NUTRITION

Managing gout
MELANIE REID Limit alcohol acid levels and risk of gout. However, a large
Observational studies have found that alcohol sudden increase may trigger an acute attack in
intake is positively associated with serum a manner similar to xanthine oxidase inhibitor
uric acid, risk of gout and recurrent gout drugs. Coffee should be consumed regularly
Diet as adjunctive therapy. attacks.1,3,4 Experimental studies show that and in moderation.
beer, in particular, significantly raises serum
Gout is a form of inflammatory arthritis, uric acid levels.3 Vitamin C supplement
typically characterised by recurrent incidence It is best to avoid alcohol completely during Vitamin C supplements of 500 mg/day have
of joints that are red, tender, hot and swollen. an acute attack of gout. been used experimentally to reduce serum uric
It is generally managed by drugs that either acid.3 Observational studies have found that
control inflammation during acute episodes Eat regularly vitamin C intake over 500 mg/day is associated
or reduce serum uric acid levels in the longer Skipping meals or fasting will increase uric acid with lower risk of gout.
term; however, dietary measures can also help levels.3 Advise patients to eat moderate-sized
reduce serum uric acid levels and risk of gout. meals regularly throughout the day. A serve of cherries
The European League Against Rheumatism Limited evidence from small trials and
(EULAR) and the American College of Limit sugar-sweetened drinks observational studies suggest a lower uric acid
Rheumatology (ACR) recommend diet and Large observational studies generally find level and risk of acute gout attacks with daily
lifestyle strategies as adjunctive measures for a positive association between intake of intake of 1–2 serves of cherries (one serve is
the management of gout.1,2 sugar-sweetened drinks and fruit juice, serum 10–12 cherries).3
Gout is often associated with common uric acid levels and risk of gout.3,4
and serious comorbidities, such as Meta-analysis of controlled feeding studies Keep active
obesity, cardiovascular disease (CVD), shows that adding fructose to the diet raises People who exercise regularly are less likely to
dyslipidemia, hypertension, hyperglycaemia serum uric acid. experience gout. Ensure that running shoes are
and renal impairment. Dietary advice Limit added sugars to a maximum supportive and fit well.
for specific patients therefore needs to amount of five teaspoons per day and avoid
include recommendations related to any fructose-based sweeteners. Drink plenty of water
comorbidities.1,2 High uric acid levels can also increase the
There is a general lack of specific evidence Limit purine-rich animal foods risk of kidney stones. Adequate fluid intake is
from prospective, blinded, randomised clinical Purines break down into uric acid. Most large important to reduce risk of stone formation.
intervention trials regarding dietary strategies observational studies show that intake of
for gout. The replication of hazardous lifestyle purine-rich meat and fish is correlated with Related problems
risk factors in a conventional clinical trial would risk of developing gout, as well as risk of People with high blood uric acid levels are
potentially pose design and ethical difficulties. recurrent attacks.1,3,4 also at greater risk of heart disease, insulin
The majority of evidence comes from Advise patients to limit intake of meat, resistance and diabetes. Weight loss,
epidemiological/observational studies, poultry and seafood to one moderate serve healthy eating and being physically active
including the Health Professionals Follow-up (eg palm-sized) per day, and avoid offal. It is all reduce the risks linked with these related
Study, NHANES III, the Nurses Health Study, prudent to avoid meat extracts (eg Bonox and health problems.
and the Shanghai Men’s Health Study.3 Bovril), brewer’s yeast and yeast extracts References
GPs can offer patients several pieces of (eg Vegemite), as these are very rich in purines.
1. Richette P, Doherty M, Pascual E, et al. 2016 updated
dietary advice for helping to manage gout. Note: there is no association between EULAR evidence-based recommendations for the
plant-based purines and gout risk. management of gout. Ann Rheum Dis 2017;76(1):29–42.
Keep weight in check 2. Khanna D, FitzGerald JD, Khanna PP, et al. 2012 American
At least 2–3 cups of low-fat dairy daily College of Rheumatology guidelines for management
While gout is far more common in people of gout part 1: Systematic non-pharmacologic and
who are overweight, those patients should Observational studies have found that higher pharmacologic therapeutic approaches to hyperuricemia.
be advised to lose weight gradually. Rapid intake of low-fat dairy products is associated Arthritis Care Res 2012;64(10):1431–46.
3. British Dietetic Association, Dietitians Association of
weight loss (more than 1 kg per week) can with lower uric acid levels and reduced Australia, Dietitians of Canada. Gout evidence summary.
increase uric acid levels and actually trigger an risk of gout.1,3,4 PEN: Practice-based evidence in nutrition. Available at
attack of gout.3 www.pennutrition.com/KnowledgePathway.aspx?kpid=195
An accredited practising dietitian Coffee in moderation 6&trcatid=42&trid=3247 [Accessed 9 October 2017].
4. Singh JA, Reddy SG, Kundukulam J, et al. Risk factors for
(APD) can help patients design a healthy Observation studies find that higher coffee gout and prevention: A systematic review of the literature.
weight loss plan. intake3,4 is associated with lower serum uric Curr Opin Rheumatol 2011 Mar;23(2):192–202.

26 Reprinted from Good Practice Issue 11, November 2017