Gout is sometimes dismissed as an ailment from another era, yet it remains one of the most common forms of inflammatory arthritis today. It is a surprisingly complex condition, with multiple dietary and metabolic triggers to understand. This evidence-based guide covers what drives gout, which foods are proven to raise risk, and what the research says about foods that may offer some protection.
Table of Contents
What is Gout?
Gout is the common name for a specific form of inflammatory arthritis that affects the joints. It causes brief but extreme swelling in joints, often specific joints, including toes, ankles, knees, fingers, wrists, and elbows.
Gout comes and goes rapidly, but the pain and stiffness can linger even after the primary symptoms fade.
What Causes Gout?
When a person eats and drinks, the body takes in a wide range of different nutrients, both good and bad. Certain chemicals in the diet, called purines, can be counted among that list. Purines are a chemical compound the body uses to build DNA and RNA and are commonly found in meat products.
Purines are important to health. In addition to their use in creating and repairing DNA and RNA, they are also used in metabolic processes to provide energy, and they help regulate enzymatic activity throughout the body.
When the body breaks down purines, the resulting byproducts include uric acid. Uric acid then builds up in the blood and is filtered out by the kidneys as part of their operation. Uric acid is then excreted in urine. Under normal circumstances, the body is able to handle the filtration just fine, so uric acid never builds up to problematic levels.
Sometimes, though, this balance is broken. Perhaps the body breaks down purines too quickly, or there are too many of them in the diet. Alternatively, the kidneys may not be able to handle and filter the amount being produced. Either way, uric acid builds up in the blood, causing a condition called hyperuricemia.
On its own, hyperuricemia is very common, with as many as one in five people having it to some degree. Often, it does not cause any problems, but if it is maintained over the long term or is severe enough, the uric acid in the blood can form crystals. These crystals are small but sharp and jagged. They also clump together to form larger and larger masses.
Two primary illnesses result from this build-up, and it depends on where the crystals accumulate. If they end up caught in joints and cause pain, inflammation, and swelling, the result is gout. As much as 5% of the people in the United States are estimated to have gout. If the crystals make their way to the kidneys but get stuck and build up there, the resulting immensely painful condition is a kidney stone.
Neither of these conditions are guaranteed with hyperuricemia, but they are both common enough to be widely recognised today.
What Are the Symptoms of Gout?
The primary symptoms of gout are a sudden onset — often developing overnight and becoming abundantly obvious in the morning — of significant swelling, intense pain, stiffness, tenderness, and warmth in a joint. The most common first location for gout is the big toe, but it can crop up in nearly any joint in the body.
Gout flares, also known as gout attacks, come on quickly and can linger with severe pain for 4–12 hours. After that, lingering pain, stiffness, redness, and inflammation can persist for days to weeks.
Who is At Risk of Developing Gout?
Anyone can develop gout. However, people with certain risk factors are much more likely to develop gout than others.
Higher-risk groups include:
- Genetically male individuals, who are three times more likely than females to develop gout.
- Females are more likely to develop gout after menopause.
- People with obesity are at greater risk.
- People with congestive heart failure are at greater risk.
- People with diabetes are at greater risk.
- People with high blood pressure are at greater risk.
- People with kidney disease are at greater risk.
- People with blood cancers are at greater risk.
- People who regularly drink alcohol are at greater risk.
- People who consume protein in excess are at greater risk.
Additionally, people who take immunosuppressants or diuretic medications are at greater risk, as these can impact kidney function.
What Foods Can Trigger Gout?
Gout is caused by uric acid building up in the blood, and uric acid is created through the breakdown of purines, which are found in the diet. This leads to an obvious question: which foods are high in purines and, thus, can trigger a gout attack?
First, it is worth considering why gout occurs. Is it as simple as eating too many purines, or is there another mechanism at play?
According to a significant systemic review from 2022 of gout symptoms, management, and dietary control, there are several factors involved beyond simple purine consumption. Consuming foods high in purines is one factor, but gout is also impacted by high dietary fat, high sugar, and even gut microbiome changes, all of which can play a role. Dietary modification is effective at controlling gout, but it is not as simple as just reducing foods high in purines; other factors must be considered as well.
In broad strokes, the best dietary change is emphasising a low-fat, low-carb, primarily plant-based diet that maintains nutritional balance and moderation in all things. Fortunately, this is in line with most recommendations for a generally healthy diet, absent other specific concerns.
The areas of highest concern, according to a meta-analysis published in 2018, are:
- Red Meat
- Seafoods
- Alcohol
- Fructose
Interestingly, high-purine foods from vegetable sources (rather than animal sources) were not associated with hyperuricemia, nor were dairy products, soy foods, or coffee.
It is also worth looking at specific foods more closely, which was done in a 2022 analysis of a wide range of studies.
Alcohol
Alcohol intake has been historically associated with gout in anecdotal reports, but until relatively recently, the research base was limited.
Recent studies did find some notable results:
- Beer appears to carry the highest increase in risk of gout, followed by spirits.
- Wine appears to carry the least risk of gout, but was not free of risk.
- Those experiencing gout flares were more resistant to drug-based treatment if they consumed alcohol regularly.
That final observation may, however, be more related to treatment noncompliance than to a direct physiological effect of alcohol itself.
Fructose
Sugar, in general, is often attributed as a factor in gout. So far, however, very few studies have been conducted specifically into sugar and gout risk.
One small study examined fructose specifically and found that intake of high fructose corn syrup produced both an immediate and a sustained long-term increase in serum urate levels, suggesting that added sugars merit consideration alongside purine-rich foods.
Protein
One of the largest studies on hyperuricemia and gout evaluated a study group of 47,150 men over the course of 12 years. During that time, 730 confirmed new cases of gout were observed. The study found that higher consumption of purine-rich protein sources from animals — specifically red meat and seafood — was associated with a significantly higher risk of gout, whereas consumption of purine-rich vegetables was not associated with increased risk at all.
This finding suggests that purines alone may not be wholly responsible for gout risk, and that other factors from animal protein may be relevant. Further research is necessary to evaluate the precise mechanisms involved.
Foods that Might Reduce the Risk of Gout
While examining foods that are worth reducing in the diet is a good place to start, research has also investigated whether certain foods might help reduce gout risk when consumed regularly. Some areas of study have found a few potentially protective options.
Coffee, Tea, and Caffeine Intake
One area evaluated across these studies was caffeine and caffeinated beverage intake. The most notable finding was that people who consumed 4, 5, and 6+ cups of coffee per day had lower serum urate levels than those who drank less. Coffee shows an inverse association with serum urate levels, while tea showed no association at all, at least in one Japanese cohort study.
Another finding of interest was that decaffeinated coffee was also inversely associated with gout and gout flare-ups.
It is worth noting that caffeine, as a chemical molecule, shares a similar structural relationship to allopurinol, one of the primary medications used for gout. There is no firm understanding as to whether caffeine specifically has an impact, however, and the fact that coffee does appear to decrease gout risk while tea does not would suggest that the responsible molecule is not caffeine, which is shared between both beverages.
Cherries and Cherry Juice Concentrate
Another area of interest was cherries, which — with their antioxidant properties — may offer a benefit in reducing inflammation associated with gout and could potentially have an impact on reducing uric acid in the blood.
A small trial of 26 individuals without gout found that tart cherry juice reduced serum urate by 19.2%. Unfortunately, another study of 50 patients with gout found no significant impact of cherry juice. A slightly larger study involving 633 people found a 35% lower risk of gout flares when cherries were consumed, but this was a very short, two-day study.
Broadly, while cherries appear promising, more evidence is needed before drawing firm conclusions.
Tempering Expectations
There is a great deal to consider with dietary management of gout. It is established that, broadly speaking, adjusting diet can help reduce the incidence and severity of gout flare-ups in people who already have gout, and that maintaining a healthy diet can help reduce the risk of developing gout.
However, any specifics need to be tempered by three main considerations.
The first is that relatively few studies have been performed that conclusively prove significant impacts. Essentially, only two large studies have been performed, and they echo common wisdom: reduce red meat and alcohol intake, reduce sugar intake, and maintain a healthy diet and weight. Beyond that, the relationship is not as simple as "eat less beef, have less gout."
The second is that many studies into gout are not actually directly studying gout; they tend to study hyperuricemia instead. While people who have gout by definition have hyperuricemia, the opposite is not true — many people have hyperuricemia and never develop gout or even any symptoms at all.
The third is that dietary changes alone are often not sufficient to control gout if a person has already experienced flares. While dietary changes are still strongly recommended, it may not be possible to completely control gout through diet alone. Medication such as allopurinol is likely still necessary and should be discussed with a treating physician.
There is also relatively little data about the precise purine content of specific foods. In response to increasing concerns about gout, the USDA did produce a large report, both into purine itself and the four main components of purines — adenine, guanine, hypoxanthine, and xanthine — but even this data set is relatively limited.
The evidence points consistently toward a few key dietary principles:
- Strive to maintain a healthy diet, with all things in moderation.
- Reduce the primary dietary drivers of elevated uric acid, including red meat, seafood, and refined sugar.
- If symptoms of gout or any acute joint illness arise, consult with a doctor promptly. Gout is very painful and, while not immediately life-threatening, benefits significantly from medical management.
Dietary change is a meaningful component of gout management, but it works best alongside professional medical care. Medications prescribed by a treating physician remain an essential part of the picture for established gout.
Sources:
- Cleveland Clinic – Gout and the Low Purine Diet: https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet
- NHS Gout: https://www.nhs.uk/conditions/gout/
- Mayo Clinic Gout Overview: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
- Cleveland Clinic Gout Overview: https://my.clevelandclinic.org/health/diseases/4755-gout
- Cleveland Clinic Hyperuricemia Overview: https://my.clevelandclinic.org/health/diseases/17808-hyperuricemia-high-uric-acid-level
- Purine – National Cancer Institute: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/purine
- National Institutes of Health – Special Component Databases – Choline, Fluoride, Iodine, Purines, and Other Compounds: https://ods.od.nih.gov/Research/specialdatabases.aspx#purines
- Gout and Diet: A Comprehensive Review of Mechanisms and Management: https://pmc.ncbi.nlm.nih.gov/articles/PMC9459802/
- The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents: https://pmc.ncbi.nlm.nih.gov/articles/PMC7765492/
- Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review: https://pubmed.ncbi.nlm.nih.gov/30485934/
- Role of Diet in Hyperuricemia and Gout: https://pmc.ncbi.nlm.nih.gov/articles/PMC8678356/
