Recent Developments in Diet and Gout

Susan J Lee; Robert A Terkeltaub; Arthur Kavanaugh

Disclosures

Curr Opin Rheumatol. 2006;18(2):193-198. 

In This Article

Conclusion

The US prevalence of gout has risen, particularly in those over the age of 65.[45] Dietary and lifestyle changes, including popularity of diets high in meat and seafood, and the rising consumption of beer may be contributing. Recent studies highlight the importance of dietary measures and alcohol restriction in the prevention of hyperuricemia and gout. The treatment of underlying risk factors remains a key cornerstone in the management of gout. Lifestyle modifications, including dietary intervention, weight loss and reduction of alcohol, can significantly lower the serum uric acid and the risk of developing gout. More importantly, diet in the gout patient can be employed for preventive effects on insulin resistance, hyperlipidemia, atherosclerosis, hypertension and alcoholic liver disease. The most effective forms of dietary regimens for both hyperuricemia and gout flares remain to be identified for patients with gout. Recent open study of a low-carbohydrate and high-protein diet featuring preferential monounsaturates in the fat component of the diet and tailored for insulin resistance, however, appeared promising for patients with gout.

Until a large, controlled study confirms these findings, it is prudent to advise patients to consume meat, seafood and alcoholic beverages in moderation, with special attention to food portion size and content of non-complex carbohydrates which are essential for weight loss and improved insulin sensitivity. Although the total protein intake does not appear to be correlated with hyperuricemia and the risk of gout, given the potential for ketosis induced by currently popular 'low-carb' diets, caution should be exercised during the initiation phase of these diets.

Gout patients should consider fulfilling their protein quota with purine-rich vegetables instead of meat and seafood. Low-fat dairy products and wine appear to be protective for the development of gout in several epidemiological studies. Due to potential confounding variables and ascertainment bias, however, it remains premature to recommend their use (preferential to other foods and beverages) in the management and prevention of gout or hyperuricemia, particularly in the patient with stable gout under pharmacologic control. Heavy consumption of alcohol, in the form of either beer or liquor, however, should be discouraged, as it increases serum uric acid and potentially promotes gout flare, particularly in association with heavy meals. With a better understanding of the impact of these lifestyle modifications, physicians can more effectively educate and motivate patients on non-pharmacological measures to better manage gout.

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