Gout

Diet and self-management for gout

People commonly think that gout is caused by eating rich foods or drinking too much alcohol. Gout occurs when people have higher than normal levels of uric acid in their blood. A small amount of uric acid in the bloodstream comes from the breakdown of purines in food, but most comes from the natural breakdown of purines in cells in the body.

It is not always possible for people to prevent gout attacks by changing their diet. This is because their gout may be caused by other factors such as inherited genes or medical conditions such as kidney problems or high blood pressure (see ‘Causes of gout’).

A consultant rheumatologist explains who can get gout and what the most common causes are.

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Sex: Female

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Anyone can get gout - it's one of the commonest reasons for inflamed joints. About one in 100 people in the UK have gout. We know gout affects more men than women, and it's unusual in women before they have their menopause. People with gout often have other health conditions, like being overweight, or having kidney disease or diabetes. But people often think that gout is self-inflicted and caused by eating the wrong types of food or drinking too much alcohol, whereas in fact for most people, their gout is caused by a combination of their genetic makeup, or their other health conditions, or the tablets they take.

Most people are not able to reduce their uric acid levels enough to prevent attacks and/or long-term damage without medication. However, there are a number of changes that people can make to help reduce their uric acid levels.

• Losing weight (if overweight) is an effective dietary treatment for gout

Being overweight means that the kidneys are not as effective at getting rid of uric acid, so gradual weight loss combined with exercise can improve this. Extreme or rapid weight loss is not advised because it can raise uric acid levels.

Several people we spoke to believed that it was important to stay healthy by exercising.

Jeff Z lost weight after a heart attack by eating smaller portions of food.

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Age at interview: 74

Sex: Male

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Obviously first thing they said to me, I was around - when I had my heart attack I was around about 13.2 and the rehab nurse said, "You're not overweight, but for your own benefit just try and lose a little bit of weight." And that's when she said, you know, "Try and reduce your diet a little bit." Not so much reduce your diet as regards - she obviously recommended oily fish and stuff like that, you know, and I said, "Well, we eat fish, chicken, salads, plenty of fruit, orange juices and this type of stuff." And she said, "Well, you're doing everything right." So she recommended that instead of going on a diet as such, where people are saying, you know, "I can't eat that and I can't - I'm on a diet. I can't touch that." She said, "Just try to reduce your intake," which we did and, I'm now down to 11 and a half, 12 stone. But it's not from the fact that A, I am on a diet. It’s just I have reduced the intake. Instead of having a large portion, just have a medium portion. That's, touch wood, it's working.

• Drinking less alcohol

It is possible for people with gout to stay well without becoming teetotal. However, excessive alcohol consumption – particularly beer – can increase the risk of developing gout and can cause attacks for people who have gout.

The purines in some alcohol (e.g. beer) can increase the amount of uric acid in the body. Alcohol binges can also result in a build-up of lactic acid in the body which can make the kidneys less effective at removing uric acid. Doctors do not think that drinking wine in moderation increases the risk of developing gout but It is important for many reasons that people make sure their alcohol consumption is below the recommended healthy limit of 3-4 units a day for men and 2-3 units a day for women.

John Y found that he was more likely to get an attack if he drank more beer than usual.

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Sex: Male

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Well I felt strange, because it’s, like I said, it’s an old man’s, or you think it as being an old man, I mean Henry VIII had it, didn’t he, or George IV had it and they were, I suppose perhaps even a bit younger than me. And, you know, you sort of think, “Well it’s a strange thing to have really”. You think it’s your own fault. Something you’re doing. I know, you know, you sort of look then, you can’t have different foods. Well, I didn’t like offal, you know, so I didn’t have none of that. I did like a beer, a pint of beer. And, I think, beer does, you know, it does affect it. So, I’m careful, that way. Because, I know if I’ve been a party or something like that, and I have had a few more beers, than I normally have, you know, I have had an attack.

• Drinking fewer sugary soft drinks

Many soft drinks contain a lot of fructose (sugar) (also called glucose-fructose syrup or corn syrup). This is likely to increase the levels of uric acid in the blood, so these drinks should be kept to a minimum. Diet soft drinks do not appear to increase the risk of gout.

• Eating less foods that are high in purines

Research on diet and gout suggests that it is only excessive consumption of high purine foods (e.g. red meat, offal and seafood) and alcohol (particularly beer) that should be avoided. These foods can be eaten in moderation and there is no evidence that it is necessary to avoid them entirely. Eating less of these foods may be helpful but most people are not able to reduce their uric acid levels enough to prevent attacks and/or long-term damage without medication.

Ivor read a lot about gout and diet. He tried changing his diet but found that it made no difference.

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Age at interview: 69

Sex: Male

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Well we went to the library, I don’t think in those days we had internet, [laughs] you know, and I got various publications on gout, from time to time there are articles in newspapers which we picked up on. In more recent years I've looked up online information relating to gout and the causes of it. And I think for as many articles that are written there's a different identifier and you know if I were to - I just get the impression that if I were to follow all the advice that’s in all the articles that I've read, I wouldn't eat or drink anything ever again [laughs]. Because there just seems to be such a wide array of possible causes. And I'm sort of a bit nonplussed by it all really.

And have you ever noticed any links between anything you’ve eaten and the onset of symptoms?

From time to time I thought I had done, so for example I thought it might have been beer, but I've never been a really big beer drinker, and then I thought maybe it was just bottled beer as opposed to draft beer. And then I went through a phase where I thought it might be wine, then there was a phase where it was foods with high protein like liver or whatever, so from time to time over the years I've cut out one or other of these particular - particular foods and drinks and it's never really had any effect whatsoever.

So I've not actually found anything that either seems to be the particular cause for my condition or a particular remedy for it either. So some years ago I just gave up with all this experimentation and just carried on.

Some people we spoke to had started to make changes to their diet as soon as they were diagnosed. Many people had tried to identify foods that might be triggering their attacks. Some noticed that they had attacks after eating certain foods (though this may have been coincidence) but other people did not find any particular foods that made a difference. A few people bought gout recipe books to give them ideas about how to eat fewer foods that were high in purines. Jonathan bought a kit to test his own levels of uric acid. He did not find any differences in his levels when he ate different foods.

Some people found that the dietary advice for their other health conditions conflicted with information on gout. They found it hard to work out what they could eat that would not cause problems. Several thought that it would be helpful to discuss gout with a dietician (for more see ‘Finding information on gout’).

Eddie was advised to eat plenty of oily fish because of his heart condition, but then found out on the internet that eating less oily fish could be helpful for gout.

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Sex: Male

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This is where you’re at cross purposes you see, the hospital said, “Now eat plenty of fish”, you know, “Eat your mackerel” and them and that, and when you look at the gout, “Don’t eat that fish” you see, “You mustn’t eat that.” So I’m a bit crossed purposes sometimes and you have to sort of go down the middle yeah.

You mentioned the sort of conflict between the advice that you’re given in terms of diet for your heart and the advice for gout, have you ever discussed that with any of, your GP or anyone?

No, not at all, it’s something I just found out myself, because when I left the hospital, they looked after me very well, I had cardiac nurses come to see me, “Oh you must eat this and this.” It wasn’t until I started looking on the internet and, gout, mackerel it’s the worst thing you can do sort of thing, yes so there was conflicts yeah but it was, nobody told me about the gout.

Jeff X cut down on alcohol and red meat. His family were happy to eat less red meat, and he noticed that he felt ‘brighter’ in the mornings when he drank less alcohol in the evening. Val found it difficult to eat less red meat because her family enjoy it, but she started having smaller portions.

Many people agreed that the best option was to eat in moderation and cut down on any foods that they knew triggered attacks in them. Some people were pleased to discover that they did not eat many high purine foods anyway, so did not need to consider reducing them. Others found it easy to make changes to their diets, though some missed eating certain foods. Hazel finds it difficult to eat out.

Joe’s gout is controlled by medication so he has not changed his diet. Eating foods in moderation works well for him.

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Sex: Male

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I’m on allopurinol for it and - the 300mg now - and I’ve been, I haven’t had gout for 3, 4 years, which I’m pleased with because I haven’t really cut anything out, I haven’t cut red meat out, I haven’t cut beer out, and where I’ve got relations who have, and still get it on a regular; he gets it monthly and I’ve been free, like I say, at least 3 or4 years, which I’m really pleased with.

I think it’s just a bit of moderation. I think you can have everything if you know, you don’t have it to an extent - well my diet hasn’t really changed and like I say, I’ve got a brother in law who cut all - he doesn’t eat mackerel, he doesn’t eat red meat, he doesn’t eat this, he doesn’t drink that - but he still gets it, you know, I think, it’s just one of them things, but I’m sticking to my; you know, I take my tablets regularly every day, and I drink a lot of water, I drink between 6-8 pints a day and I have done for a long time and that seems to work for me, you know. I think everybody would be different, but for me it works, and I’ll stick to it.

Carole wanted to avoid taking medication – she tried managing her gout by diet for about 10 years. It did not stop her attacks but did make her feel like she was in control. Not everyone believed it was necessary to change their diet. Jonathan and Ian found that medication stopped their attacks. Jeff Y did not believe that diet was important in managing gout compared to genetic factors. Other people did not want to have so many restrictions that they felt they were not leading a normal life.

Tony discussed diet with his GP. He did not make any changes because he was unsure how effective they would be. He did not want to spend time worrying about what he could eat.

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Age at interview: 71

Sex: Male

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When the GP was talking to me about the medication, I mean, he did say an alternative to the medication is to try to manage the thing through diet and that kind of thing. But he said two things about that. One was that the, that there isn’t clear agreement, anyway, so you might spend your time barking up the wrong tree, anyway. And, secondly, he was saying to me, “I don’t think you’d want to be bothered with that kind of thing, to be honest”, and I think he was right - that I wouldn’t want to spend my life having to worry about what I could eat and what I could drink, or whatever, beyond what’s ordinarily sensible.

John Z believes that making too many unnecessary dietary changes could be unhealthy and cause other problems. He believes that it is important for people to know that diet is only one factor that can contribute to attacks so that they do not excessively restrict what they eat and drink.

• Other dietary changes

There is a small amount of evidence that eating cherries might reduce the frequency of attacks, but more research is needed to find out whether this is the case.

Jonathan found that cherries made no difference to his uric acid levels. Other people found it difficult to know whether eating cherries had made a difference or not. Some people found it hard to find fresh cherries or cherry juice in their local shops.

Jill takes allopurinol every day, but also believes that cherries have made a difference to her uric acid levels.

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Age at interview: 53

Sex: Female

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Now I didn't know anything about uric acid, anything about gout or anything, so obviously you tend to look books - read books, get as much information as you can, and somewhere along the line I read that cherries were supposed to be very good. I quite like fruit so I'm lucky, so to prevent the gout from coming because you - it's a silent creeper, you never know when you're going to have a gout attack, you go to bed normal and you wake up and you can't walk. You spend the rest of the day, a couple of days, until the gout goes, on the sofa, or at least that’s what I do. So it makes me immobile, it makes be disabled, if you like, for a couple of days. So obviously I've got the colchicine in for when it's a very bad attack, but like I say there are side effects to that. I take the allopurinol as a preventer on a daily basis anyway, but also I found that just simply by eating a handful of cherries a day, that also keeps the gout away.

Arthur tried eating lots of cherries but found that they did not reduce his attacks.

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Age at interview: 63

Sex: Male

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And have you tried any sort of alternative or complementary therapies or anything like that?

Now then, cherries, I don’t know if this is really going to answer your question but, I suffered quite badly, when I was in Australia I suffered quite badly with it, whether that was heat related I don’t know, but cherries seem to be something that people were taking and cherry extract, and you can get from herbal shops cherry, you know, tablets based on those kind of fruits and whatnot. I took those for a while to see if those would help at all, but they didn’t - bit of a lost cause really.

There is not yet enough evidence to show whether increasing consumption of coffee or foods rich in vitamin C can decrease the risk of getting attacks. However, some people tried these things and believed that they had reduced the number of attacks.

Although some people believe that drinking plenty of water will help, there is no evidence that this makes a difference to the risk of getting attacks. Several people had decided to drink more water, particularly if the weather was warm or they were visiting a hot country.

• Complementary treatments and therapies

Many people had tried eating or drinking things that they had heard might help with gout, like natural or herbal remedies. Michael wore a magnetic bracelet that he hoped would prevent attacks. There is no clear evidence that any of these treatments reduce the risks of gout attacks, and most people noticed no difference when using them.

Some people preferred to rely on advice from their doctors. Some GPs had told people that complementary products were unlikely to work. Others had warned them to be careful when buying remedies on the internet. Several people thought products were expensive and did not work. Others were so desperate to prevent attacks that they would ‘try anything’ that they heard might help.

Joe says the pain of gout is so bad that many people will try anything to stop it.

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Sex: Male

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I think it is one of them that when you’ve got the pain, you’ll take something, if somebody says that will work, you’ll try it, you know, and if it works for you, great, you know, it might be eating a cucumber, I don’t know, but if somebody says it works, you’d try it, because when the pain is there, it’s, you just want it gone.

Jeff V had tried acupuncture when he had his first attack. He found that it reduced the pain and swelling at first but it came back the next day. Jacqui tried reflexology but did not find it very helpful. Jill found that energy therapies like reiki helped her to cope with the pain.

Last reviewed December 2016
Last updated December 2016