found that tart cherry concentrate had no effect on serum urate or urine urate excretion at any dose tested (7.5-30 ml twice daily). 4 This high-quality study directly contradicts earlier observational findings.
Clinical Approach to Juice Consumption
Patients should be counseled to avoid or severely restrict fruit juices, particularly those with added sugars or high natural fructose content. 2 If patients wish to try cherry juice as an adjunctive measure, they should understand:
- It should never replace pharmacological urate-lowering therapy (allopurinol or febuxostat). 2
- Dietary modifications alone typically provide only a 10-18% decrease in serum uric acid levels, which is insufficient for most patients with significantly elevated uric acid. 2
- Any potential benefit from cherry juice is not mediated through serum urate reduction based on the most recent evidence. 4
Priority Dietary Modifications
Instead of focusing on juice consumption, emphasize these evidence-based dietary changes:
- Limit alcohol intake, especially beer and spirits (beer increases gout flare risk by 49% per serving per day). 5
- Encourage low-fat or non-fat dairy products, which are associated with lower risk of gout. 2
- Promote weight loss for overweight/obese patients (>5% BMI reduction associated with 40% lower odds of recurrent flares). 6
- Limit purine-rich meats and seafood. 2
Important Clinical Caveat
Do not allow dietary discussions to delay or replace initiation of appropriate pharmacological urate-lowering therapy. 2 The therapeutic goal is maintaining serum uric acid <6 mg/dL lifelong, which typically requires medication such as allopurinol starting at 100 mg daily and titrating to target. 2, 6