What is the "gout diet"?

If you've been diagnosed with gout, you may have been handed an overwhelming list of foods to avoid. But in truth, the latest dietary recommendations for gout aren't a radical departure from the way most of us are encouraged to eat anyway. In fact, they look a lot like the plant-forward Mediterranean-style diets that benefit nearly everyone.

"It turns out that the eating patterns that are healthiest for your heart, and for the rest of you, are also the ones that tend to be the best for gout," says Dr. Robert Shmerling, senior faculty editor at Harvard Health Publishing and former clinical chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center.

Gout is the most common form of inflammatory arthritis, affecting more than 55 million people worldwide, according to a 2024 study. Men are about three times more likely than women to develop gout, though the difference narrows after women reach menopause. The incidence of gout has doubled over the past three decades - possibly linked with rising obesity rates.

What causes gout?

Gout begins with purines - compounds found in many foods and in your body's cells. When your body breaks down purines, an important byproduct is uric acid. Normally, most of the uric acid dissolves in the blood, passes through the kidneys, and is excreted, mostly in the urine and some in the stool. But when too much uric acid builds up, it can settle in joints, forming needle-shaped crystals - most famously in the big toe, but sometimes in the ankle, knee, or wrist (or almost any other joint). Those crystals trigger the immune system, producing the intense inflammation, swelling, and pain known as a gout flare-up.

The goal of gout treatment is to prevent future flares and, over time, dissolve the crystals. Usually this involves a combination of medications and lifestyle changes. Losing excess weight is key, as is staying well hydrated to help flush out excess uric acid in your urine. A healthy diet helps, too.

What to eat to manage gout

Research consistently links varied, plant-forward eating patterns with lower rates of gout. Both the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet have been shown in clinical trials to meaningfully lower uric acid levels. These diets are thought to help because they

• emphasize vegetables, fruits, whole grains, olive oil, and avocados - all rich in inflammation-fighting phytochemicals
• include low-fat dairy products, linked in studies to lower uric acid levels
• provide fiber-rich foods that help support a more diverse population of gut microbes, which may help the kidneys eliminate uric acid more efficiently
• limit red meat and added sugars, which can drive up uric acid levels.

Foods to avoid with gout

Some foods can trigger gout flares by boosting uric acid levels.

High-purine animal foods. It's best to limit or avoid

• organ meats (liver, kidneys, sweetbreads)
• red meat
• game meat (venison, boar, bison)
• shellfish, trout, haddock, anchovies, sardines, herring
• gravies and meat-based sauces.

Some vegetables, like asparagus and spinach, contain purines, but they don't seem to be linked with increased gout risk; the reason isn't clear. And, though it's important to limit purines, today's guidelines are more flexible than in the past, says Dr. Shmerling. "A strict low-purine diet can be hard to follow, and it's not nearly as reliable at preventing attacks as medications are."

Alcoholic drinks. Alcohol, especially beer and distilled spirits, can hinder the kidneys' ability to process uric acid. It's also dehydrating, which can put more stress on the kidneys. "Beer is especially problematic, because it also contains purines," adds Dr. Shmerling. If you drink, make it just an occasional one - and avoid alcohol completely during a flare.

Sodas and other processed foods made with high-fructose corn syrup. Research suggests that people who consume more of these products tend to have higher rates of gout. Though the mechanism isn't clear, fructose, also found in table sugar, may speed purine breakdown and raise uric acid levels. A diet high in added sugars also promotes inflammation throughout the body, which can worsen the inflammatory response when a gout flare-up occurs.

The good news, says Dr. Shmerling, is that unlike some other forms of arthritis, gout is highly manageable. "We have a lot of good treatments for gout, and you can prevent flare-ups, potentially, with lifestyle changes, medicines, and usually both."

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