Gout Prevention

People at risk for chronic gout will want to take steps to prevent a painful attack. There are several lifestyle and dietary changes that can reduce the risk of a gout attack and joint degeneration associated with gout. When these changes are not enough to stop gout episodes from happening, a doctor may recommend allopurinol or another daily prescription medication.

This page describes gout prevention strategies and a gout prevention diet, including which foods to avoid.

Strategies for Preventing a Gout Attack

A combination of one or more of these strategies can help prevent uric acid build-up that leads to a gout attack. Doctors and patients are encouraged to talk about which prevention strategies may be the most effective and achievable.

Avoid or limit alcohol

Consuming alcohol inhibits the body’s ability to excrete uric acid, increasing the risk of hyperuricemia and a gout attack. Just one or two glasses of beer, wine, or hard liquor can increase the likelihood of a gout attack, and the risk increases with the number of drinks consumed. ¹ Neogi T, Chen C, Niu J, et al. Relation of temperature and humidity to the risk of recurrent gout attacks. Am J Epidemiol. 2014;180(4):372-377. DOI: 10.1093/aje/kwu147

Drink plenty of water

Increasing water intake will help keep the kidneys healthy and help them flush out uric acid from the body. The recommended daily intake of fluids varies depending on an individual’s age, weight, sex, and other factors. ² Getting the Facts: Drinking Water and Intake. Centers for Disease Control and Prevention. Last Reviewed August 9, 2016. Accessed July 10, 2020. https://www.cdc.gov/nutrition/data-statistics/plain-water-the-healthier-choice.html

Lose excess weight or maintain a healthy weight

Obtaining and maintaining a healthy weight through diet and exercise helps reduce the risk of gout. ³ Dessein PH, Shipton EA, Stanwix AE, et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59(7):539–43. As cited in Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004

Research evidence ⁴ Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Annals of the Rheumatic Diseases 2017;76:1870-1882. suggests that sudden, dramatic weight loss, such as after bariatric surgery, may increase the likelihood of a gout attack in the short term. In the long term, excess weight loss—sudden or gradual—is an effective way to reduce risk.

Treat sleep apnea

While more research is needed, some evidence suggests that treating sleep apnea may significantly affect the frequency of gout episodes. ⁵ Abrams B. Sleep apnea and gout. Can Fam Physician. 2009;55(3):243-244. PMID: 19282526 ^{, 6} Choi HK, Niu J, Neogi T, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555-562. doi: 10.1002/art.38917 ^{, 7} Zhang Y, Peloquin CE, Dubreuil M, et al. Sleep Apnea and the Risk of Incident Gout: A Population-Based, Body Mass Index-Matched Cohort Study. Arthritis Rheumatol. 2015;67(12):3298-3302. doi: 10.1002/art.39330 Treatment typically includes using a C-Pap machine or another treatment device designed to increase oxygen intake while sleeping. Increased oxygen intake may lower uric acid production and reduce the risk of a gout attack.

The primary goals of sleep apnea treatment include improving sleep quality and heart health. ⁸ Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD001106. Update in: Cochrane Database Syst Rev. 2006;(3):CD001106. PMID: 16437429. DOI: 10.1002/14651858.CD001106.pub2 ^{, 9} Bouloukaki I, et al. (2014). Intensive versus standard follow-up to improve continuous positive airway pressure compliance. European Respiratory Journal, 44(5): 1262–1274. DOI: 10.1183/09031936.00021314 ^{, 10} Milleron O, et al. (2004). Benefits of obstructive sleep apnoea treatment in coronary artery disease: A long-term follow-up study. European Heart Journal, 25(9): 728–734. DOI: 10.1016/j.ehj.2004.02.008

Avoid foods that can trigger a gout flare-up

People who are prone to gout can prevent uric acid buildup in the bloodstream by avoiding certain foods, including seafood, red meats, organ meats, and sugary drinks and foods.

Avoid medications that trigger gout

Certain medications, such as diuretics, are associated with hyperuricemia. ¹¹ Gout. Centers for Disease Control and Prevention. Page last reviewed January 28, 2019. Accessed July 14, 2020. https://www.cdc.gov/arthritis/basics/gout.html People who take these medications and have gout may ask their health care providers other medications or treatments approach might be appropriate.

Take prescription gout medication

A doctor may prescribe medication to reduce the amount of uric acid produced by the body. Urate lowering medication is typically recommended to people who ¹² Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 :

• Experience more than two gout attacks per year
• Have a gout attack and also have a history of tophi or renal stones (from previous attacks)
• Have a gout attack and also have chronic kidney disease

Commonly prescribed medications include allopurinol and febuxostat. ¹² Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 Additional or alternative medications may be prescribed depending on the patient’s circumstances.

Gout Diet

Consuming certain foods and drinks can raise uric acid levels in the blood and trigger a gout flare-up. Other food may help decrease the likelihood of a gout flare-up. Experts estimate that an appropriate gout prevention diet can reduce uric acid levels up to 15%. ¹³ Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y

Foods that may trigger a gout attack

Physicians recommend avoiding or limiting consumption of ¹⁴ Ramirez-Sandoval JC, Madero M. Treatment of Hyperuricemia in Chronic Kidney Disease. Contrib Nephrol. 2018;192:135-146. doi:10.1159/000484288 :

• Alcoholic beverages, especially beer
• Sugary foods and beverages, particularly those made with high fructose corn syrup, such as sodas ¹⁵ Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8. doi: 10.1001/jama.2010.1638
• Meat, particularly organ meat or “sweetmeats,” such as liver, and game meats ⁶ Choi HK, Niu J, Neogi T, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555-562. doi: 10.1002/art.38917
• Seafood, particularly scallops, anchovies, and herring ¹⁶ George C, Minter DA. Hyperuricemia. [Updated 2020 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459218/

Alcohol increases the amount of uric acid in the blood and limits the body’s ability to process and eliminate uric acid. ¹⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973

Foods that may help prevent a gout attack

A gout prevention diet includes plenty of vegetables, fruits, and complex carbohydrates, including whole grains and beans. Such a diet may also include low-fat dairy products and cherries:

• Low-fat dairy products, such as skim milk and yogurt, may decrease the levels of uric acid in the blood and thereby decrease their risk of gout attacks. ¹⁸ Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005;52(1):283-9. DOI: 10.1002/art.20761 High-fat dairy products do not have the same protective effect.
• Cherries have long been thought to prevent gout flare-ups, and there is some scientific evidence to support this. ¹⁹ Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. 2005;11(32):4133-8. Review. PubMed PMID: 16375734. ^{, 20} Jacob RA, Spinozzi GM, Simon VA, Kelley DS, Prior RL, Hess-Pierce B, Kader AA. Consumption of cherries lowers plasma urate in healthy women. J Nutr. 2003 Jun;133(6):1826-9. PubMed PMID: 12771324. ^{, 21} Chen PE, Liu CY, Chien WH, Chien CW, Tung TH. Effectiveness of Cherries in Reducing Uric Acid and Gout: A Systematic Review. Evid Based Complement Alternat Med. 2019;2019:9896757. Published 2019 Dec 4. DOI: 10.1155/2019/9896757 ^{, 22} Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi HK. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012;64(12):4004–4011. DOI: 10.1002/art.34677 ^{, 23} Collins MW, Saag KG, Singh JA. Is there a role for cherries in the management of gout? Ther Adv Musculoskelet Dis. 2019;11:1759720X19847018. Published 2019 May 17. doi: 10.1177/1759720X19847018 Fresh or frozen tart cherries, 100% unsweetened tart cherry juice, or cherry extract may be beneficial. Avoid sweetened cherries, such as cherry pie filling.

Eating a healthy, plant-based diet and taking other preventative steps, such as drinking plenty of water, avoiding alcohol, and maintaining a healthy weight, can go a long way towards preventing gout, other types of arthritis, and heart disease.