Gout is a type of arthritis that occurs when uric acid builds up in the body and forms crystals in the joints, causing inflammation and pain. It is linked with a lot of factors from a nutrition perspective, particularly purines. This post aims to cover most things worth knowing about nutrition and gout.
Purines
Purines are the most frequently linked dietary component with gout. If you google “nutrition for gout,” most articles will focus on the importance of a low-purine diet. This is partly sensible advice, but it is worth exploring more deeply.
Uric acid is formed when the body breaks down purines. It is normally excreted, but in gout, it continues to build up beyond normal levels.
If gout is caused by uric acid build-up, then it makes sense why people focus on limiting purine-rich foods.
Nearly two-thirds of the purines in our body are produced within the body though. Just over one-third is coming from the diet on average. It is important to be aware of this since it means that even if you consumed zero purines you would still have purines being produced in your body.
Even though purines are produced in our bodies, it is clear that dietary intake of purines plays a role. One study found that having a high purine intake in the short term increased the risk of a flare-up fivefold in those who had gout.
Complicating things though is that a high intake of purine-rich vegetables has not been linked with an increase in uric acid production.
Dairy contains purines and has also been linked with a reduction in uric acid levels. The mechanisms are thought to be related to a decrease in uric acid production and inflammation.
If you want to limit purines, it is complicated because they are in pretty much everything, just to varying degrees. The goal would just be to reduce your intake of particularly high-purine foods.
Instead of simply focusing on purines though, the research indicates that it makes sense to reduce animal-based non-dairy purine sources. For fruits, vegetables and dairy, it likely makes sense to not even think about purines.
Weight Loss
Losing weight can help with gout management.
Having a higher amount of body fat is linked with increased uric acid levels. It also increases the likelihood of factors involved in metabolic syndrome, which is also linked with gout.
Losing weight quickly can potentially increase the risk of a gout attack though. This is because fat loss can release uric acid production in the short term.
If you have excess weight to lose, you want to lose it at a gradual rate. A safe recommendation would be to aim for 0.5-1% of body weight each week on average.
Since fat loss in general is a large topic, it could be worth checking out a post written specifically on that topic.
Protein
Protein itself is not detrimental to gout management.
Animal-based, non-dairy sources of protein are linked with higher rates of uric acid formation. It is unlikely to be the protein specifically though, and more about other aspects of those foods.
Evidence for this interpretation can be found in the form of research finding higher-protein plant-focused diets outperforming lower-protein plant-focused diets in gout management. If it was specifically protein that needed to be limited, this would not occur.
It makes sense to focus on reducing animal-based protein sources and increasing plant-based protein sources.
Sugar
High sugar intake in those with insulin resistance can increase serum uric acid levels.
It is difficult to separate the impacts of sugar specifically from the impacts of calories in general though since higher sugar intake usually means higher calorie intake. It also often means a lower micronutrient intake per calorie intake too.
Whether sugar intake directly contributes to gout, or indirectly contributes, in most cases it makes sense to limit added sugar where possible.
Vitamins
Vitamins C, D and E can all potentially help reduce uric acid levels.
Most epidemiological research has found a link between higher vitamin C intake and lower uric acid levels.
If supplementing with vitamin C, it is worth being cautious of having a high dosage for an extended period of time. Supplementing with significantly more vitamin C than people naturally get through food has been shown to increase uric acid levels.
Low vitamin D levels are linked with higher uric acid levels too. Increased vitamin D levels typically have an anti-inflammatory and antioxidant effect, which could explain this.
There are many downsides of a vitamin D deficiency, and it is surprisingly common, so it would be worth addressing regardless.
Vitamin E can play a role in reducing the growth of the crystals that are found in the joints in gout patients. It is unclear if supplementation is beneficial, but higher dietary intake appears to help reduce uric acid in the blood.
Fruits, Vegetables and Fibre
Increasing intake of fruits, vegetables and fibre has been linked with reductions in gout attacks.
Dietary approaches such as the Mediterranean Diet and The Dash Diet which heavily feature these components consistently show reductions in gout risk and flare-ups.
One explanation for this is that they are anti-inflammatory-style approaches. Another explanation is that gut health plays a role.
Short-chain fatty acids, for example, play a role in the excretion of uric acid. Diets that contain higher amounts of fibre typically lead to more short-chain fatty acids produced in the large intestine.
Eating more fruits, vegetables and fibre-rich foods have consistently been linked to positive health outcomes, so it likely is a good thing to do regardless. They also contribute to taking care of the dietary intake of vitamins that were discussed above.
Alcohol
Drinking alcohol has long been linked with gout.
People often point to the fact that beer is high in purines as a reason why this occurs.
This mechanism falls apart when you identify that research has found no difference between types of alcohol and gout risk.
Theoretically, if purines were the driving force, wine should cause fewer flare-ups due to being lower in purines than beer. But that is not the case.
The lack of difference is also another reason why it is important not to solely focus on purines.
Alcohol reduces the amount of uric acid that is excreted by the body. This contributes to the build-up of uric acid that forms crystals in the joints.
If you have gout, reducing alcohol intake is one of the highest priorities for improving symptoms. The lower the intake, the better.
A Novel Treatment Idea – Cherries
If you want a strategy involving something to ADD to your diet, cherries would be the go-to option.
They have antioxidant and anti-inflammatory properties. This likely explains how they help, in combination with their ability to reduce uric acid in the blood.
Consumption of cherries on a daily basis in the short term has been shown to reduce the risk of a gout attack by 35-45%. That is a pretty easy win if you like cherries.
Tart cherries in particular likely are more effective due to their antioxidant content. They are up to 5x higher in antioxidants than sweet cherries, which are already high in antioxidants.
To make it even more effective, you can have tart cherry juice. Having 240ml of cherry juice is the equivalent of having 45-60 cherries.
Concentrating it makes it even easier to consume. Just 30ml of concentrated cherry juice is the equivalent of 90 cherries.
Two doses of concentrated tart cherry juice in a has been shown to reduce uric acid levels by 36% in a single day.
If you would prefer not to drink or eat cherries, supplementing with tart cherry extract appears to be similarly effective.
Summary
There are many ways to help reduce the risk of gout or manage symptoms if you already have it.
Reducing purine intake is the most common recommendation, but it is nuanced and should not be the sole focus.
If you have excess weight to lose, losing weight at a gradual rate can help.
Limiting alcohol is important. Prioritising fruits, vegetables and fibre are also a helpful part of management too.
Outside of nutrition, if you have severe symptoms, it could also be worth exploring medications with your doctor too.
