Gout is caused by too much uric acid (serum uric acid) in the blood. If you have recurrent gout attacks, it is important to reduce the level of uric acid in the blood to prevent more attacks.
Some people with gout have an inherited tendency to have high uric acid levels, but in most people lifestyle factors such as alcohol or diets rich in seafood or red meat, or drinks sweetened with sugar or fructose are important risk factors. Self-management and lifestyle changes are vital.
In some people, certain medicines including aspirin and some medicines for blood pressure can make gout attacks more likely, so speak to your doctor if you think this may be relevant to you.
Lowering uric acid levels will reduce the frequency of attacks. European guidelines for gout prevention recommend a target serum uric acid level of less than 360 (micromoles per litre), however British Society for Rheumatology (BSR) guidelines suggest even lower levels of 300.
The lower your level of uric acid, the fewer gout attacks you will have. Keeping to a healthy weight can also significantly reduce uric acid levels and the risk of gout, and current BSR guidelines suggest slow weight reduction by healthy eating rather than fasting, as sudden fasting can trigger an acute attack.
BSR guidelines also include several specific dietary measures that may help reduce uric acid and the risk of gout attacks. These include:
- Reducing alcohol intake, especially beer or avoiding alcohol completely
- Avoiding sugar-sweetened and fructose-containing drinks
- Increasing your intake of fruit and vegetables, especially those containing Vitamin C
- Including additional skimmed milk or low fat yoghurt
- Avoiding high purine foods such as yeast extract, offal, pate or too much red meat
- Following a diet generally high in fibre and low in fat and added sugars
- Drinking cherry extract
New evidence shows that diets low in salt such as the “DASH” diet designed to treat high blood pressure can also reduce serum uric acid levels and help with gout management.
Acute gout attacks can also follow a period of dehydration, for example after travelling, so you should make sure that you stay hydrated and drink plenty of water.