Developing a diet plan for gout patients and modifying lifestyle recommendations are among the most common conversations between gout patients and their clinicians.
The link between various dietary components and an increased risk for gouty arthritis has been well researched in recent years, but is often misunderstood by patients. The truth is, lifestyle and dietary changes alone are typically not enough once a patient has been diagnosed with gout.
Many gout specialists have studied the effect of diet on uric acid levels. At best, a healthy or balanced diet may beneficially contribute to a reduction of a patient’s uric acid levels by 1.0 mg/dL. This reinforces the importance of taking daily medication, as this reduction in uric acid is not sufficient to reach the target sUA of less than 6.0 mg/dL in the vast majority of people with gout.
Because uric acid is formed from the breakdown of purines, a healthy diet that eliminates certain foods that are particularly high in purines should be recommended.
Diet plays only a minor role in determining who gets gout (genetic factors are most important), but overindulgence in these foods may trigger flares of this disease.
What Diet Plan for Gout Should You Recommend?
It’s been said that a plant and grain-based diet is good for overall health —our cardiovascular health, gastrointestinal system and more. This works to help reduce gout flares, too. If a patient has gout, advise them to follow a low-purine diet, which includes foods such as low-fat or non-fat dairy products, fresh vegetables and fruits, nuts, and grains.
Understanding Purines and Their Impact
Because uric acid is formed from the breakdown of purines, it is best to limit the amount of purine-rich foods that patients consume. Diet may play only a minor role in determining who gets gout (genetic factors are most important), but overindulgence in these foods may trigger flares of this disease. The purine-rich foods include: beer; red meat, lamb and pork; organ meats such as liver, kidneys and sweetbreads; and seafood, especially shellfish like shrimp, lobster, anchovies and sardines.
While these foods are not the main cause for a person developing gout, they have been known to trigger gouty flares. Limiting the intake can be beneficial but, by itself, will be an insufficient approach to treating gout.
Limiting Fructose and Other Dietary Considerations
Gout sufferers are also encouraged to reduce high-fructose corn syrup. Fructose is a naturally occurring simple sugar found in fruit, vegetables and honey. Many fruits have naturally occurring high fructose levels, so they should also be limited to one or two cups per day. However, in the typical American diet, high-fructose corn syrup is added to many foods and drinks.
The Gout Education Society recommends limiting table sugar, table salt , and any products containing high-fructose corn syrup, including soft drinks and juices, cereals, store-bought baked goods, ice cream, candy, and processed foods from fast food restaurants.
Research Supporting Dietary Recommendations
A 2004 study published in the New England Journal of Medicine, conducted by Dr. Hyon Choi, found that each additional serving of purine-rich red meat was associated with a 21% increase in the risk of gout in men over age 40. The study also found that each additional weekly serving of seafood (particularly shellfish) was associated with a 7% increase in risk. Protein, purine-rich vegetables and moderate wine drinking were found not to be as harmful to gout sufferers as once believed.
In addition, the study found that low-fat dairy products, specifically skim milk and low-fat yogurt, may actually decrease the risk or provide some protection against gouty arthritis.
CME Courses
The Gout Education Society believes that continuing education for medical professionals and their staff is crucial when it comes to keeping up with the latest in gout treatment, diagnosis and management.
ACR Guidelines
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Gout Education Library
With gout on the rise, it is essential that all patients, especially those touched by gout, are knowledgeable about this serious disease. You can always learn more from your doctor during regular visits. Take a stand on gout!
What Lifestyle Changes Should My Patient Make?
Monitor Their Uric Acid Level—and “Go for Six”
Monitoring your patients’ uric acid level is as important as knowing other healthy benchmark numbers, like cholesterol, blood pressure and heart rate. The Gout Education Society recommends people with gout aim for a healthy uric acid level of 6.0 mg/dL or below. It is good to maintain a transparent doctor-patient relationship to find what treatment is best and keep gout at bay. It’s also important to check your uric acid levels every six months to ensure target levels are being met.
Exercise Regularly
Adults should engage in moderate-intensity physical activities for at least 30 minutes most days of the week, according to the Centers for Disease Control and Prevention. This includes activities such as walking briskly or swimming laps, mowing the lawn, dancing, swimming or bicycling on level terrain. Increasing the intensity or the amount of time you are physically active can have even greater health benefits and may be needed to prevent weight gain. Develop an appropriate exercise program that is tailored to your patients body, lifestyle and needs.
Maintain a Healthy Body Weight
An obese person is three times more likely to develop gout than someone with a normal body weight. Advise your patients to avoid crash diets, since fast or extreme weight loss can increase the amount of uric acid in the body. High-protein diets that contain high-purine foods may also be a problem for people with gout.
Stay Hydrated
Many dietitians recommend consuming at least 64 ounces of water daily and more if you are exercising. Water helps the body transport nutrients and waste, regulates body temperature and cushions joints and tissues. Research also suggests that drinking adequate water might guard against kidney stones and constipation. Tell your patients to avoid sports drinks sweetened with high-fructose corn syrup.
Take Vitamins
The risk of gout appears to be lower in men taking daily vitamins. Vitamin C may be a useful supplement in the 500 to 1,000 mg per day range.
In addition to knowing their uric acid number – aiming for 6.0 mg/dL or below and getting sUA levels checked twice a year—patients should also be keeping track of these other healthy benchmarks, too.
