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Food help for gout
~9.2 million Americans (3.9%) have gout. Black men have highest prevalence (5.5%) compared to white men. Gout is the most common inflammatory arthritis. Caused by hyperuricemia (uric acid >6.8 mg/dL) crystallizing in joints (typically big toe, but also knee, ankle, hand). Diet is HIGHLY modifiable factor: changes can reduce serum urate 1-2 mg/dL.
DASH-style diet for gout
DASH and Mediterranean diets reduce uric acid. Choi 2017 study showed DASH reduces serum urate 0.35 mg/dL.
Foods to AVOID (high purines)
- Organ meats: liver, kidneys, brain, sweetbreads. Highest in purines.
- High-purine seafood: anchovies, sardines, mussels, oysters, scallops, roe, mackerel, canned tuna, herring.
- Excess red meat: >3 servings/week increases risk.
- Game and fowl: venison, goose, turkey (moderate).
- Concentrated broths and consommés.
- Meat sauces/gravy.
Foods to LIMIT
- Alcohol — the worst trigger:
- Beer — double effect (purines + alcohol). Increases attack risk 2.5x.
- Liquor — increases risk 1.6x.
- Wine — smaller effect, but limit to 1 glass/day.
- Fructose:
- Sugary sodas — high-fructose corn syrup increases risk 85%.
- Concentrated fruit juices.
- Agave syrup.
- Red meat — <3 servings/week.
- Concentrated nutritional yeast.
PROTECTIVE foods (reduce uric acid)
- Low-fat dairy — skim milk, unsweetened yogurt, low-fat cheese. Choi study showed 1+ serving/day reduces risk 50%.
- Cherries — anthocyanins reduce flares. Study: 10-12 cherries/day or tart cherry juice concentrate reduces flares 35-50%.
- Coffee — 4-6 cups/day associated with lower risk (prospective studies). But do NOT start if you never drink coffee (risk of flare with abrupt changes).
- Vitamin C 500 mg/day — reduces serum urate ~0.5 mg/dL.
- Vegetables (even previously forbidden ones like spinach, asparagus, mushrooms, beans) — Choi study: do NOT increase gout risk (vegetable purines are different).
- Low-purine fish — salmon, trout, tilapia in moderation.
- Fruits: berries, citrus, kiwi (vitamin C).
- Olive oil.
- Hydration 8-12 glasses/day — helps eliminate uric acid.
Chronic treatment (urate-lowering)
- Allopurinol (Zyloprim) — first line. Generic ~$5-15/month. Start 100 mg, titrate to target <6 mg/dL. Stevens-Johnson syndrome risk in HLA-B*5801+ patients (more common in Asians, Africans) — genetic testing recommended.
- Febuxostat (Uloric) — second line. Generic since 2019, ~$50-100/month. FDA boxed warning 2019 for higher cardiovascular mortality vs. allopurinol; reserve for allopurinol-intolerant.
- Probenecid — uricosuric. For patients with normal renal function.
- Lesinurad (Zurampic) — discontinued 2019.
- Pegloticase (Krystexxa) — IV uricase every 2 weeks. For refractory gout. ~$25,000/dose list. Horizon Therapeutics Patient Connect program.
- Start PROPHYLACTIC colchicine 0.6 mg 1-2x/day — first 3-6 months when starting allopurinol/febuxostat to prevent flares.
Acute attack treatment
- NSAIDs: indomethacin, naproxen, ibuprofen — first line for acute attack. Cheap generics.
- Colchicine (Colcrys, Mitigare) — 1.2 mg + 0.6 mg 1 hour later. Generic since 2024 (was $5-7/pill under Takeda monopoly).
- Corticosteroids: prednisone 30-40 mg/day tapering over 7-10 days. For CKD patients who can't take NSAIDs.
- Intra-articular injection — triamcinolone if only 1-2 joints affected.
- Anakinra (Kineret), canakinumab (Ilaris) — IL-1 inhibitor for severe refractory flares.
SSI/SSDI under Listing 14.09 (Inflammatory arthritis)
- Listing 14.09A — persistent inflammation or deformity in one of lower extremities resulting in inability to ambulate effectively; or upper extremity resulting in inability to perform fine motor movements effectively.
- Listing 14.09B — inflammation or deformity of one of major joints lasting ≥12 months with systemic effects (fever, malaise) AND marked limitation in one of several functions.
- Advanced tophaceous gout with multiple tophi can qualify.
Important comorbidities
Gout is associated with metabolic syndrome:
- Hypertension — 75% of gout patients.
- Type 2 diabetes.
- Cardiovascular disease.
- CKD — both cause and consequence.
- Sleep apnea.
- NAFLD/NASH.
- Manage all comorbidities.
Caution with medications that raise uric acid
- Diuretics (HCTZ, furosemide) — raise serum urate. Switch to losartan (uricosuric effect).
- Low-dose aspirin — raises serum urate but cardiovascular benefits outweigh.
- Niacin, cyclosporine, tacrolimus.
SNAP, Medicare, Medicaid
- SNAP covers protective foods (dairy, cherries, coffee, vegetables).
- SNAP medical deduction (7 CFR 273.9(d)(3)) — patients 60+ or SSDI/SSI deduct expenses >$35/month.
- Tart cherry concentrate covered by SNAP (juice, not supplements).
Community resources
- Arthritis Foundation — arthritis.org. 1-800-283-7800.
- American College of Rheumatology (ACR) — rheumatology.org. Clinical guidelines.
- Gout Education Society — gouteducation.org.
- Mayo Clinic Gout — mayoclinic.org.
- Black Health Matters — resources for Black men.
- HealthWell Foundation, NeedyMeds.