Why Diet is important

If you have gout, you've probably wondered whether something you ate caused your latest attack. Food can play a role in gout, but the relationship between gout and diet is more complicated than simply avoiding a list of “bad foods”.

Gout develops when urate crystals form in and around the joints. These crystals are associated with raised levels of uric acid (urate) in the blood. Diet can influence uric acid and may contribute to some people's risk of gout, but it is only one part of the picture.

Genetics, body weight, certain medicines and health conditions can also influence your risk. Nice

Does diet cause gout?

Not by itself.

It can be tempting to blame one particular meal or drink for gout, especially when an attack appears shortly afterwards. However, gout is a medical condition involving the build-up of urate crystals rather than simply a reaction to eating the wrong food.

NICE states that there is currently not enough evidence to show that any specific diet prevents gout attacks or lowers blood urate levels. Its guidance recommends following a healthy, balanced diet rather than relying on a special “gout diet”. Nice

That distinction is important.

Changing what you eat can form part of managing your overall health, but it should not be viewed as a replacement for medical treatment when treatment is required.

What does food have to do with uric acid?

Uric acid is produced when the body breaks down substances called purines.

Purines occur naturally within your body and are also found in foods and drinks. This is why discussions about gout often focus heavily on high-purine foods.

But concentrating exclusively on purines can make gout diets unnecessarily confusing.

Instead of trying to remove every food containing purines, a more practical approach is usually to think about your overall diet and lifestyle.

Alcohol and gout

Alcohol is particularly relevant when discussing gout.

The NHS lists drinking alcohol as a factor associated with an increased chance of gout and says that drinking too much alcohol can trigger an attack. It advises having alcohol-free days and staying within recommended alcohol limits. nhs.uk

NICE also advises that excessive alcohol consumption may exacerbate gout flares and symptoms. Nice

That doesn't necessarily mean everybody with gout must completely stop drinking alcohol. Individual circumstances vary, and you should discuss concerns about alcohol and gout with an appropriate healthcare professional.

Sugary drinks

Sugary drinks are another area worth considering.

The NHS recommends avoiding lots of sugary drinks and snacks as part of lifestyle measures that may help reduce further gout attacks. nhs.uk

Water is therefore a straightforward everyday choice, particularly because dehydration itself can trigger a gout attack.

Don't forget hydration

Hydration can easily be overlooked when thinking about gout and food.

The NHS specifically identifies dehydration as a potential trigger for a gout attack and recommends drinking plenty of fluids to avoid becoming dehydrated. nhs.uk

Your individual fluid requirements may be different if you have certain medical conditions, so follow advice from your healthcare professional where applicable.

Weight and gout

Body weight can also be relevant.

NICE identifies excess body weight and obesity among the risk factors that should be discussed with people diagnosed with gout. It also advises that excess body weight or obesity may exacerbate gout flares and symptoms. Nice

The NHS recommends trying to lose weight if you're overweight, while specifically advising against crash diets. nhs.uk

A sustainable approach to eating is therefore more useful than following an extremely restrictive diet every time you experience a gout attack.

So, what should I eat if I have gout?

There isn't one officially prescribed “gout diet” that everyone needs to follow.

NICE recommends a healthy, balanced diet and notes that the evidence isn't strong enough to recommend a particular diet specifically to prevent gout attacks or reduce serum urate. Nice

That means your diet should be considered as part of the bigger picture rather than as a miracle treatment for gout.

Understanding your own habits can still be useful. Some people choose to keep a record of their food, alcohol intake and gout attacks to help identify patterns they may want to discuss with their doctor or another healthcare professional.

Diet is only one part of managing gout

This is perhaps the most important point.

You shouldn't feel that experiencing another gout attack automatically means you've “failed” with your diet.

Gout is a long-term medical condition. NICE guidance describes long-term urate-lowering therapy as an important part of management for appropriate patients and recommends discussing or offering it depending on an individual's circumstances. Nice

If you're having repeated or troublesome attacks, don't simply keep removing foods from your diet. Speak to your GP or another appropriately qualified healthcare professional about managing the underlying condition.

The bottom line

Diet matters with gout, but it isn't the whole story.

A healthy, balanced diet, avoiding excessive alcohol, maintaining a healthy weight and avoiding dehydration are sensible parts of living with gout. However, there is currently insufficient evidence that a particular “gout diet” alone prevents attacks or lowers uric acid. Nice

Understanding that difference can make eating with gout considerably less confusing.

Sources & further reading

NHS — Gout

NICE — Gout: diagnosis and management

Medical information: This article is intended for general information only and is not a substitute for diagnosis, treatment or individual advice from a doctor, pharmacist or other qualified healthcare professional.