If you have had gout, don't eat large amounts of meat and seafood at one sitting at a barbecue or group meal, and drink less alcohol

Cost

Free. At a barbecue or group meal, order fewer meat skewers and less seafood, and drink less. The hard part is holding yourself back at the table.

What you get

A case-crossover study compared the two days before each patient's attack with two days when they had no attack, following 633 gout patients online for 1 year. Purine is a component of food that the body turns into uric acid. The total purine eaten over the two days was split into five levels from low to high; compared with the lowest level, the chance of an attack at the other four levels was 1.17, 1.38, 2.21 and 4.76 times (OR, trend P<0.001). Counting only purine from animal sources, it was 1.42, 1.34, 1.77 and 2.41 times. Counting only purine from plants, it was 1.12, 0.99, 1.32 and 1.39 times. Results were the same when split by sex, whether the person drank alcohol, and whether they took diuretics, allopurinol, anti-inflammatory painkillers or colchicine. Another study by the same researchers looked at the alcohol 724 gout patients drank in the 24 hours before an attack. Compared with no drinking, more than 1 up to 2 drinks was 1.36 times (95% CI 1.00–1.88, the plausible range), and more than 2 up to 4 drinks was 1.51 times (1.09–2.09). Wine, beer and spirits were each linked to attacks. For people who have never had gout, look at another follow-up study: 47150 U.S. men followed for 12 years, with records only and no assigned groups. The fifth who ate the most meat had about 41% higher risk of getting gout than the fifth who ate the least (RR 1.41, 1.07–1.86). For seafood it was about 51% higher (1.51, 1.17–1.95). Those who ate the most dairy products had about 44% lower risk instead (0.56, 0.42–0.74). No link was seen with vegetables high in purine or with total protein. In the same group, each extra 12-ounce (about 355 milliliters) bottle of beer a day meant about 49% higher risk (1.49, 1.32–1.70). A shot of spirits a day was about 15% higher (1.15, 1.04–1.28). Wine showed no statistically significant difference (1.04, 0.88–1.22)

Notes

This is written mainly for people who have already had an attack. For people who have never had gout, what they eat affects uric acid less than most people think. Among 16760 white U.S. adults without gout, eating habits could explain no more than 0.3% of the differences in blood uric acid, while common genetic differences explained 23.9%. So when someone around you gets gout from barbecue and beer, diet is one trigger, and body constitution counts for more. What matters is the amount of meat, seafood and alcohol eaten, and has nothing to do with whether it is grilled; cold seafood dishes with beer are the same. All three are observational studies, what was eaten at the time of an attack was reported online by the patients themselves, all the subjects were Americans, and no data on Chinese people was found. The dairy figure is also only follow-up records, and no trial has shown that drinking more milk prevents gout. Eating less cannot replace urate-lowering drugs; avoiding certain foods does not get you down to the target line, see §16.9 (if gout is diagnosed, take a urate-lowering drug long term). For the death-rate accounting on processed meat and alcohol, see §2.18 (eat less processed meat) and §2.19 (drink little or no alcohol)

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, Neogi T (2012). Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases, 71(9), 1448-1453. https://doi.org/10.1136/annrheumdis-2011-201215
2. Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y (2014). Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American Journal of Medicine, 127(4), 311-318. https://doi.org/10.1016/j.amjmed.2013.12.019
3. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine, 350(11), 1093-1103. https://doi.org/10.1056/NEJMoa035700
4. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Alcohol intake and risk of incident gout in men: a prospective study. Lancet, 363(9417), 1277-1281. https://doi.org/10.1016/S0140-6736(04)16000-5
5. Major TJ, Topless RK, Dalbeth N, Merriman TR (2018). Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ, 363, k3951. https://doi.org/10.1136/bmj.k3951

Translated from the Chinese original. Original book, section 16, tip 10. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer