What natural remedies can help manage gout symptoms in a patient with hyperuricemia?

Natural Remedies for Gout Management

While dietary and lifestyle modifications can help reduce gout flare frequency and modestly lower uric acid levels, they typically provide only a 10-18% decrease in serum urate—which is therapeutically insufficient for most patients—and must be combined with pharmacological urate-lowering therapy for optimal management. 1, 2

Critical Context: Limitations of Natural Remedies

• Dietary modifications alone cannot replace medication for most gout patients, as they have a small effect on serum urate levels and their impact on long-term clinical outcomes remains uncertain 3
• The primary goal remains achieving serum uric acid <6 mg/dL through pharmacological therapy, with natural remedies serving as important adjuncts 1, 2
• Many nutritional recommendations lack high-quality evidence despite being recommended for nearly 150 years 2

Foods and Beverages to Strictly Limit or Avoid

Alcohol

• Limit all alcohol consumption, with particular emphasis on beer and spirits, as they raise uric acid through adenine nucleotide degradation and lactate production that impairs renal excretion 1, 2, 4
• Consuming >1-2 alcoholic beverages in 24 hours increases flare risk by 40% 2
• Complete alcohol abstinence is mandatory during active gout flares 1, 2
• Note: A single unit of beer raises uric acid by only 0.16 mg/dL, demonstrating the modest impact of individual dietary factors 1

High-Purine Meats and Seafood

• Limit organ meats, red meat, and game meats as they raise serum uric acid and increase gout flare risk through increased purine metabolism 1, 2
• Shellfish and seafood increase gout risk with a relative risk of 1.51 1, 2
• Japanese guidelines recommend consuming less than 400 mg of dietary purines per day 1, 5
• Purine-rich foods (>200 mg/100 g) should be eaten in even lower quantities 5

Sugar-Sweetened Beverages and Fructose

• Avoid sugar-sweetened beverages and energy drinks containing high-fructose corn syrup as they raise uric acid through increased production and/or decreased excretion 1, 2, 4
• Limit fruit juices, particularly orange and apple juice, due to high fructose content 1, 2
• Fructose ingestion (1 gm/kg body weight) increases serum uric acid by 1-2 mg/dL within 2 hours 1

Foods and Beverages to Encourage

Low-Fat Dairy Products

• Strongly encourage low-fat or non-fat dairy products (skimmed milk, low-calorie yogurt, cheese, eggs) as they are associated with lower gout risk and may have antihyperuricemic effects through uricosuric properties 1, 2
• At least 50% of dietary protein should be of high biological value, with dairy and eggs providing excellent options with minimal purine content 1

Cherries

• Cherries or cherry juice may help reduce serum urate levels and decrease the frequency of gout attacks, though the certainty of evidence is low to very low 1, 2

Coffee

• Regular coffee consumption is negatively associated with gout and may lower urate levels 1, 6

Vitamin C

• Vitamin C supplementation could be considered as a preventive measure as it can lower urate levels and the risk of gout 6

Weight Management and Exercise

• Weight reduction through daily exercise and limiting excess calories is essential for overweight and obese patients 1, 2, 4
• Weight loss >5% BMI is associated with 40% lower odds of recurrent gout flares 1, 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 levels independently of purine restriction 1
• Regular physical activity decreases the excess mortality associated with chronic hyperuricemia 4

Comprehensive Dietary Patterns

• Consider adopting Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, as these have beneficial effects on gout endpoints while simultaneously addressing cardiometabolic comorbidities 7
• Dairy products, vegetables, nuts, legumes, less sugary fruits, and whole grains are healthy choices that may help prevent gout by reducing insulin resistance 6, 7

Critical Pitfalls to Avoid

• Do not eliminate all purine-rich foods, including those with cardiovascular benefits such as fatty fish with omega-3 fatty acids 1
• Avoid patient-blaming discussions, as gout has important genetic contributions and patients frequently feel stigmatized 1
• Recognize that dietary factors serve more as flare triggers than primary causes of sustained hyperuricemia 1
• Do not rely solely on dietary modifications when serum uric acid is substantially above 7 mg/dL, as pharmacological therapy is required 1, 2

Comorbidity Management

• Address associated comorbidities including hyperlipidemia, hypertension, hyperglycemia, obesity, and smoking as part of comprehensive gout management 1, 2, 4
• When gout occurs in patients receiving diuretics, consider discontinuing loop or thiazide diuretics if possible 4