Gout is the result of an increased uric acid level: if there is too much uric acid in the body, it can settle in joints and trigger an attack of gout. Some people manage to keep uric acid levels low by eating meat, fish and seafood in moderation and drinking little alcohol.
Uric acid is a breakdown product of the so-called purines. They are mainly produced in the body itself, but are also partly absorbed through food. Purines are contained in many foods. Fish, meat and seafood are particularly rich in purines. Sometimes people with gout are recommended a diet low in purines. However, it is not known exactly how effective such a diet is.
What role do purines play?
It is estimated that 70% of uric acid in the blood is produced in the body itself. Even a diet low in purines can therefore only reduce the uric acid level by a maximum of 30%. But not all foods are the same: the body absorbs purines from different sources differently. It is therefore questionable whether it makes sense to generally avoid foods containing purines – especially if you have a balanced diet. There are no reliable studies on the effects of a strictly low-purine diet. Moreover, it is difficult to keep it up.
What influence do diet and weight have?
Individual studies suggest that certain foods are associated with gout attacks. For example, gout attacks seem to occur more often if a lot of meat, fish or seafood was eaten in the days before. This is in line with the experience of many people affected. Vegetarian foods containing purine, such as peas, beans, lentils, spinach, mushrooms, oatmeal, cauliflower and broccoli, on the other hand, had little or no effect on the risk of a gout attack. Overall, the connection between certain foods and gout attacks has not yet been very well researched.
The consumption of cherries is sometimes recommended to prevent gout attacks. However, there is no scientific evidence of such an effect.
As the metabolism does not react in the same way in all people, it is useful to try out for yourself what is good for you and what is not – and what quantities you can tolerate. Some people feel better if they adjust their diet. Others successfully lower their uric acid levels with medication and manage well without changing their diet.
Some studies also suggest that it can help people who are very overweight to lose weight. However, it is better for people with gout to avoid strict fasting – because this can even trigger an attack of gout.
Does not drinking alcohol help?
There are few studies on the influence of alcohol on gout attacks. They suggest that people with gout are more likely to have an attack if they have drunk more than one or two alcoholic drinks in the 24 hours before. An alcoholic drink might be a small bottle of beer (0.33 l), a small glass of wine (0.1 l) or a double shot of brandy (4 cl).
There are several reasons why alcohol can cause gout attacks. Firstly, it itself promotes the formation of uric acid and reduces the excretion of uric acid by the kidneys. Secondly, the draining effect of alcohol can promote gout. In joints whose tissue contains too little fluid, uric acid crystals form more easily. Beer in particular also contains a comparatively high amount of purine, which could also play a role.
What should I pay attention to when taking medication?
There are certain medications that can increase uric acid levels and thus promote gout. These include diuretics, acetylsalicylic acid (ASA) and certain drugs used after organ transplantation. The Parkinson’s drug levodopa and some cancer drugs can also promote gout.
If you are taking these drugs, it is best to discuss with your doctor whether it is possible to change your medication.
Can dietary supplements help?
Sometimes people with gout are recommended to take dietary supplements containing vitamin C, as they are supposed to lower uric acid levels. But so far, only one good study has investigated the effect of vitamin C on gout. That study showed a weak effect on uric acid levels. The study did not investigate whether this reduces the risk of gout attacks.
And if a change in diet is not enough?
Some people manage to get their uric acid levels under control by changing their diet. However, many people need medication to do this. A lot of uric acid is produced in the body itself, so diet has only a limited effect. Treatment with medication is useful if there are frequent attacks of gout, as well as in cases of secondary symptoms such as gout nodules or kidney stones.