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Gout is a common form of arthritis that is characterized by recurrent attacks of swollen, red, hot and stiff joints. Gout can occur in various joints such as ankles, knees, elbows, toes and fingers. Gout attacks can be painful and last several days. This article will discuss the causes of gout and how to manage it from a nutrition perspective. 

What Causes Gout?

Gout is caused by the accumulation of urate crystals in the joints, which can cause inflammation and pain. Urate crystals are formed because of elevated uric acid in the blood, which can be due to overproduction of uric acid, underexcretion of it, or both. Uric acid is the end-product of purine metabolism. Purines are substances that are found naturally in the human body and in foods such as animal products, organ meats, seafood and beer. Gout was known as “the disease of kings” or “rich man’s disease” since high-purine foods such as meat, seafood and alcohol were expensive back in the ancient times.

Males who are over 45 years old are more commonly affected by gout. The risk of getting gout increases among postmenopausal women. Other risk factors of gout include family history of gout, overweight/obesity, alcohol intake, and a high purine diet.

Common symptoms of gout include intense joint pain, lingering discomfort, limited range of motion, inflammation and redness. 

Gout & Diet

Since gout is a chronic and recurrent condition, it is important to manage it with lifestyle modifications to reduce acute attack episodes. 

According to the Nutrition Care Manual, current guidelines for treating people with gout include a balanced meal plan that is limited in animal products and alcohol intake (especially beer), and encourages adequate fluid intake. 

It is important for patients with gout who have other conditions such as hyperlipidemia, hypertension, diabetes or obesity to manage these conditions with healthcare providers. Weight loss in obese patients is beneficial to help improve gout symptoms. 

During Acute Attack

• Consume 8-16 cups (64-128 ounces) of fluid/day, with at least half being water
• Avoid alcohol
• Avoid high purine foods such as organ meat and some seafood (see the table below) 
• Limit animal products such as meat, fish and poultry to 4-6 oz/day
• Eat a moderate amount of protein with the recommended sources such as low-fat or nonfat dairy, tofu, eggs and nut butter

During Remission 

• Follow a balanced diet based on the dietary guidelines
• Consume 8-16 cups (64-128 ounces) of fluid/day, with at least half being water
• Avoid alcohol, particularly beer and hard liquor
• Consume animal products as tolerated
• Continue moderate protein intake
• Avoid soft drinks and foods that contain high fructose corn syrup 
• Limit intake of high-purine foods (see the list below). High purine vegetables like spinach and asparagus are still fine to have
• Maintain an appropriate body weight 
• Avoid fasting or high-protein diet for weight loss

Please feel free to ask your dietitian in your care team if you have any questions about the gout diet or any specific foods!