New Data on Diet and Alcohol and the Risk of Gout

Special Report


Theodore R. Fields, MD, FACP

Theodore R. Fields, MD, FACP

Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College

If you have gout, you'll welcome the news from recent studies suggesting that you may be able to eat some foods that are limited in the restrictive, not-too-tasty, diet generally recommended for gout patients. The purpose of the traditional diet has been to reduce your consumption of foods rich in purine, a protein that is converted to uric acid in the blood. This uric acid, deposited in the joints as small crystals, causes the inflammation, redness, and pain symptomatic of gout.

Currently, your diet requires you to limit red meat, many types seafood, and some vegetables, such as beans, asparagus, and spinach, in order to achieve a modest reduction of the uric acid in your blood. However, there is a possibility that you'll be able to to eat all you like of nutritious, flavorful vegetables that have been considered a risk for gout patients. You are likely to be able to have all you like of low-fat dairy products, such as skim milk, low-fat (or no-fat) yogurt and low-fat cheeses as well. It seems that the purines in certain vegetables and in low-fat dairy products probably do not set off gout. A recent study of the risk of gout in gout-free men has shown that neither the consumption of vegetables nor total protein intake increased the risk that they would get gout. The study also showed that increased consumption of low-fat dairy products might actually lower the risk of gout in gout-free men.

The study[1] (by Choi et al) of 47,150 men who had no history of gout found:

  • the men who ate the most meat and seafood had the highest risk of developing gout; and
  • the men with the highest intake of dairy products, especially low-fat dairy products, had the lowest risk.

The team that conducted the study think that the explanation for the beneficial effect of dairy protein relates to the facts that this type of protein:

  • causes excretion of urate, and
  • contains lower levels of purine than other types of protein.

The study was powerful because it was so large (over 47,000 men) and because it followed the men over time. The team did not study men who already had gout, so the results of the study may apply only to men who have never been diagnosed with gout. However, even if you already have gout, it is possible that your doctor might allow you to eat vegetables and more low-fat dairy products based on these results. It is clear that you should continue to eat as little meat and seafood as possible.

The authors of this recent study on diet and gout suggested that more data is needed before a complete change in dietary recommendations.

Another recent study[2] suggested that alcohol, although still bad for patients with gout, is worse in the form of beer and hard whiskey than with wine. Two glasses of wine a day, in fact, were not found to be a gout risk factor (although more than that was a problem). The reason why alcohol in different forms acts differently in gout is unclear.

Realistically, the results of this recent research, and the fact that studies are being conducted, should be considered as progress toward more enjoyable meals and improved health for gout patients. In the meantime, you may want to discuss your diet with your physician to see whether any changes are appropriate. It may be reasonable to continue to restrict your meat and seafood consumption, while feeling free to eat a range of vegetables and increase your intake of low-fat dairy products. Moderation in alcohol remains important, and beer and hard liquor seem especially to be problems for gout patients.

Remember also that the article on alcohol and gout only looked at the risk of getting your first attack of gout. It did not look at the effect of alcohol if you already have gout. We know that alcohol of all types increases the production of uric acid and decreases the amount that comes out in the urine. As of this moment, we have no reason to change the long-standing recommendation that patients who already have gout should limit alcohol of all kinds as much as possible.

Summary prepared by Nancy Novick.

[1] Choi HK, Atkinson A, Karlson EW, Willett W, Curhan G: Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004 Mar 11;350(11):1093-103.

[2] Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004 Apr 17;363(9417):1277-81.

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