Clinician Round Table: The Role of Diet in Gout Management

Gout affects an estimated 8.3 million US adults, with rates approximately 3 times higher in men than women.¹ For people who suffer from the disorder, dietary choices can play a critical role in symptom management.

To explore this topic in greater detail, Rheumatology Advisor interviewed a panel of experts: Theodore R. Fields, MD, FACP, a rheumatologist at Hospital for Special Surgery (HSS) and professor of clinical medicine at Weill Cornell Medical College in New York; Dana Pitman, MS, RD, CDN, a clinical nutritionist at HSS; and Christine Peoples, MD, a rheumatologist and clinical assistant professor of medicine at the University of Pittsburgh Medical Center in Pennsylvania.

Rheumatology Advisor: What is the relationship between gout and diet?

Dana Pitman, MS, RD, CDN: While obesity is one of the risk factors for developing gout, there is no causal relationship between gout and diet. Food plays an important role in the prevention and promotion of gout attacks, and as with everything diet-related, each individual responds differently.

When we talk about gout and diet, what we’re really looking at are purines. Purines are not themselves the problem, as they are produced naturally in our bodies and are also found in many foods. When purines are broken down, they are converted to uric acid, which can build up as crystals that are deposited in joints, causing pain and inflammation if we are unable to appropriately get rid of them — which is what happens with gout attacks.  

Theodore R. Fields, MD, FACP: Diet is important for people with gout. However, people need to understand that gout is not actually a dietary disease — it’s a genetic disease. Gout is caused by deposits of uric acid crystals in the joints, and people with gout have inherited a tendency for a high uric acid level in their systems. They can get gout even if their diet is “perfect” from a gout point of view. Because of this, if a person has gout they will often need to take medication in addition to watching their diets. There is no question that the wrong diet can make gout worse, and can even make gout start at an earlier age than it would have otherwise; it’s just that people who don’t have a genetic tendency to high uric acid can eat the same foods and not get gout. 

Christine Peoples, MD: There is a strong relationship between gout and diet, and this has been the case for quite some time. As research on gout progresses, more knowledge is gained regarding the role of diet and nutrition and the relationship to serum uric acid levels and gout flares. I find that more patients are asking about the role of diet and their disease — this provides a great opening for discussion.

There has always been an emphasis on alcohol avoidance and limiting purine-rich sources of meat and seafood. However, I try to emphasize that one of the primary goals is overall achievement of a healthy lifestyle, which will have a positive impact on a patient’s gout treatment. In addition, it will affect the patient’s other comorbidities.