A study offers proof that diet modification can have a dramatic effect on the risk of recurrent gout attacks. Published online in Annals of the Rheumatic Diseases, the study found that for people with gout, eating a lot of purine-rich foods – like red meat, organ meat, certain fish and vegetables – over a short period of time can increase the risk of a gout attack almost fivefold compared to their risk when eating fewer purine-rich foods.

Avoiding or limiting purine-rich foods is not new advice for gout patients. When purines are metabolized by the body, they break down into uric acid. Gout occurs when excess uric acid in the bloodstream – called hyperuricemia – builds up too quickly or can’t be eliminated fast enough and is, instead, deposited as needle-shaped crystals in the tissues of the body, including joints, causing intense pain. In theory, avoiding or reducing purine-rich food should reduce the risk for a gout attack.

This scientific study, conducted by researchers at the Boston University School of Medicine, is the first to formally test the hypothesis, show a direct association between purine intake and gout attacks, and quantify the risk. The authors conclude that ingestion of purine-rich foods can actually trigger a gout attack within days – and that the risk rises as more purines are included in the diet.

“The biological mechanisms linking purine-rich food intake with hyperuricemia as well as with [the] incidence of gout are well understood,” says study co-author Yuqing Zhang, professor of medicine and public health at Boston University. “Our study added new evidence that [an] increase of purine intake within a short period could trigger gout attacks among subjects with pre-existing gout.”

Purines, which are found in protein-rich foods, are most abundant in food from animal sources – especially organ meats and some oily fishes, such as anchovies and sardines. But some vegetables contain purine, too, including spinach, mushrooms, beans, peas, asparagus and cauliflower.

The study involved more than 630 participants with a history of gout within the previous 12 months. Participants were asked to fill out a lifestyle questionnaire over the Internet every three months – data that served as a control – then an additional questionnaire any time a gout attack occurred.