Effects of diet in patients with gout

Has evidence-based medicine been able to prove beneficial or harmful effects of any particular diets in patients with gout?

George Nuki: There have been several studies which have shown that dietary modification can have a rather small effect in lowering serum urate. The oldest ones and the most widespread show that gradual loss of weight can be associated with a lowering of urate levels – usually not below the target in patients who are overweight and who have gout. The most recent studies have been interesting, using the DASH (Dietary Approaches to Stop Hypertension) diet, which has been used effectively for treating patients with hypertension, and that also lowers the serum urate level. But we still need further randomized controlled trials to actually see whether that can have an important effect in managing patients with gout.

One of the problems is the patients are actually very, very fixated on what is good to eat and what is not good to eat. An important principle there is not that a particular food should never be eaten – anchovies or something like that. It is the quantities of these things that are very important. Having an occasional glass of beer is not something that should be forbidden, but on the other hand, drinking a great deal of beer is certainly an important risk factor.