Q:  I have gout. Can you tell me which fruits, vegetables, meats or seafoods I should eat – or avoid? Is there any type of alcohol – wine, beer, spirits – that is better or worse for me than others?

A:  Because dietary management of gout is so restrictive and of limited benefit, medication is the best way to treat gout. In addition to medications that treat the inflammation and other symptoms that occur during a gout attack, medications exist that can treat the underlying metabolic condition of hyperuricemia – too much uric acid in the blood. Hyperuricemia can occur either when the body produces too much uric acid or when the body does not excrete enough uric acid. Drugs exist to treat both causes.

Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Dietary management focuses on reducing the amount of uric acid in the system and on managing the disorders that occur frequently among patients with gout, including diabetes mellitus, obesity, hyperlipidemia (high blood levels of fats), hypertension and atherosclerosis (hardening of the arteries).

Dietary Management of Gout

The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. People with gout should learn by trial and error what their personal limit is and which foods cause problems.

Laura Rall, PhD, nutrition researcher at Tufts University in Boston, says, "Begin by eliminating foods in the 'high-purine' category while reducing your intake of foods in the 'moderate-purine' category. If you don't have gout attacks after trying this, you may add more foods from the 'moderate' category or occasionally try a food from the 'high' category. Using these guidelines, you may be able to determine a safe level of purine consumption and enjoy some of your favorite foods without experiencing attacks."

High-Purine Foods Include:
    * Alcoholic beverages (all types)
    * Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock
    * Some meats, such as bacon, turkey, veal, venison and organ meats like liver

Moderate Purine Foods Include:
    * Meats, such as beef, chicken, duck, pork and ham
    * Shellfish, such as crab, lobster, oysters and shrimp

Ronenn Roubenoff, MD, Rheumatologist