What role do purines play?

An estimated 70% of uric acid in the blood is made inside the body. This means that even by following a strict low-purine diet, it will only be possible to lower uric acid levels by 30% at the most. But not all foods are the same: Our bodies absorb purines differently from different foods, so it might not make sense to avoid all foods that contain purines – especially if you already eat a balanced diet. There are no high-quality studies on the effectiveness of strict low-purine diets. Besides, they can be quite difficult to stick to.

What effect do your weight and diet have?

Some studies suggest that certain foods are linked to gout attacks. Gout attacks are apparently more common in people who have eaten a lot of meat, fish or seafood a few days before. That matches many people's experiences. On the other hand, purine-rich plant-based foods such as peas, beans, lentils, spinach, mushrooms, oats, cauliflower and broccoli were found to have little to no effect on the risk of a gout attack. Overall, there hasn’t been much good quality research into the link between certain foods and gout attacks.

Eating cherries is sometimes recommended to prevent gout attacks, but there’s no scientific proof that fruits can help prevent gout.

Because not everybody has the same metabolism, it’s a good idea to try out for yourself what helps you and what doesn’t – and how much of different foods your body tolerates. Some people feel better after changing their diet, while others successfully lower their uric acid levels with medication and cope just fine without any changes to their diet.

Individual studies also suggest that losing weight can help if you're very overweight. People with gout should be careful not to go without any food, though – fasting can itself trigger a gout attack.

Does avoiding alcohol help?

There are only a few studies looking into the influence of alcohol on gout. They suggest that people with gout are more likely to have an attack if they have had more than one or two alcoholic drinks in the last 24 hours. One alcoholic drink is equivalent to a small bottle of beer (0.33 L), a small glass of wine (0.1 L) or a double schnapps (4 cL).

There are various reasons why alcohol can trigger gout attacks. On the one hand, it increases uric acid production and reduces the amount of uric acid expelled by the kidneys. On the other, the diuretic effect of alcohol can increase the risk of gout. Uric acid crystals form more readily in joints if the surrounding tissue doesn’t contain enough fluid. Beer in particular contains a relatively high amount of purines too, which could also be a factor.

What should I consider if I take medication?

There are certain medications that can raise the levels of uric acid, thereby increasing the risk of gout. These include diuretics (substances that increase the production of urine), acetylsalicylic acid (the drug in e.g. Aspirin) and some medications that are taken after an organ transplant. Levodopa (a treatment for Parkinson's disease) and some cancer medications can also increase the risk of gout.

If you take any of these medications, it's best to discuss with your doctor whether it would be possible to switch to a different drug.

Can dietary supplements help?

People with gout are sometimes advised to take vitamin C supplements because they are believed to lower uric acid levels. But there has only been one good-quality study on the effectiveness of vitamin C in gout. That study found that vitamin C had a weak effect on uric acid levels, but the researchers didn’t look into whether that also lowered the risk of gout attacks.

What if changing your diet isn’t enough?

Some people manage to get their uric acid levels under control by changing their diet. But many people will need to take medication. Most of the uric acid in your body is made inside your body, so changing your diet only has a limited effect. Treatment with medication is considered if the gout attacks are frequent or if you have complications like kidney stones or tophi.

Sources

• Andrés M, Sivera F, Falzon L et al. Dietary supplements for chronic gout. Cochrane Database Syst Rev 2014; (10): CD010156. [PubMed: 25287939]
• Khanna D, Fitzgerald JD, Khanna PP et al. American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64(10): 1431-1446. [PMC free article: PMC3683400] [PubMed: 23024028]
• Nielsen SM, Bartels EM, Henriksen M et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis 2017; 76(11): 1870-1882. [PMC free article: PMC5705854] [PubMed: 28866649]
• Qaseem A, Harris RP, Forciea MA. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017; 166(1): 58-68. [PubMed: 27802508]
• Roddy E, Mallen CD, Doherty M. Gout. BMJ 2013; 347: f5648. [PubMed: 24473446]
• Shekelle PG, FitzGerald J, Newberry SJ et al. Management of Gout. (AHRQ Comparative Effectiveness Reviews; No. 176). 2016.

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