Foods to Avoid in Gout
Patients with gout should limit alcohol (especially beer and spirits), purine-rich meats and seafood, and beverages containing high-fructose corn syrup, while encouraging low-fat dairy products and weight loss if overweight. 1
Alcohol - Highest Priority Restriction
- Limit all alcohol consumption, with particular emphasis on beer and spirits, as these raise uric acid through adenine nucleotide degradation and lactate production that impairs renal uric acid excretion 1, 2
- Consuming more than 1-2 alcoholic beverages in 24 hours increases gout flare risk by 40%, with a clear dose-response relationship 1, 3
- Beer has the strongest association, increasing flare risk by 49% per serving daily, while spirits increase risk by 15% per serving 3
- Complete alcohol abstinence is mandatory during active gout flares, especially when medical control is inadequate 2, 3
- Heavy drinkers (≥30 units/week) continue having flares despite urate-lowering therapy 1
High-Purine Foods to Limit
- Organ meats (liver, kidney), red meat, and game meats should be limited as they raise serum uric acid and increase flare risk through increased purine metabolism 2, 4
- Shellfish and seafood increase gout risk with a relative risk of 1.51 and should be consumed sparingly 2, 4
- General meat products should be consumed in moderation 2
- The American College of Rheumatology conditionally recommends limiting purine intake for all gout patients regardless of disease activity 1
Sugar-Sweetened Beverages and High-Fructose Corn Syrup
- Avoid sugar-sweetened beverages and energy drinks containing high-fructose corn syrup, as they raise uric acid through increased production and/or decreased excretion 2, 4
- Fructose ingestion (1 gm/kg body weight) increases serum uric acid by 1-2 mg/dL within 2 hours 1
- Limit fruit juices, particularly orange and apple juice, due to high fructose content 2
- Sweet fruits containing fructose should be moderated 5
Foods to Encourage
- Strongly encourage low-fat or non-fat dairy products (skimmed milk, low-calorie yogurt, cheese) as they are associated with lower gout risk and may have antihyperuricemic effects through uricosuric properties 2, 4, 6
- Eggs provide high biological value protein with minimal purine content and are acceptable animal protein sources 2
- Cherries or cherry juice may help reduce serum urate levels and decrease the frequency of gout attacks 2, 4
Weight Management for Overweight/Obese Patients
- Weight reduction through daily exercise and limiting excess calories is essential for overweight and obese patients 2, 4
- Weight loss greater than 5% BMI is associated with 40% lower odds of recurrent flares 2, 4
- A mean weight loss of 5 kg resulted in mean serum uric acid lowering of 1.1 mg/dL 1
- Weight loss reduces serum uric acid independently of purine restriction 2
Critical Limitations and Clinical Context
- Dietary modifications alone typically provide only 10-18% decrease in serum uric acid, which is therapeutically insufficient for most patients with sustained hyperuricemia substantially above 7 mg/dL 2, 4
- Pharmacologic urate-lowering therapy (allopurinol or febuxostat) is required for most patients to achieve target serum uric acid <6 mg/dL, with dietary modifications serving as important adjuncts 2, 4
- A unit of beer raises uric acid by only 0.16 mg/dL, demonstrating the modest impact of individual dietary factors 1
- Most nutritional recommendations lack high-quality evidence despite being recommended for nearly 150 years 4
Common Pitfalls to Avoid
- Do not eliminate all purine-rich foods, including those with cardiovascular benefits such as fatty fish with omega-3 fatty acids 2
- Avoid strenuous exercise, starvation, and dehydration, as these may raise serum uric acid and trigger gout flares 5
- Dietary discussions should not be misinterpreted as "patient-blaming," as gout has important genetic contributions and patients frequently feel stigmatized 2
- Dietary factors serve more as flare triggers than primary causes of sustained hyperuricemia 2