If you have had gout, do not eat a large amount of meat and seafood at a barbecue or a group meal, and drink less alcohol

For people who have had gout, when purine intake over the pair of days before was at its highest, the chance of a flare was nearly 5 times the chance when intake was lowest, and the same held while taking a urate-lowering drug. After 2 to 4 drinks the day before, the chance of a flare was about half higher; beer, spirits, and wine all count.

Cost

No cost. At a barbecue or a group meal, order fewer meat skewers and less seafood, and drink less. The hard part is holding yourself at the table.

Benefit

A study followed 633 gout patients online for 1 year, comparing a pair of days before each person's flare with a pair of their own days when they did not flare (a case-crossover study). Purine is a component of food that the body turns into uric acid. Splitting the purine total over that pair of days from low to high into bands, and comparing with the lowest band, the chance of a flare in the higher bands was 1.17, 1.38, 2.21, and 4.76 times (OR, trend P<0.001). Counting only purine from animal sources, the figures were 1.42, 1.34, 1.77, and 2.41 times. Counting only purine from plant sources, they were 1.12, 0.99, 1.32, and 1.39 times. Split by sex, by whether the person drank, and by whether they took a diuretic, allopurinol, an anti-inflammatory pain drug, or colchicine, the result was the same. Another study by the same researchers looked at alcohol in the 24 hours before a flare in 724 gout patients. Compared with not drinking, more than 1 drink up to 2 drinks was 1.36 times (95% CI 1.00–1.88, confidence interval), and more than 2 drinks up to 4 drinks was 1.51 times (1.09–2.09). Wine, beer, and spirits were each linked to flares. For people who have not had gout, another follow-up study applies: 47150 men in the United States followed for 12 years, recorded only, not assigned to groups. The top fifth by meat intake had about a 41% higher risk of gout than the bottom fifth (RR 1.41, 1.07–1.86). Seafood was about 51% higher (1.51, 1.17–1.95). The top fifth by dairy intake was instead about 44% lower (0.56, 0.42–0.74). Vegetables high in purine, and total protein, showed no link. In the same men, an extra 12-ounce bottle of beer a day (about 355 ml) raised risk by about 49% (1.49, 1.32–1.70). A daily drink of spirits raised it by about 15% (1.15, 1.04–1.28). Wine showed no statistical difference (1.04, 0.88–1.22)

Notes

Written mainly for people who have already had a flare. For people who have not had gout, what you eat moves uric acid less than most people think. Among 16760 white adults in the United States without gout, diet could explain no more than 0.3% of the difference in serum uric acid, while common genetic differences could explain 23.9%. So when someone nearby gets gout after barbecue and beer, diet is a trigger and constitution accounts for more. The studies looked at how much meat, seafood, and alcohol was eaten, not at whether it was grilled; cold seafood with beer counts the same. All of the studies only followed and recorded, with no assignment to groups; what was eaten at the time of a flare was reported by the patients online, the people studied were American, and no Chinese data were found. The dairy figure is also only a follow-up record; no trial has shown that drinking more milk prevents gout. Eating less cannot replace a urate-lowering drug, and cutting foods lowers uric acid only so much; see item 9 (once gout is diagnosed, take a urate-lowering drug long term). The mortality account for processed meat and alcohol is in section 2, item 18 (eat less processed meat) and section 2, item 19 (drink little or no alcohol)

Sources · 5

1. Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, Neogi T (2012). Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases, 71(9), 1448-1453. doi.org/10.1136/annrheumdis-2011-201215
2. Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y (2014). Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American Journal of Medicine, 127(4), 311-318. doi.org/10.1016/j.amjmed.2013.12.019
3. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine, 350(11), 1093-1103. doi.org/10.1056/NEJMoa035700
4. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). Alcohol intake and risk of incident gout in men: a prospective study. Lancet, 363(9417), 1277-1281. doi.org/10.1016/S0140-6736(04)16000-5
5. Major TJ, Topless RK, Dalbeth N, Merriman TR (2018). Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ, 363, k3951. doi.org/10.1136/bmj.k3951