Gout flares and diet

Robert McLean, MD, is a rheumatologist and associate clinical professor of medicine at Yale School of Medicine, USA.

Which foods actually increase/reduce the frequency of attacks in chronic gout?

Historically, we’ve always thought that foods that were higher in purines had broken down from a metabolic standpoint as proteins into uric acid. Organ meats, red meats, richer meats tended to historically have that… we feel that. At the same time, some studies have looked at people following them and it’s not clear that that is the case as much. It’s hard to generalize.

However, we see patients time and again who are very sensitive to certain foods. They’d had gout before and they’ll tell me, “I had 2 shrimps and my foot started hurting.” So, is it in their head or is it really their gout? I honestly don’t know. I think that I will tell people that they might notice that certain foods, rich foods, shellfish, things that are higher in purines might increase their risk for gout. I think the guidelines would suggest that it’s hard to really make that as a blanket statement for everyone, but we really classically will see people who, on individual basis, seem to be very sensitive to that.

Similarly with alcohol intake, we tend to talk about that. I think it seems to be some studies suggesting there’s a higher risk of people getting gout flares with beer and with spirits, and less with wine. We don’t really understand why that is, it’s not really well studied, and there is difference in research, but it’s a feeling that we have.