What Role Does Diet Play in Gout Management?

If you’ve experienced the horrible pain of a gout attack, you surely don’t want it to happen again. Your doctor may recommend getting your serum uric acid (SUA) level below 6 mg/dL by changing your diet and taking urate-lowering medicine. But how much does food really matter and what diet should you follow?

The Role of Purines and Uric Acid

Too much uric acid in your body causes gout. Your body produces most of your uric acid naturally — about two-thirds of it. The rest comes from your diet, often in the form of purines. Purines are substances in animal and plant foods that your body converts to uric acid. If you can’t flush the uric acid out through your kidneys, it can build up in the bloodstream and be deposited as needle-shaped crystals in your joints. These crystals cause the severe inflammation and intense pain of a gout attack.

Like most experts, rheumatologist Larry Edwards, MD, a professor of medicine at the University of Florida and chair of the Gout Education Society, thinks the best eating plans for gout and overall health are the Mediterranean diet and DASH diet. But diet alone is not enough to stop gout flares for most people, he says.

“You can lower your uric acid a little bit — by no more than 1 mg/dL — but that’s not going to get most people who have clinical symptoms of gout into the range that they’re going to stop having flares,” he says.

Still, cutting out high-purine foods could reduce the number of flares for people not taking uric acid-lowering medication.

Others, including Hyon Choi, MD, an internationally noted gout expert, and rheumatologist with the University of British Columbia and Vancouver General Hospital and epidemiologist at Brigham and Women’s Hospital in Boston, think some people can be helped by diet alone, especially if they have a single mild attack. People in this camp argue against the lifetime use of gout drugs, which may have serious side effects, for patients unlikely to have more than one flare.

Diet vs. Genetics?

Another point of contention: to what extent is gout genetic? Scientists have identified certain genes that make it more likely a person will develop gout. But a 2022 study published in BMC Medicine found that a healthy lifestyle — regular exercise, moderate alcohol consumption, not smoking and healthy eating — was enough to override genetic risk by at least one-third.

The study followed nearly half a million people from the UK BioBank, a large database of health and genetic information on participants in the UK. People who were least likely to develop gout had low genetic risk and a healthy lifestyle; those more likely to develop it had a high genetic risk combined with a lifestyle that wasn’t so healthy. But even high-risk patients could reduce their risk by changing unhealthy factors to healthier ones, including choosing anti-inflammatory foods instead of gout triggers like red meat, beer and sugary drinks.