Got Gout? You're not alone. In fact, thousands of North Americans suffer from this painful joint disease. As we all know by now, diet and disease are related. However, our historical associations between diet and gout have been far off the mark. Let's investigate more recent research on gout.
Historically, gout was believed to be due to overindulgent lifestyles. Avoiding foods such as excessive amounts of meat and fish were all part of the gout folklore. As was consuming dairy for a protective effect.
Gout is caused by the deposition of urate crystals in the joints, most commonly the big toe. These crystals are sharp and can damage tissue resulting in inflammation, pain and joint stiffness.

Current dietary advice now focuses on increasing fluid intake and reducing the consumption of purine foods. Foods that are high in purine include organ meats and seafood. The idea is that the catabolism of purine nucleotides produces urate or uric acid.

However, two recent studies have added to the confusion of a good gout diet. First, in the American Journal of Clinical Nutrition (2003; 78(4)) gout was found to be associated with a high intake of alcohol and lower intake of fruit and vegetables, not with purine intake. This control study of 184 subjects suggests that it is not about meat or purine foods. On the other hand, a more recent prospective observational study of 47,150 males reported that high meat and low dairy intake are linked with gout. (N Eng J Med. 2004;350(11):1093-103)

Therefore, does a good gout diet include purine foods, or not? It has been estimated that purine in the diet contributes only around 15% of total blood urate. (N Eng J Med 1996;334(7)) And, that many nutritional factors affect uric acid levels. Obesity, alcohol, coffee and fructose can raise it, while cherries can lower it.

Cherries are a natural gout solution. Cherries are anti-inflammatory. About 11 ng of melatonin is thought to be an effective anti-inflammatory. It inhibits COX 1 and 2, (i.e. cyclooxygenase 1 and 2), which are precursors to damaging inflammation. The most common inflammatory disease treated with cherries is gout. (N Engl J Med 1996, J Nutr 2003, Br J Nutr 1999)

What about dairy? Some studies have noted that dairy may decrease urate levels. (Eur J Epidemiol. 1995;11(3)) However, why this happens it unknown. Perhaps, low purine animal sources, such as dairy, are used in substitution for higher purine animal foods. Or, casein and lactabumin reduce urate levels. (Am J Clin Nutr. 1991) Whatever the cause, low fat dairy may be part of a good gout diet.

All in all, we see that science does correlate diet with gout, and that purine intake should not be the only concern. Obesity and alcohol should be considered. Fruits and vegetables should be consumed, particularly cherries. And, dairy should be controlled as studies both support and caution its use in a good gout diet.