From the Guidelines
To effectively lower uric acid levels and manage gout, it is crucial to combine dietary changes, lifestyle modifications, and, when necessary, medication, with a focus on reducing purine intake, staying hydrated, and maintaining a healthy weight, as supported by the 2017 updated EULAR evidence-based recommendations for the management of gout 1.
Key Dietary Changes
- Limit or avoid foods high in purines such as organ meats (liver, kidneys), red meat, seafood (especially shellfish, anchovies, and sardines), and alcoholic beverages (particularly beer) 1.
- Reduce intake of sugary foods and drinks, especially those with high-fructose corn syrup, as they can increase uric acid production 2.
- Emphasize low-purine foods like fruits (except for dried fruits and those high in fructose), vegetables (except mushrooms, asparagus, and spinach), whole grains, and low-fat dairy products, which can help lower uric acid levels or have a neutral effect on uric acid production 1, 2.
Lifestyle Modifications
- Stay well-hydrated by drinking 8-10 glasses of water daily to help flush uric acid from your system, as recommended for managing gout and reducing uric acid levels 1.
- Maintain a healthy weight through regular exercise, as excess weight contributes to higher uric acid production and is a risk factor for gout attacks 1, 2.
Medication
- For patients requiring medication, allopurinol is recommended as the first-line urate-lowering therapy (ULT), starting at a low dose (100 mg/day) and increasing as needed to reach the target serum uric acid level of <6 mg/dL, with febuxostat or uricosurics considered if allopurinol is not tolerated or effective 1.
- During acute gout attacks, medications like colchicine, NSAIDs, or corticosteroids may be prescribed to manage pain and inflammation, with the choice of medication depending on the patient's medical history and current health status 1.
Additional Considerations
- Regular physical activity and weight loss, if appropriate, can decrease the excess mortality associated with chronic hyperuricemia and reduce the risk of gout attacks 1.
- Consumption of coffee and cherries has been inversely associated with gout risk, suggesting potential benefits in gout management, although more research is needed to confirm these findings 1, 2.
From the FDA Drug Label
Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber
To lower uric acid levels, dietary changes are recommended, including:
- Reduction of: + Animal protein + Sodium + Refined sugars + Oxalate-rich foods + Excessive calcium intake
- Increase in: + Oral fluids + Dietary fiber It is also important to note that allopurinol tablets can help reduce serum and urinary uric acid levels by inhibiting the formation of uric acid. The dosage of allopurinol tablets varies with the severity of the disease, and the patient's serum uric acid level should be monitored to determine the effective dosage 3.
From the Research
Lowering Uric Acid Levels
To lower uric acid levels, several options are available, including:
- Urate lowering medications (ULMs) such as xanthine-oxidase inhibitors (e.g., allopurinol, febuxostat) and uricosuric agents 4, 5, 6
- Dietary changes, including the consumption of dietary polyphenols, which have been shown to have a significant impact against hyperuricemia 7
Foods to Avoid
While the provided studies do not specifically mention foods to avoid, it is generally recommended to limit or avoid foods that are high in purines, such as:
- Organ meats (e.g., liver, kidney)
- Seafood (e.g., anchovies, sardines)
- Red meat
- Processed meats (e.g., hot dogs, sausages)
- Sugary drinks and foods high in sugar
- Refined carbohydrates (e.g., white bread, sugary snacks)
Comparison of Urate-Lowering Therapies
Several studies have compared the efficacy and safety of different urate-lowering therapies, including:
- Febuxostat vs. allopurinol: Febuxostat has been shown to be more effective in lowering serum urate levels and reducing gout flares 5, 6
- Lesinurad vs. allopurinol and febuxostat: Lesinurad in combination with febuxostat or allopurinol has been shown to be effective in urate lowering, but may have a higher risk of adverse events 6
- Persistence rates of allopurinol and febuxostat: Febuxostat has been shown to have better persistence rates than allopurinol among patients with gout 8