After a satisfying meal the night before, you wake up with a really grouchy big toe — inflamed, throbbing, and red. Could this be an attack of gout?
Gout is a form of inflammatory arthritis that typically affects men older than 40 and women after menopause, according to the Arthritis Foundation. It’s caused by a buildup of uric acid, which is a by-product of chemicals known as purines that are found in your body’s cells — and in many foods.
In people with gout, uric acid builds up in your blood faster than your kidneys can remove it and excrete it in your urine. Once uric acid builds up in your blood, it forms needle-like crystals that lodge around joints, often in the big toe. The result? Potentially excruciating pain.
Gout tends to cause painful attacks that build up over 12 to 24 hours and then go away on their own. It’s possible to have only one gout attack in your life, or to have them only every few years. But some people experience recurrent attacks that become more severe over time.
To get a definitive diagnosis of gout, you’ll need to have a needle inserted into your joint to take a fluid sample that shows uric acid crystals, according to Joan M. Von Feldt, MD, a rheumatologist and emeritus professor of medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
But your doctor may strongly suspect gout — and recommend certain dietary changes, or even prescribe medications — based on your symptoms and the appearance of your affected joint.
Dr. Von Feldt notes that while dietary changes are important in the management of gout, they may not be enough to resolve your symptoms. “Some patients can have an essentially purine-free, alcohol-free diet and still have episodes of gout,” she says. “You can’t necessarily control gout with diet.”
What’s more, Von Feldt says, quality of life is an important consideration for treating gout — including being able to eat a variety of foods in moderation. If you can’t follow a normal diet without having gout attacks, “Then an adjustment of your medications or starting a new medication is essential.”
While dietary changes alone may not eliminate painful gout attacks, it’s still important to know about gout-fighting foods — and avoid or limit those that trigger attacks or make your pain worse. Here are some of the best and worst foods for people with gout.
Common Trigger Foods for Gout
Gout trigger foods affect everyone differently. There’s no guarantee a food that causes a painful attack in one person will affect someone else the same way — or even the same person at a different time. But certain foods and beverages, overall, have been shown to increase the risk of a gout attack.
1. Alcohol, Especially Beer
Both beer and distilled spirits are linked to gout attacks, including recurrent ones, according to the Mayo Clinic. For reasons that aren’t quite clear, a moderate intake of wine doesn’t appear to increase this risk.
Alcohol affects how your kidneys remove uric acid from your blood, but other components of alcoholic beverages affect the level of uric acid in the blood, as well. A study that looked at the health records of more than 78,000 Japanese participants found that those who drank beer regularly showed a clearly higher blood uric acid level than nondrinkers, while wine drinkers' levels were moderately higher, and those who drank sake (Japanese rice wine) had barely any increase in uric acid.
Beer, in particular, can cause gout attacks, because in addition to containing alcohol, it’s high in purines — the chemicals that break down to form uric acid. For this reason, the Mayo Clinic recommends that people with recurrent gout attacks limit their beer intake — even if you’re not currently having an attack. Avoid all alcohol during gout attacks.
2. Organ Meats
Organ meats like liver, kidney, and sweetbreads (thymus or pancreas) are high in purines and can contribute to high uric acid levels.
In one study, researchers found that eating more organ meats, processed meats, and seafood was linked to a higher risk for a new diagnosis of high uric acid levels, even after adjusting for other factors that are linked to gout risk. Compared with the quarter of participants who ate the least of these foods, those who ate the most were 50 percent more likely to be diagnosed with high uric acid levels.
High blood uric acid levels, or hyperuricemia, most often cause no symptoms but can lead to gout in some people.
3. Seafood
Certain types of seafood are especially high in purines, raising your risk for a gout attack. Shellfish like shrimp, lobster, and scallops fall into this group, as do anchovies, herring, sardines, and tuna.
But purines may not be the whole story when it comes to seafood and gout risk.
A study found that in a group of more than 12,000 American adults, there was no relationship between consuming seafood rich in omega-3 fatty acids — such as anchovies, herring, sardines, and salmon — and gout. But consuming seafood with low levels of omega-3, such as shrimp and lobster, was linked to a higher gout risk. These results suggest that omega-3 fatty acids may have a protective effect against gout that counteracts the higher gout risk that comes with purines.
4. Sugary Beverages
Drinking sugar-sweetened beverages like soft drinks is linked to increased body weight, which in turn is linked to a higher risk of gout.
According to a research review, evidence suggests that each additional weekly serving of sugar-sweetened beverages is linked to a 4 percent higher risk for gout, as well as a 4 percent higher risk of death from all causes. The researchers cautioned, though, that this evidence is considered to be of low quality compared with many other scientific studies.
Helpful Foods and Beverages for Gout
Eating to prevent a gout attack is about more than avoiding or including specific foods — it’s also about following an overall healthy diet with moderate portion sizes. Still, there are some healthy foods that are likely to be particularly helpful in reducing your uric acid levels and gout symptoms.
1. Vegetables, Legumes, and Fruits
The fiber, complex carbohydrates, and other nutrients found in vegetables and legumes (beans and peas) and many fruits support a healthy body weight and reduce inflammation in your body, potentially reducing your gout symptoms. Even vegetables that are high in purines — like spinach and asparagus — have not been shown to worsen gout symptoms, according to Mayo Clinic.
Cherries, in particular, may offer some protection against gout symptoms. A research review found that across six different studies, participants with gout who consumed cherry juice or extract had fewer gout attacks than those who didn’t consume these products. Specifically, consumption of tart cherry juice was linked to lower blood levels of uric acid.
2. Water
Staying well hydrated by drinking water or unflavored tea throughout the day can help flush uric acid out of your body.
It may have other benefits, as well. A study found that among participants with elevated uric acid levels, drinking less than 0.5 liters (2.1 cups) of water daily was linked to increased arterial stiffness — a key indicator of worse cardiovascular health — in combination with other risk factors like older age and higher blood pressure.
3. Low-Fat Dairy Products
Low-fat dairy foods are linked to lower uric acid levels and a lower risk of gout, according to the American College of Rheumatology.
The protective effects of dairy foods on gout are supported by a number of studies. A research review found that drinking at least two to four glasses of milk or 2 cups of yogurt weekly was linked to a lower gout risk. Another review found that a high level of dairy consumption was linked to a 44 percent lower risk of gout.
4. Coffee
The same research reviews that linked milk and yogurt consumption to a lower gout risk also found that drinking coffee regularly may help prevent gout. The researchers found that drinking at least 4 cups of coffee daily was linked to both lower uric acid levels and a lower gout risk.
Another review found that participants with the highest levels of coffee consumption were 53 percent less likely to develop gout.
The Takeaway
Dietary changes alone may not be enough to prevent gout attacks, but they can be an important part of managing the condition.
If you have repeated attacks of gout, try cutting back on the foods that are common triggers, such as beer and shellfish, and increase your intake of fruits, vegetables, whole grains, low-fat dairy foods, legumes, and nuts.
Work with your healthcare provider to come up with an overall gout plan that controls your symptoms.