Coffee or tea? Wine or beer? Mushrooms or anchovies? Regular or diet?

If you’re one of the estimated 8 million Americans who have gout, you share a common confusion about how your diet can bring on or stave off a gout attack. The latest research may provide some answers.

Most people with gout believe they should avoid all purines, the nitrogen-containing compounds that are metabolized into uric acid in the body. But the reality is, the over-consumption of purine-rich foods and the under consumption of water are often what lead to gout attacks, and research has shown that not all purines are bad – and they aren’t the only part of your diet to watch.

A gout attack can occur when uric acid builds up in the bloodstream. High levels of uric acid in the blood lead to the formation of crystals that often accumulate in the joints at the base of the big toe, but also can form in the elbows, ankles, wrists and other joints. Painful gout flares are characterized by severe pain and inflammation.

The good news is there are many ways to alter your diet to help keep a gout flare at bay. Based on recent research, here are some of the best preventative measures you can take.
Go with good dairy. Investigators also found that low-fat dairy products may improve excretion of uric acid in the urine. Those who consumed a serving or more of low-fat milk or yogurt a day had less uric acid in their blood than those who abstained. High protein and low purine content of milk may explain dairy’s protective effect.

Get your java perks. Once thought to contribute to gout attacks because of its caffeine content, coffee may now be in the clear. Two separate studies reveal that drinking coffee reduces the risk of gout for men and women. Results of the larger study, which included 45,869 men older than age 40 with no history of gout, showed the risk of gout was 40 percent lower for men who drank four to five cups a day – and 59 percent lower for men who drank six or more cups a day when compared to men who never drank coffee. In the other study researchers reviewed food questionnaires from 14,000 men and women age 20 or older, and found that the more coffee (regular or decaf) the participants drank, the lower their uric acid levels were. Tea seemed to have no effect.

Switch to diet soda. Fructose (a component of sugar) has come under fire for bringing on bouts of gout inflammation. Over 12 years, data was collected on soft drink intake from 46,000 men without gout. The more regular soda (a concentrated source of fructose) the men drank, the higher their risk of gout. Diet soda however, had no effect.

Fill up on water. Research shows drinking more water means fewer gout flares. One study done at Boston University School of Medicine revealed that with each glass of water consumed in 24 hours before an attack, the risk for recurrent gout attacks decreased. For example, those who drank five to eight glasses of water had a 40 percent reduced risk of a gout attack compared with those who drank only one glass of water or less in the prior 24 hours. The study’s authors could not make specific recommendations about the amount of water people should drink because it depends on their underlying medical conditions and physical activity levels. Talk to your doctor about how much water you should drink each day.