Medical Nutrition Therapy: Nutrition Tips to Lower Risk of Gout Attacks
Gout is one of the oldest known kinds of arthritis, and it has long been linked with a diet rich in food and drink. It happens when higher-than-normal levels of uric acid in the blood (called hyperuricemia) cause solid crystals to form in a joint or joints. These crystals, which can be seen under a microscope, are shaped like sharp needles, and are responsible for the intense, severe pain that gout is known for.
Gout can be divided into 3 phases:
• symptom-free hyperuricemia - uric acid levels in blood are higher than normal, but no crystals have formed in joints
• acute attack – pain, tenderness, and/or swelling in a joint (occasionally more than one joint), that develops rapidly to severe pain within 6-24 hours. Pain generally starts to decrease within days, and usually stops completely within several days to 2 weeks.
• chronic symptomatic gout – includes build-up of uric acid crystals (called tophi) and pain that doesn’t go away
Although a rich diet has long been thought to be linked to gout, there are several factors that more strongly affect your risk for developing higher-than-normal levels of uric acid and/or gout attack:
1. Genes – One in four people with gout have a family history.
2. Gender and age - More men than women between the ages of 30 and 50 are likely to develop gout, mostly because women tend to have lower uric acid levels than men. Women generally develop symptoms after menopause (it is thought that estrogen may play a protective role).
3. Medical conditions – Untreated obesity, high blood pressure, diabetes, cardiovascular disease, metabolic syndrome, hyperlipidemia, arteriosclerosis, insulin resistance, decreased kidney function (and other conditions that affect the kidney’s ability to get rid of uric acid), surgery, a sudden or severe illness or injury, or not moving much due to bed rest are all conditions linked with higher risk of gout.
4. Medications -Thiazide and loop diuretics, low-dose aspirin, cyclosporine, niacin, tuberculosis drugs (ethambutol, pyrazinamide), didanoside, and some chemotherapy cancer treatments raise the risk of gout.
Is diet the first line of defense to treat gout and hyperuricemia?
No. Recent guidelines from the American College of Rheumatology indicate that patients with gout should try to maintain a serum (blood) uric acid level of less than 6 mg/dL, which usually requires a medication such as allopurinol. Studies show that most patients are not able to lower their serum uric acid level to that goal through diet alone. Long-term management of serum uric acid levels is thought to reduce permanent joint damage, so medication is considered the first line of treatment.
How can diet be part of gout and hyperuricemia management?
Uric acid is made when the body breaks down purines, as part of normal
metabolism. Purines occur naturally in the body, and some foods also contain them. In the past, the relationship between diet and gout has focused on severely limiting all purine-rich foods and alcohol. However, research has shown that diets high in purine-rich vegetables do not raise risk of gout. And while beer and hard liquor are linked to higher risk of gout, wine has not been shown to raise risk.
High intake of red meat and high intake of beer are the lifestyle factors most strongly linked to gout; high intake of seafood and high intake of spirits (hard liquor) have a smaller but still significant effect on risk of gout.
So, to help reduce your risk of gout attacks and permanent joint damage from chronic gout, follow these tips:
• Limit meat, poultry and fish. Animal protein in general is high in purines, but some very-high purine foods should be avoided entirely such as organ meats, herring, anchovies, and mackerel. Other high-purine foods that have been shown to increase risk of gout should be severely limited, including red meat (beef, pork, and lamb) and seafood (tuna, shrimp, lobster, scallops, salmon and other fatty fish). Limit your intake of poultry, fish, and meat to 4-6 cooked ounces per day.
• Limit or avoid alcohol. Alcohol makes it harder for your body to get rid of uric acid. Drinking beer, especially, has been linked to gout attacks, and hard liquor has also been shown to increase risk of gout attacks, but to a lesser extent than beer. Wine in moderation (one or two 5-ounce servings per day) does not seem to increase risk of an attack, but should be avoided during a flare-up.
• Limit or avoid high-fructose corn syrup (HFCS). Fructose is the only sugar known to raise uric acid levels, so it is best to avoid soda and juice drinks sweetened with HFCS. 100% fruit juice also contains fructose, but has a smaller effect on uric acid levels, and should be limited to 4-8 ounces per day.
• Watch your weight. Overweight and obesity are linked with a higher risk of gout, so if you have excess weight, try to exercise more and reduce your calorie intake to gradually lose weight. Fasting or skipping meals, and rapid weight loss can actually promote a gout attack, as can high-protein weight-loss diets, so it pays to have a healthy approach to weight loss, i.e., smaller meals and snacks regularly throughout the day.
• Choose healthy carbohydrates. Eat more vegetables, fruit, and whole grains, and limit refined carbs like white bread, sweets, candy, etc.
• Eat less saturated fat. Saturated fat (fat that is solid at room temperature) lowers the body’s ability to get rid of uric acid. Red meat and other animal protein sources tend to be high in saturated fat, so choose beans, legumes, and low-fat or fat-free milk or yogurt often to replace or at least reduce your use of animal protein sources.
What Should You Eat?
In contrast, some foods may protect against gout. Advice to eat diary products to lower risk of gout has been around for a long time: as far back as the 1600s, the philosopher John Locke had proposed that a diet low in meat and high in dairy foods would help prevent gout, and modern research supports this advice. Since saturated fat can affect uric acid levels, and dairy fat is mostly saturated, it is recommended that only low-fat or fat-free dairy products be eaten. Avoid or limit regular cheese, sour cream, cottage cheese, ice cream, whipped cream, half-n-half, butter, etc. Skim or 1% milk, and low-fat or fat-free yogurt are the best dairy choices.
Research has also suggested that consuming cherries may reduce gout attacks, and men who drink 4-6 cups of coffee per day may lower risk than men who don’t drink coffee (this protective effect wasn’t seen in women). More research is needed to confirm this preliminary evidence.
In general, you want to eat vegetables, fruit, whole grains, legumes, low-fat or fat-free milk and/or yogurt, nuts, and lots of fluids such as water, coffee, or tea. In other words, a healthy diet! But remember, diet alone is unlikely to prevent gout flare-ups. Most people will need to take medication to help keep serum uric acid levels under 6 mg/dL and prevent long-term joint damage. But eating a healthy diet may result in fewer, and less severe, attacks.
Teach Back:
What is the most important thing you learned from this handout?
What changes will you make in your diet/lifestyle, based on what you learned today?
If you are a UW Health patient and have more questions, please contact UW Health at one of the sites listed below:
| Nutrition Clinic University Station 2880 University Avenue Madison, WI 53705 Office 608-263-5012 Appt scheduling 608 263-4360 |
Nutrition Clinic UW Health West Clinic 451 Junction Road Madison, WI 53717 Office 608-265-7526 Appt scheduling 608 262-9181 |
Nutrition Clinic UW Health East Clinic 5249 East Terrace Drive Madison, WI 53718 Office 608-265-0963 Appt scheduling 608-265-7405 |
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/22/2013
Copyright © 01/03/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5526
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