Medical Edge Newspaper Column

Can Gout Be Improved Through Diet?

January 21, 2008
Dear Mayo Clinic:
My mother has had five or six attacks of what certainly seems to be gout in her toes. Her doctor stopped her diuretic and did a blood test. But since the change in meds she had another episode. She also takes warfarin for a heart valve that was replaced. She is not anxious to take more medicine (and none have been offered). Any suggestions for diet?

Answer:
Gout is a form of arthritis that involves sudden, severe attacks of pain, redness and tenderness in joints. It occurs when high levels of uric acid in the blood (hyperuricemia) cause the acid to build up and be deposited in joints, often in the toes. Uric acid is a waste product formed by the break down of purines, a substance found naturally in the body and in certain foods. Eating a diet low in purines may help lower uric acid levels, reducing the frequency and severity of gout attacks.

Foods that have high levels of purines include: anchovies, game meats (such as venison and duck), gravies, herring, organ meats (liver, brain, kidney and sweetbreads), sardines and scallops. To keep uric acid levels lower, your mother should try to avoid these foods. In addition, most experts advise eating no more than 6 ounces of lean meat, poultry or fish a day for nearly everyone, especially people who have gout, because these high-protein foods increase uric acid levels.

For a more detailed list of foods high in purines that your mother may want to limit or avoid, she should talk with her physician or a dietitian. They can guide her on how to best meet her nutritional needs while reducing the risk of gout.

Other lifestyle modifications that can help prevent gout include avoiding or limiting alcohol consumption, maintaining a healthy weight and drinking plenty of fluids. Each of these measures can help lower uric acid levels in the blood, which in turn may decrease painful gout attacks.

Keep in mind that some medical conditions can be associated with gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis). Certain medications, including the use of low-dose aspirin and thiazide diuretics, often used to treat high blood pressure, also can contribute to increased uric acid levels. However, your mother should not change any medications without first consulting with her doctor.

If medical conditions have been taken into account and diet and lifestyle changes are not effective, your mother may want to talk with her physician about preventive medicines for gout, especially if she's experiencing several attacks a year. Some medications (allopurinol) block the production of uric acid, others (probenecid) improve your kidney's ability to remove uric acid from the body. Both help by reducing the level of uric acid in the blood.

When gout does occur, nonsteroidal anti-inflammatory drugs (NSAIDs) can help control acute inflammation and pain. These include over-the-counter products such as ibuprofen (Advil, Motrin) and naproxen (Aleve) and more powerful prescription NSAIDs. If the potential side effects of NSAIDs (stomach pain, bleeding and ulcers) rule them out, your mother's physician may recommend colchicine or a steroid, such as prednisone to control acute gout attacks.

— Kevin Moder, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.