Gout is an inflammatory form of arthritis that usually affects one joint at a time, commonly the big toe joint. It occurs when there is a buildup of uric acid in the blood, leading to the formation of uric acid crystals in the joints and other areas of the body.
Symptoms of gout include severe pain, swelling, and redness on and around the affected joint. Gout flares usually last anywhere from a few days to two weeks with treatment. If left untreated, gout flares can last weeks to months.
What is Uric Acid?
Uric acid is a waste byproduct of purine breakdown in the body. Purines are naturally produced in the body, as well as found in some foods. As purines are broken down, uric acid is created. Normally uric acid is either reabsorbed in the body or excreted via the urine and feces.
When there are more purines in the body than it can process, uric acid builds up in the bloodstream. This is called hyperuricemia. Hyperuricemia can cause gout and/or kidney stones in some people, while others have no signs or symptoms at all.1
Treatment for gout often includes medications, diet modification, and lifestyle changes, such as managing weight and quitting smoking. The foods you eat can have a direct impact on gout flares.
During a gout attack, modifying your diet may help decrease the length of the flare. Continuing to follow a gout-friendly diet, specifically a low-purine diet, may help prevent the risk of future gout attacks up to five fold.2
Cherries have been studied for their role in the prevention and management of gout. Their deep red color is due to natural compounds called anthocyanins, which contain antioxidant and anti-inflammatory properties.
Research has shown that cherry consumption may help reduce uric acid levels, and thus decreasing inflammation and lowering the risk of future gout attacks.3 The most commonly studied types of cherries for gout therapy have been tart cherries. More specifically, Montmorency or Balaton varieties.
Fresh, frozen, juice or extract forms are commonly consumed, however there are no defined amounts to eat per day for gout prevention. Studies vary widely in the amounts of cherries researched, such as servings of 1/2 cup of fresh cherries or 1 cup of cherry juice per day. For cherry extract supplements, it is best to follow the suggested dose amount on the label.
Using Tart Cherry Juice for Gout
Tart cherry juice may help decrease uric acid levels and inflammation in gout. Research is limited, with often small numbers of study participants and short-term follow-up.
Nevertheless, a 2019 review of six studies that looked at the effect of cherry juice or cherry extract intake on gout concluded that cherry intake was associated with a reduced risk of gout attacks. Researchers did note that larger, more long-term studies are needed to clarify this association.3
When choosing tart cherry juice, be sure to look for unsweetened varieties to help reduce the amount of added sugar in your diet.
High-Vitamin C Foods
Vitamin C is a well-known antioxidant, but it is lesser-known for its potential role in the treatment of gout. The means by which it may help is by lowering blood uric acid levels.
A prospective study published in 2009 followed nearly 47,000 men for 20 years, and examined their risk of gout in relation to their vitamin C intake. The researchers concluded that higher vitamin C intake was associated with a lower risk of developing gout, with up to a 45% lower risk when consuming 1,500 milligrams or more of vitamin C per day.4
A 2011 analysis of 13 randomized controlled clinical trials in people with high blood uric acid levels found that vitamin C supplementation with a median dose of 500 milligrams per day for a median duration of 30 days modestly reduced serum uric acid levels. Whether this amount is significant or not in reducing the risk of gout needs to be further studied.5
Foods high in vitamin C include citrus fruits like oranges, lemons, and grapefruit, cherries, spinach, kale, broccoli, strawberries, sweet bell peppers, and tomatoes. If you have an increased risk for kidney stones (particularly calcium oxalate stones), it is not recommended to consume high doses of supplemental vitamin C on a regular basis.
Being one of the most widely consumed beverages in the world, coffee has been studied for its various effects on health. Early studies suggest that coffee may decrease the risk of gout. However, research shows that it may vary based on sex.
A 2015 review of studies found that in men who drank 4 to 5 cups of coffee per day had a 40% decreased risk of gout, and those who drank 6 cups or more per day had a 59% lower risk, when compared with no coffee consumption.6
In women who drank 1 to 3 cups of coffee daily, the risk of gout was 22% lower, and in those who drank 4 or more cups daily the risk was 57% lower, compared with no coffee consumption. From this review, the researchers concluded that drinking 4 or more cups of coffee per day lowers uric acid levels and decreases the incidence of gout.6
However, there has been no research to look at the effects of coffee intake on the risk of recurrent gout attacks.
One of the most widely accepted and recommended dietary approaches in managing gout is to reduce purine intake from foods. By choosing to eat low-purine foods instead of those higher in purines, you can help prevent your blood uric acid levels from getting too high.7
Additionally, the DASH diet, which encourages many low-purine foods, has been associated with a lower risk of gout.8 Low-purine foods include certain fruits, like cherries and citrus fruits, low-fat dairy, plant-based protein foods such as nuts, seeds and legumes, whole grains, and vegetables.
What Are Purines?
Purines are naturally occurring chemical compounds. There are two types of purines: exogenous and endogenous. Those found in foods are called exogenous purines. Purines made by our body are called endogenous purines.
It is normal for the body to contain some purines at all times. Typically, when the body processes purines, uric acid is created as a byproduct and it is either reabsorbed in the body or excreted as waste. High purine intake from foods may increase uric acid levels in your body, thus increasing the risk of gout.
Many plant-based foods are low in purines, making them an excellent choice on a gout-friendly diet. Plant-based vegetarian diets have been shown to decrease the risk of gout, according to two separate prospective cohort studies.9
Some vegetables are higher in purines, though research has found that they might be processed differently by the body, and therefore do not increase the risk of gout and may actually decrease risk.10
A 2019 review of plant-based diets and their association with gout suggested that a reasonable consumption of higher purine plant foods as a part of a plant-based diet may be safely tolerated in healthy people.11 Researchers noted that additional studies are needed in people with high uric acid levels, especially those who suffer from chronic kidney disease.
Many plant-based foods contain numerous health-promoting nutrients, such as vitamins, minerals, and fiber, which are beneficial to overall health. Plant-based foods include whole grains, nuts, seeds, beans, and other legumes, soy-based protein, such as tofu, fruits, vegetables, and nut and vegetable-based oils.
Dairy products have been found to decrease the risk of gout. In particular low-fat or non-fat dairy may be protective against recurrent gout flares.12 Low-fat dairy may decrease uric acid levels, as well as contain certain anti-inflammatory properties that decrease the inflammatory response to monosodium urate crystals within the joint.13
The Dietary Guidelines for Americans suggest 3 servings of dairy per day for healthy adults.14 This includes low-fat milk, yogurt, cheese, or cottage cheese.
Staying hydrated has numerous health benefits, including for people with gout. A 2017 prospective study looked at the association between water intake and uric acid levels.15
After examining the data, researchers determined that water intake has an association with lower uric acid levels in people with gout, possibly due to increased uric acid excretion with higher water intake. However, more research is needed to look at a more direct effect of water intake on gout.
A review in the American Journal of Lifestyle Medicine found that excess sweating, such as after exercise or sauna bathing, decreased urinary excretion of uric acid, leading to an increase in uric acid levels.16 Therefore, researchers recommend drinking plenty of water to avoid increased serum uric acid levels after activities that cause heavy sweating.
Additionally, researchers also found that adequate water consumption in the 24-hour period before a gout flare was associated with a significant decrease in recurrent gout attacks.16
Water is the best source of hydration, but other beverages such as coffee, and foods such as some fruits and vegetables, contain water and can contribute to your overall hydration status. Drinking to thirst is best, but some experts suggest drinking half of your body weight in ounces each day for optimal hydration.
Foods to Avoid
Just as important to know which foods to add to your gout-friendly diet, is knowing which foods to avoid. Below is a short summary of some foods to avoid with gout.
Gout has been associated with alcohol intake for centuries. Frequent and high alcohol consumption is known to cause chronic hyperuricemia, increasing the risk of gout and gout attacks. Because of this, it is recommended to avoid some alcohol altogether, including beer, hard liquor and other grain alcohols.17
Recent research has shown that not all alcohol needs to be avoided with gout, though. Wine, when drunk in moderation and with meals, may not contribute to an increased risk of gout. Moderate consumption of wine is considered 2 (5-ounce) drinks per day for men and 1 drink per day for women. 18
Avoiding or limiting foods high in purines can help reduce the length of a gout attack, as well as the risk of recurrent gout flares. According to a 2014 study, acute purine intake increased the risk of recurrent gout attacks by nearly fivefold in people with gout.2
High-purine foods include organ meats such as beef, pork, and chicken liver, wild game, certain seafood such as sardines, and anchovies, alcoholic beverages such as beer and hard liquor, yeasts, and some foods and beverages high in fructose and high fructose corn syrup.
Fructose is a naturally occurring form of sugar found in some foods, such as fruit. Research has shown that fructose, including high fructose corn syrup added to some foods and beverages, can increase serum uric acid levels.19 Avoiding or limiting foods high in these types of sugars may help reduce the symptoms and severity of gout.
One of the main natural sugars in many fruits is fructose. However, the association between gout and fruit intake is unclear. You do not need to avoid all fruit on a gout-friendly diet, though some fruit juices may need to be avoided or limited.
Sugar-sweetened beverages can increase uric acid levels in the blood. Consumption of sugar-sweetened beverages was significantly associated with an increased risk of gout and hyperuricemia in adults, according to a 2020 review of studies.20 Sugar-sweetened beverages, such as soft drinks or soda, sports drinks, and energy drinks should be avoided with gout.
Foods with yeasts and yeast extracts are high in purines and should not be included in your diet if you have gout.20 Foods, such as vegemite, as well as supplements containing yeast should be avoided in order to keep uric acid levels down.
Yeast extract can sometimes be found in prepared foods, such as some frozen meals, canned soups and stews, soy sauces, and salty snacks.
A Word From Verywell
A healthy, balanced diet built around a variety of colorful, whole foods while limiting highly processed foods is not only beneficial for gout, but overall health as well. Finding out your individual gout triggers by trialing specific foods and amounts can go a long way in offering more flexibility to your diet.
As always, be sure to talk with your healthcare provider before making any changes to your diet or treatment plan.
Author: Brittany Poulson, MDA, RDN, CD, CDCES
Source: Very Well Health: How Food Can Help Treat Gout