Lower Gout Risk

The most common and effective treatment for gout is through medication such as uricosuric drugs that increase the excretion of uric acid via the kidneys. Modifying the diet to avoid very high purine foods may have an additional minor benefit with drug therapy, although dietary changes rarely lower serum uric acid by more than 10-20% (Fam 2005; Shils 2006). This small lowering of uric acid is not thought to be of therapeutic benefit in many gout sufferers (Khanna 2012).

There is now evidence that most purine-containing food, especially non-animal food, has little influence on gout. In the past, the most common dietary advice was to avoid purine-rich foods like animal flesh and offal, seafood, yeast extracts, peas, legumes, lentils, spinach, asparagus and mushrooms.

It is not clear why spinach, asparagus and mushrooms were mentioned so frequently, as green peas, broccoli and Brussels sprouts have more purine yet are never mentioned in text books or websites giving dietary advice on gout.

Foods such as dairy foods, possibly due to the dairy proteins, and vegetables, even those with moderate purine content, seem to be protective against gout (Lee 2006; Choi 2004; Choi 2010; Zgaga 2012). One paper showed that coffee reduces gout risk (Chuang 2011). Those who most closely followed a traditional Mediterranean had the lowest uric acid levels and less likely to have high uric acid levels associated with gout (Kontogianni 2012).

There is no evidence that a vegetable or mushroom with a modest amount of purine will raise uric acid levels and trigger a gout attack. A study of over 47,000 men over a period of 12 years (aged 40-75 yrs at the start of the study) found that a “moderate intake of purine-rich vegetables is not associated with an increased risk of gout”, whether purine-rich vegetables were considered as a food group or as individual vegetables (Choi 2004).

Another study of 92 men with gout and 92 controls found no link between purine intake and the occurrence of gout, or between fruit and vegetable intake and gout (Lyu 2003). In fact, the authors state that: “Our data support the observation that increased consumption of foods from plant sources, especially fruit and vegetables, reduce the risk of gout development.”

A review of the lifestyle evidence to reduce gout attacks specifically mentions to consume purine-rich vegetables “as they do not increase the risk of gout.” (Choi 2010). The review goes on to say that people who ate the most vegetable protein actually had a 27% lower risk of gout compared with those that ate the least.

A study of over 2000 adults concluded that: “… we found no association between purine-rich vegetables consumption and plasma urate” (Zgaga 2012). The authors said that their results reinforced the concerns about recommendations that restrict the eating of purine-rich vegetables. However, they did find an association between plasma uric acid and sugar-sweetened drinks.

Two surveys of Taiwanese adults showed an inverse relationship between vegetables, mushrooms and gout risk (Chuang 2011). The more mushrooms consumed, the lower the average uric acid levels.

A review of gout management by the American College of Rheumatology recognised that dietary changes alone did not sufficiently lower plasma uric acid levels for many people with gout, and specifically encouraged the consumption of vegetables and low-fat dairy foods (Khanna 2012).