Gout: Nutritional Considerations

Gout is significantly influenced by diet. A high intake of meat, for example, is a known risk factor for the elevated uric acid level that is associated with gout. Gout occurs more commonly in overweight persons, particularly those with metabolic syndrome (see Obesity).

The following factors are associated with decreased risk of gout:

Reducing or avoiding meat. Studies have found that, compared with persons eating the least red meat, poultry, or fish, those eating the highest amount have higher uric acid levels and a significantly greater risk for developing gout.^1,2

Weight control. After adjustment for uric acid level, body mass index independently predicts gout risk.³ Compared with men at or near their ideal weight, overweight men (BMI of 25 to 29.9) have almost double the risk for developing gout. Risk is nearly tripled for those with a BMI of 35 or greater.⁴

Avoidance of alcohol. Serum uric acid is associated with alcohol intake in men.⁵ With the possible exception of moderate wine intake, the risk for gout appears to increase linearly with alcohol consumption.⁶

In addition, the following diet and lifestyle considerations should be noted:

Elevated lead levels. Elevated body lead burden increases serum uric acid and can compromise kidney function,⁷ although evidence for a connection between lead exposure and the development of gout has not been established.⁸ Lead exposure in adults can occur through many mechanisms, notably occupational exposures, storage of alcoholic beverages in lead crystal, and lead piping in older homes. For further details, see the Foodborne Chemicals chapter. Chelation treatment to remove lead results in improved clearance of uric acid from the blood.⁹

Kidney stones. Gout appears to increase the risk for kidney stones,¹⁰ and consuming 2 liters or more of water and water-based beverages per day may be helpful in reducing the risk of stone formation in gout patients.¹¹ (See also Nephrolithiasis.)

Cherry consumption. An intriguing but unconfirmed report found that consuming roughly 9 ounces of bing cherries (280 g, or 45 cherries) daily was associated with a significant reduction in blood uric acid concentrations. Postulated mechanisms include an increase in the rate of renal glomerular filtration, reducing tubular reabsorption of uric acid, and anti-inflammatory effects.¹²

Orders

See Basic Diet Orders.

Alcohol restriction.

What to Tell the Family

Gout is a treatable disease that often responds well to a combination of diet therapy and medication. Loss of excess weight may enhance treatment by improving the kidney's ability to clear uric acid from plasma. Avoidance of alcohol and meat is important for lowering blood levels of uric acid and may also reduce the symptoms of metabolic syndrome that often accompany elevated uric acid.