Historically called the disease of kings, gout was common among wealthy gents who could afford to eat and drink to excess. These days it doesn’t just affect the rich: rates of gout have been increasing globally since the 1960s. It now affects around 70,000 Australians a year and is more common in men aged over 70.
Worldwide, the prevalence is highest in Taiwan (2.6% of the population and 10.4% of Indigenous Taiwanese) and among the New Zealand Maori (6.1%).
You get gout when your metabolism of purine – a chemical component of DNA which is made in the body and found in some food and drinks – gets out of kilter.
Purine is broken down in the liver, producing uric acid as a byproduct. Uric acid enters the bloodstream, travels to the kidneys and is excreted in urine. If uric acid can’t be cleared, blood uric acid levels rise.
Once uric acid rises above 0.42 mmol/L (millimoles per litre), crystals can start to form in tissues and joints, particularly in toes and fingers. This can culminate in sudden and excruciating joint pain, called an acute gout attack.
Healthy diets play an important role in managing gout or reducing your risk of the disease. Cherries, dairy products, coffee and vitamin C have shown benefits.
Foods that are high in purine or that increase uric acid metabolism should be limited. These include red meat, seafood, sugar-sweetened drinks, fruit juice, foods high in fructose, and alcohol.
Foods to eat more of
Bioactive components in cherries lower uric acid production in the liver and improve excretion via the kidneys. They also have anti-inflammatory properties.
In a study of 633 gout sufferers followed for a year, those who had eaten cherries in the past few days were 35% less likely to have an acute gout attack than those who hadn’t.
Similarly, a four-month trial found those who consumed cherry juice had significantly fewer attacks.
Milk promotes uric acid excretion. Having two or more daily serves of dairy, especially from reduced fat and skimmed milk, confers a 42-48% lower risk of gout compared to less than one serve.
A number of studies have shown that coffee is associated with a lower risk of gout. Coffee is a diuretic and therefore increases urine production. Coffee’s chlorogenic acid promotes uric acid excretion, while the chemical xanthines lower uric acid production.
A 12-year study of more than 45,000 men found those who drank four or more cups of coffee a day had 40-60% lower risk of getting gout than those who didn’t drink coffee.
Interestingly, even drinking decaffeinated coffee conferred a lower risk of gout.
A large review of 13 studies found taking vitamin C supplements (about 500 mg a day for around a month) led to a small reduction in blood uric acid of 0.02 mmol/L.
But one word of caution before you start popping vitamin C: high intakes increase the risk of kidney stones.
Things to cut down on
Meat and seafood
High intakes of red meat (including liver, kidneys and other offal) and seafood (shellfish, scallops, mussels, herring, mackerel, sardines and anchovies) are associated with a greater risk of gout because of their high purine content and impact on uric acid production.
Foods that contain yeast, such as Vegemite and Marmite, are also high in purine.
Fructose is a “simple sugar” found in honey, fruit, some vegetables and sweeteners. Fructose increases purine metabolism, raising blood uric acid levels.
Avoid sweeteners high in fructose such as honey, brown sugar, high-fructose corn syrup, golden syrup and palm sugar. Check your tolerance for fruits, vegetables and other foods high in fructose.
Uric acid levels tend to be higher in people who regularly consume sugar-sweetened drinks. Those drinking one to two sugar-sweetened soft drinks a day are almost twice as likely to have gout as those who drink only one a month.
When it comes to whole fruit, results are not clear. While one study found a higher risk of gout with higher fruit intakes, another found a lower risk. The opposing results are partly confounded by the variation in fructose content of different fruits.
The effect of specific alcoholic beverages on blood uric acid levels varies. Beer is high in purine and increases uric acid more than spirits, while moderate wine intake appears neutral.
Non-drinkers have been shown to have lower uric acid levels than those who drink beer or spirits. The more they drank, the higher their uric acid levels.
In a meta-analysis of 17 studies involving 42,000 adults, the relative risk of gout for those with the highest alcohol intakes was almost double compared to non-drinkers or occasional drinkers.
Ten tips for beating gout
If you have gout, use these nutrition tips to lower your risk:
- See your GP to check or monitor gout risk factors
- Drink up to four cups of regular or decaffeinated coffee a day
- Have two to three serves of reduced-fat or skim dairy foods daily (for example, milk on cereal, milky coffee, custard or yoghurt)
- Eat cherries regularly (fresh or frozen). Add to breakfast cereal and snacks, or mix with yoghurt
- Avoid fasting and feasting. Both increase purine turnover and blood uric acid
- Manage your weight by trying to prevent weight gain. If you are overweight, try to drop a few kilograms
- Avoid foods high in purines (offal meats, sardines, anchovies, yeast spreads, beer) and rein in the portion size of foods with a medium purine content
- Cut out soft drinks, sports drinks and fruit juice. Aim for two litres of water daily (or enough so your urine is the colour of straw)
- Limit alcohol, especially beer and spirits
- Manage your fructose by avoiding honey, brown sugar and corn syrup solids (check food labels). Eat fruit and vegetables with a low to moderate fructose content. Avoid those that are very high in fructose, except for cherries.