What’s a good diet for people with gout to follow?

Diet for gout

Can you tell me a good diet to follow for gout? My fiance was diagnosed with gout and now excludes red meat, salt, fish, milk, and alcohol from his diet. I would like to know if this is extreme, or if he’s doing the right thing. He had only one “episode” in his foot and does not want it to come back.

Gout, a type of arthritis caused by urate crystals forming in the joints, was traditionally associated with high living and a rich diet. Urates are salts of uric acid, the byproduct of a group of chemicals in our DNA and RNA called purines. Purines are found in foods containing high levels of protein, especially meats. Organ meats such as liver, kidneys, and sweetbreads are thought to be the highest in purines. Foods that contain carbohydrates or fat contain proportionately less purine.

What's a good diet for people with gout to follow?

Doc’s Advice: What's a good diet for people with gout to follow?

Before drugs were developed to control the metabolism of uric acid, and therefore control gout, a sufferer had very little choice but to try to control the attacks by dietary means. I think this was generally unsuccessful, and people went on to develop chronic gout, which has more serious complications, such as hypertension and kidney failure.

Many people have excess uric acid in their blood but do not have gout, kidney stones, or other complications. Weight loss, if they are obese, and a modest restriction in dietary protein may be helpful in reducing their uric acid. But most experts would recommend that anyone with gout be treated with medication, with diet playing little or no role in their treatment, although alcohol and diuretics which can raise uric acid levels should be avoided.

There are drugs that increase the excretion of uric acid by the kidneys and others that reduce the formation of uric acid. Although all drugs can have side effects, they’re unlikely with these drugs. They will have to be prescribed by a physician, and regular checks of the uric acid levels will probably be necessary for the rest of your fiance’s life. The fact that he has not had any more gout attacks, while great, doesn’t mean that his diet is preventing more urate deposits from developing, so there is still potential for long-term harm. Early in the course of gout, it’s common to have long periods between attacks. Even if your fiance insists that he wants to restrict his diet rather than take medication, he needs to have his blood checked regularly to be sure he is really accomplishing anything.

I’m not sure why your fiance is avoiding salt and milk. There are no purines in salt. Milk has substantial amounts of protein, but few cells, which is where purines are found. There may be other good reasons to avoid salt or milk, but gout isn’t one of them. Red wine was traditionally thought to precipitate gout. And it’s true that alcohol can raise the uric acid level in the blood, so it should be avoided.

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