When gout strikes your toes, feet, ankles, or knees, the pain can be so intense that a bedsheet on your skin can be unbearable. Redness, swelling, and pain intensify for the first 24 hours and then linger for a week or more. Over time, untreated gout can destroy joint tissue, causing long-term pain, disability, and deformity.

Under the surface

Gout starts with a basic molecule called a purine. Humans need purines to build DNA. You make some purines naturally and get more from your diet. After your body uses purines, they are broken down into uric acid. Normally, this acid is removed by your kidneys and causes no problems. But in some people, such as those with kidney disease or overconsumption of high-purine foods, the uric acid level can get too high and forms crystals that resemble microscopic needles. Those crystals can get trapped inside a joint, where they cause a sudden and severe attack of inflammation and pain.

People at risk

Not everyone with high levels of uric acid forms these crystals. In fact, researchers have discovered that several inherited genes may be to blame for those who do. If you have a family history of gout, you’ll want to be extra careful to reduce other modifiable risk factors. You can’t do anything about your age (the risk of gout increases as you grow older) or your sex (it’s more common in men than women up to the age of menopause), but you can control your diet. There are three diet changes to help reduce gout:

  • Limit your calories and get adequate exercise to prevent obesity.
  • Avoid purines in your diet.
  • Follow the Dietary Approaches to Stop Hypertension (DASH) diet to lower your risk of gout, even if you have gout genes.

Avoiding purines

Avoiding purine-rich foods can lower your risk of developing gout and, if you already have it, help manage the condition.

  • Avoid alcohol, especially beer. Having two or more beers per day more than doubles your gout risk. If you want to drink, the safest choice is a glass of wine.
  • Avoid sugar-sweetened beverages and anything sweetened with fructose to decrease your gout risk by about 80 percent.
  • Avoid eating shellfish and ocean fish, which increase gout risk by about 50 percent.
  • Avoid red meat, especially wild and organ meat to reduce risk by about 40 percent.
  • You may be able to lower gout risk by about 50 percent by eating more low-fat dairy products and foods high in vitamin C and drinking six or more cups of black coffee every day.

The DASH diet

At the 2021 meeting of the European Congress of Rheumatology, researchers presented a study that showed that the typical American diet, which is rich in red meat, saturated fat, processed foods, refined grains, and sugar-sweetened beverages, was associated with a higher risk of gout than the DASH plan, even in people who had a genetic risk for gout. The DASH diet was originally developed to reduce high blood pressure and the risk of heart disease, but studies published in 2016 and 2017 found that it also lowers uric acid levels.

This diet limits calories to an average of 2,000 per day and outlines a target number of servings by food group:

  • Six to eight servings of whole grains
  • Four to five servings of fruits and vegetables
  • Two to three servings of low or fat-free dairy foods
  • Six or fewer servings of lean meat, poultry, and fish
  • Two to three servings of fats and oils, but no trans fats
  • No more than 2,300 milligrams of sodium
  • The diet also limits nuts, seeds, dry beans, peas, and sweets to five or fewer servings per week. (See the sidebar for examples of serving sizes.)
  • Not only can the DASH diet help prevent and control gout, but it can help you maintain a healthy blood pressure and body weight, too.

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