Gout is caused by the deposition of monosodium urate crystals in joints, driven by persistently elevated serum uric acid. Genetic factors determine approximately 25 to 40 percent of the variance in serum uric acid levels, with the remainder determined by dietary and environmental factors. For most adults with gout, dietary modification can reduce the frequency and severity of attacks and lower serum uric acid by 1 to 2 mg/dL, a clinically meaningful reduction.
Dietary Triggers to Reduce
- Alcohol: particularly beer which contains both ethanol and purines from brewer's yeast; alcohol inhibits uric acid excretion by the kidneys and increases uric acid production
- Sugar-sweetened beverages and fruit juice: fructose metabolism produces uric acid as a by-product; eliminating these is one of the most impactful dietary interventions for gout
- Organ meats: liver, kidney, and sweetbreads are extremely high in purines
- Shellfish: high purine content particularly in anchovies, sardines, mussels, and scallops
Protective Dietary Factors
Low-fat dairy products consistently reduce uric acid levels in research, through unclear mechanisms possibly involving lactate competition for uric acid excretion channels. Vitamin C reduces serum uric acid by competing for the renal uric acid reabsorption transporter. Cherry and tart cherry consumption is associated with a 35 percent reduced risk of gout attack in observational research, through anthocyanin-mediated inhibition of xanthine oxidase, the enzyme that produces uric acid. Coffee consumption is inversely associated with serum uric acid and gout risk in multiple large cohort studies.