A gout diet is a nutritional routine that includes eating foods low in purines to help reduce the occurrence and severity of gout attacks. Gout is a form of arthritis with symptoms of sudden and severe pain, redness, and tenderness in joints.
Physicians have known that there is an association between gout and diet for at least 2,000 years. It is the oldest known type of arthritis and was described by the Greek physician Hippocrates 2,500 years ago. It subsequently became known as the disease of kings due to its association with eating rich foods and alcohol consumption, a lifestyle to which only the wealthy had access. The association between gout and the production of uric acid has been known since the 1800s. In his 1861 medical book, Gunn's New Domestic Physician: Home Book of Health, American physician John Gunn describes gout as, “a peculiar disease, somewhat resembling rheumatism, affecting the joints, most generally those of the foot or toes.” Gunn writes that the cause of gout is excess uric acid in the blood. That description is generally accurate today, although much more is known about gout, including how it develops, what causes it, and how it can be treated.
It wasn't until the 1960s that researchers developed an accurate understanding of the biochemistry of uric acid production in the human body. With this understanding came effective medical and dietetic therapy for the condition. In the 1800s, a rudimentary gout diet was developed that recommended avoidance of “rich foods,” generally defined as cream and other high-fat dairy products, and alcoholic beverages. In the 1960s and 1970s, as more become known about gout and uric acid production, the diet was revised and refined. Experts encouraged avoiding high-fat and high-protein foods, alcohol, coffee, and soft drinks, along with anchovies, asparagus, legumes, mushrooms, meat, animal organ meat such as heart and liver, and shellfish.
By eating less meat, poultry, and seafood while taking in more low-fat or non-fat dairy products, men can cut their chances of getting gout by 50%, according to the results of a 12-year study of nearly 50,000 men who had no history of gout. The study was the most definitive and comprehensive research done on gout. It was conducted by rheumatologist Hyon K. Choi and his colleagues at Massachusetts General Hospital in Boston. The study followed men aged 40–75 years. During the study, the men, all healthcare professionals, were quizzed periodically on how much of 130 foods and beverages they had eaten and asked questions about weight, medications they had taken, and their medical condition. At the end of the study, 730 (about 2%) of the men had developed gout.
The study found that men with the highest consumption of seafood were 51% more likely to develop gout than those who consumed the least amount of seafood. It also found that men with the highest consumption of beef, pork, and lamb had a 41% higher incidence of gout than those who ate the least amount of these meats. Men who had the highest consumption of low-fat dairy products had a 42% lower rate of developing gout compared to those who consumed the least amount of dairy products. Vegetables high in purines that were previously associated with an increased risk for developing gout were found not to increase the risk of getting the disease. These vegetables included peas, beans, mushrooms, cauliflower, asparagus, and spinach.
The study also looked at the role alcohol consumption plays in gout. The risk of gout increased by 30% with the consumption of one drink a day, when compared to people who did not drink alcohol at all. Two drinks a day increased the risk to 50%, and three drinks a day increased the risk by 100%. There were some differences in the types of alcohol consumed. Two glasses of wine a day did not increase the risk of gout at all when compared to men who drank no wine. Alcohol other than beer or wine increased the risk by 15% per serving. Beer increased the risk by 49% per serving. Researchers were uncertain why the risk of gout varied depending on the type of alcohol consumed. Some suggested that other nonalcoholic ingredients in beer that are not found in wine or spirits might be responsible for increased risk of gout.
Gout, also called gouty arthritis, is a painful but treatable form of arthritis that affects up to five million Americans, primarily men over the age of 40. The disease is characterized by sudden and severe pain, redness, swelling, heat, stiffness, and inflammation in one or more joints. It most commonly affects the big toe first. Subsequent attacks of gout, usually limited to a single joint at a time, can occur in the instep, ankles, heels of the feet and hands, knees, wrists, fingers, and elbows.
Gout is caused by needle-like crystals of uric acid, a substance that results from the metabolic breakdown of purines, which are found in many foods and are part of normal human tissue. Uric acid is normally dissolved in the blood and filtered through the kidneys into the urine. If uric acid production is increased by the body or it is not sufficiently eliminated from the kidneys, it can build up in the blood, resulting in a condition called hyperuricemia (high uric acid). This can lead to gout. High amounts of uric acid can also collect in the kidneys, causing kidney stones.
People with gout should consult their doctors about developing individualized meal plans. Diets should take into account all aspects of medical nutrition therapy, especially for people with heart disease, high blood pressure, or diabetes. General dietary guidelines for people with gout include:
Regular physical activity can also help with weight loss or maintenance, as well as support overall health.
Dietary management of gout is centered around reducing uric acid in the body and managing conditions that often occur in people with gout, including diabetes, obesity, high cholesterol, high blood pressure, and atherosclerosis (hardening of the arteries). A diet of foods low in purines is recommended for most people with gout, although it is not possible to completely eliminate purines from the diet. The Arthritis Foundation recommends that people with gout learn by trial and error which foods cause problems and what their personal limits of these foods are.
Laura Rall, a nutrition researcher at Tufts University in Boston, advocates the trial and error method of developing a gout diet. She suggests: “Begin by eliminating foods in the high-purine category, while reducing your intake of foods in the moderate-purine category. If you don't have gout attacks after trying this, you may add more foods from the moderate category, or occasionally try a food from the high category. Using these guidelines, you may be able to determine a safe level of purine consumption and enjoy some of your favorite foods without experiencing (gout) attacks.”
The function of a gout diet is to lower uric acid levels in the blood by eating less meat that is high in purines, which increase uric acid levels in the blood. Uric acid is a waste product formed as purines break down in the body. By reducing uric acid levels in the blood, people with gout usually experience a decrease in pain and swelling in joints afflicted with the disease. Without treatment, gout can lead to joint damage and disability. Gout is also associated with an increased risk of heart disease and kidney disease, according to the American College of Rheumatology.
The main benefit of a gout diet is a decrease in the pain, tenderness, swelling, redness, warmth, and inflammation of joints associated with the condition, and prevention of joint damage and disability. It also improves the quality of life in gout sufferers by helping prevent repeat attacks.
The gout diet is designed for people who have gout or who may be prone to developing gout since it can be inherited. People who do not have gout or have no predisposition to the condition do not need to be on the diet. There are no precautions associated with the diet. However, since the diet recommends a severe curtailment or elimination of meat and seafood from the diet, people on or planning to go on the diet should consult a dietitian in addition to their physician or rheumatologist. People who eliminate meat and seafood from their diets should make sure they are getting adequate protein and other nutrients found in meat. This may include adding vitamin, mineral, and other nutritional supplements to the diet, similar to those taken by non-vegan vegetarians. These may include iron, calcium, zinc, vitamin D, riboflavin, vitamin B12, vitamin A, iodine, and omega-3 and omega-6 amino acids derived from non-fish sources, such as flaxseed oil, evening primrose oil, and borage oil.
There are no known risks associated with a gout diet.
There is general acceptance among healthcare professionals of the low-purine diet for people with gout or those who have a family history of the disease.
See also Arthritis diet .
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Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Ste. 2000, Chicago, IL, 60605, (800) 877-1600, http://www.eatright.org .
American College of Rheumatology, 2200 Lake Blvd., NE, Atlanta, GA, 30319, (404) 633-3777, http://www.rheumatology.org .
Arthritis Foundation, PO Box 7669, Atlanta, GA, 30357-0669, (800) 568-4045, http://www.arthritis.org .
National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 1 AMS Circle, Bethesda, MD, 20892-3675, (301) 495-4484, NIAMSinfo@mail.nih.gov, http://www.niams.nih.gov .
Ken R. Wells