How to prevent recurrent gout attacks by reducing uric acid levels

Gout is a common metabolic disease with excruciatingly painful inflammatory arthritis. Gout is often caused by overindulgence in food or alcohol, leading to an accumulation of salt crystals (monosodium uric acid crystals) in the joints, bones, and soft tissues. Gout is painful and often occurs recurrently. 

Heightened amounts of uric acid in the blood of over 6.8 mg/dL are the leading cause of gout. [1-2]

Uric acid levels are critical to follow as they represent the level of natural waste products leftover from food digestion. 

People with higher uric acid levels are not only at higher risk for gout flare-ups but will also have more frequent flare-ups. [3]

The same factors that lead to higher uric acid levels also lead to gout. These risk factors include aging in general, being a man, being overweight, a high purine diet, regular alcohol consumption, certain medications like aspirin and diuretics, stress, and family history. 

It is best to prevent gout; however, when a flare-up occurs, you want to treat it as soon as possible by reducing inflammation and high uric acid levels. 

Initiating uric acid-lowering medication is the first line of treatment. However, this does not solve the cause behind the high uric acid levels. Therefore dietary change along with these medications is critical for treatment and lowering recurrence frequency. Furthermore, uric acid-lowering medications may have rare yet severe side effects. [4]

Here are guidelines to help prevent gout, treat flare-ups, and prevent future ones.

1. Follow a Low Purine Diet 

Purine intake is associated with high uric acid levels and an increased risk of gout. [5] One study found that people consuming the highest amount of purine in their diet, mainly from animal products for over two days, increased their risk of recurrent gout attacks by five-fold compared with people with the lowest intake of purines. This comparison was free from other risk factors like alcohol consumption and the use of diuretics. [6]

High purine foods and beverages that you want to reduce in your diet include meat, organ meats, and meat extracts, fish and seafood, yeast and yeast extracts, beer and alcoholic drinks, sweetened beverages, sodas, and foods with high-fructose corn syrup as well as some vegetables including asparagus, spinach, and mushrooms.

Low purine foods you want to include in your diet include whole grains, fruits, most vegetables except those mentioned above, and nuts. [2,5-7]

Although you want to decrease animal protein in your diet, you want to increase plant-based protein consumption since this was associated with a 27% lower risk of gout. [8] The best plant-based protein to consume is tofu since the purines are removed while processing soybeans into tofu. 

Instead of a strict low-purine diet, moderate dietary purine consumption is best since legumes are very healthy and rich in fiber that helps reduce other factors that lead to gout. 

For more information on reducing uric acid levels, please check the uric acid chapter (#101) under the kidneys section of this book. 

2. Weight loss

Being overweight and having higher body fat levels are risk factors for gout.

Weight loss benefits people with gout by reducing serum uric acid levels and gout symptoms. [9-10]

High insulin levels were found in 95% of people with gout, and insulin resistance was found in 76% of people with gout. [11] Therefore, gout, which often appears years before type 2 diabetes, can signify your health’s direction if lifestyle changes are not made.

A high-fiber whole food diet (such as the Guerrilla Diet) can contribute to weight loss and reduce insulin resistance. One study found that a diet with 40% carbohydrates, 30% protein, and 30% fat, replacing all refined carbohydrates with complex ones and saturated fats with mono- and polyunsaturated ones, is the best for gout. [12-17]

3. Limit Alcohol

Alcohol consumption has long been closely associated with higher uric acid and gout levels. [11,17-24]

Several mechanisms are involved in the alcohol-gout connection. These include less removal of uric acid through the kidneys, increased alcohol-stimulated purine production, and alcohol-induced increased uric acid production. Furthermore, uric acid-lowering drugs are less effective in people with gout who continue to drink alcohol, and sometimes the use of alcohol leads to forgetting to take these medications.

One study showed that limiting alcoholic beverage consumption produces a more significant effect on serum uric acid levels than dietary purine restriction and may also reduce the requirements for uric acid-lowering drugs.

The quantity of purine nitrogen derived from alcoholic drinks (mainly beer) is more significant in gout sufferers; therefore, alcohol restriction is strongly recommended. [25]

4. Supplements

White hellebore is a herb historically used as a poison, especially in ancient arrow tips. Despite serious safety concerns, the bulb and root help with gout since it is rich in active components, including stilbene phenols and resveratrol, with anti-inflammatory and anti-osteoarthritis activity. [26-30] However, I advise consulting with a herbal expert to check any interactions with the medications you may be taking to prevent harmful effects.

Resveratrol is also found in red grapes, peanuts, cocoa, berries, and pomegranates, and thus these foods are also recommended.

To conclude

People with gout are encouraged to modify their dietary and lifestyle habits to limit purine-rich foods, alcohol, sweetened beverages, and high fructose corn syrup. Focusing on whole food plant-based foods to help lose weight and reduce purine-rich animal products will help prevent future attacks and their frequency. Drinking sufficient water, eating fruits, and perhaps supplementing with white hellebore is also greatly beneficial.

All references are found at this link: — I keep this list updated. 

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Dr. Galit Goldfarb


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