Gout is a type of arthritis that causes sudden, severe joint pain. It happens when there is too much uric acid in the blood, which can lead to crystals forming around the joints (NHS). Food and drink are only part of the picture. The 2020 American College of Rheumatology guideline says diet changes likely make only small changes to uric acid levels, but that dietary factors may act as triggers for attacks (FitzGerald et al., 2020). The NHS adds that uric acid-lowering medicine should be taken regularly, even when you no longer have symptoms.
This article is general information, not medical advice. If you have gout, follow the food list and treatment your own doctor gives you.
Drink enough water through the day
The NHS lists getting dehydrated as one of the things that can set off a gout attack, and its advice for preventing attacks includes drinking plenty of fluids. Plain water is the simple choice here. Keep a bottle where you can see it, at your desk or in the car, and refill it before it runs dry.
Alcohol is a different story. The NHS suggests some alcohol-free days each week and no more than 14 units a week, and the ACR guideline conditionally recommends limiting alcohol for everyone with gout.
Big meals are a trigger as well
Next to dehydration, the NHS list of triggers includes drinking too much alcohol or eating a very large meal. So portion size matters, not only which foods are on the plate.
What is in that meal counts too. In a case-crossover study of 633 people with gout, a 2-day period in the highest fifth of purine intake carried 4.76 times the odds of a gout attack compared with a 2-day period in the lowest fifth (Zhang et al., 2012). The foods the researchers counted as high in purine included meats, organ meats, meat extracts and gravies, seafood, beans, peas, lentils, oatmeal, spinach, asparagus, mushroom, yeast, beer and other alcoholic drinks. Purine from animal sources carried the higher risk. The authors still wrote that plant foods, especially nuts and legumes, should be the preferred protein sources for people with gout.
A smaller serving of meat or seafood, with the rest of the plate filled from plant foods, follows both points at once.
Sugary drinks and juice
A 22-year study of 78,906 women with no history of gout recorded 778 new cases (Choi et al., 2010). Compared with less than one serving a month, two or more servings a day of sugar-sweetened soda carried a relative risk of 2.39, and two or more servings a day of orange juice carried 2.42. Diet soft drinks were not linked with gout. The authors added that these drinks probably make a modest contribution to gout across the population, because gout is not common in women.
The NHS gout page says not to have lots of sugary drinks and snacks, and the ACR guideline conditionally recommends limiting high-fructose corn syrup. The NHS 5 A Day page also says to limit fruit juice and smoothies to a combined total of 150ml a day. Swapping a sweet drink for water covers the hydration point and the sugar point together.
Dates in portions, with a meal
Dates contain a lot of fructose. USDA FoodData Central lists 32.0 g of fructose per 100 g of Medjool dates and 19.6 g per 100 g of Deglet Noor dates. None of the studies above tested dates themselves, so they give no evidence that dates trigger gout or that they protect against it.
The NHS 5 A Day page counts a 30 g portion of dried fruit, dates included, as one of your 5 A Day, and says it should be eaten at mealtimes, not as a snack between meals, to reduce the impact on teeth (NHS). A 30 g portion of Medjool works out to about 9.6 g of fructose. Weigh one portion once so you know what it looks like, then put it on the plate with lunch or dinner.
Stocking up without eating more
If you prefer buying a proper bag over a small pack, split it into 30 g portions when you get home and keep the rest closed away. One portion comes out with a meal, and the bag in the cupboard stops being something to graze from.
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References
- NHS. Gout. https://www.nhs.uk/conditions/gout/
- NHS. 5 A Day: what counts? https://www.nhs.uk/live-well/eat-well/5-a-day/5-a-day-what-counts/
- FitzGerald JD, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. PMID 32391934
- Zhang Y, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis. 2012;71(9):1448-53. PMID 22648933
- Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8. PMID 21068145
- USDA FoodData Central (SR Legacy). Dates, medjool, FDC 168191. https://fdc.nal.usda.gov/food-details/168191/nutrients
- USDA FoodData Central (SR Legacy). Dates, deglet noor, FDC 171726. https://fdc.nal.usda.gov/food-details/171726/nutrients