Yes, Sweets and Cakes Can Raise Uric Acid and Trigger Gout Attacks
Sugar-sweetened foods and beverages, including cakes and sweets that contain high-fructose corn syrup or are rich in fructose, should be limited or avoided because they can raise uric acid levels and increase the risk of gout attacks. 1, 2
Why Sweets and Cakes Are Problematic
The mechanism involves fructose metabolism, which increases uric acid production and/or decreases its excretion from the body. 2 Specifically:
- Sugar-sweetened beverages and energy drinks containing high-fructose corn syrup are identified as modifiable risk factors that have been confirmed to increase gout risk since the 2006 guidelines. 1
- Foods rich in fructose, including certain sweet fruits and fruit juices, should be moderated as they contribute to elevated uric acid levels. 2
- The European League Against Rheumatism guidelines explicitly recommend avoiding sugar-sweetened drinks as part of lifestyle management for every person with gout. 1
Practical Dietary Recommendations
You should advise patients to eliminate or significantly reduce:
- Sugar-sweetened beverages and sodas 1, 2
- Cakes, pastries, and desserts made with high-fructose corn syrup 2, 3
- Fruit juices, particularly orange and apple juice 1
- Energy drinks 2
Instead, encourage consumption of:
- Low-fat or non-fat dairy products (skimmed milk, low-calorie yogurt), which are associated with lower gout risk and may have antihyperuricemic effects 1, 2, 3
- Cherries or cherry juice, which may help reduce serum urate levels and decrease the frequency of gout attacks 1, 2
- Regular coffee consumption, which is negatively associated with gout 1
Important Clinical Context
The impact of dietary modifications alone is limited. Diet and lifestyle measures typically provide only a 10-18% decrease in serum urate levels, which is often insufficient for patients with significantly elevated uric acid. 2, 4 Therefore:
- Dietary modifications should be combined with appropriate pharmacological urate-lowering therapy for optimal management in most patients with gout. 2
- The primary goal remains achieving and maintaining serum uric acid levels below 6 mg/dL (360 μmol/L) through medication, with diet serving as an important adjunct. 1
Complete Lifestyle Package
When counseling patients about sweets and cakes, address the full spectrum of dietary triggers simultaneously:
- Alcohol (especially beer and spirits) should be limited or avoided, as it has a stronger association with gout flares than sugar. 1, 2, 5
- Weight loss is recommended for overweight/obese patients, as it can reduce serum uric acid levels independently and decrease flare frequency. 1, 2
- Purine-rich meats and seafood should be limited in moderation, though complete elimination is not necessary. 1, 2
- Heavy meals should be avoided. 1
Common Pitfall to Avoid
Do not give patients the impression that simply eliminating sweets will cure their gout or allow them to avoid medication. 2, 4 While dietary modification is beneficial and should be implemented, urate-lowering therapy remains the mainstay of definitive gout management, with allopurinol as first-line treatment starting at 100 mg/day and titrating to achieve target serum uric acid levels. 1, 6