The data presented above reveal a clear relationship between diet and lifestyle and the development of hyperuricemia and gout. As metabolic disorders, hyperuricemia and gout are often amenable to changes in diet, lifestyle, and medication. As more data on the modifiable risk factors and co-morbidities of gout become available, integration of these data into gout management strategies may become essential, similar to the current management strategies for hypertension [46
] and type 2 diabetes [47
]. These lifestyle modifications are inexpensive and safe and, when combined with drug therapy, may result in better control of this disorder.
The lifestyle modification recommendations for the treatment or prevention of gout are similar to those for the prevention or treatment of other major chronic disorders [48
] (Fig. ). Thus, the net health benefits from these general lifestyle recommendations [49
] are expected to be even greater among patients with gout, particularly those with coexisting insulin resistance syndrome, diabetes, obesity, and hypertension [48
]. In particular, weight control, reduced consumption of red meat, and daily exercise are important lifestyle modifications for patients with gout or hyperuricemia and parallel recommendations for the prevention of coronary heart disease, diabetes, and certain types of cancer. Available open-label, interventional data suggest that weight reduction is associated with a decline in uric acid levels [36
]. Furthermore, data on the relationship between purine-rich foods and urate levels indicate that restricting purine intake can reduce serum uric acid levels. For example, substitution of a purine-free formula diet over a period of days was shown to reduce the blood uric acid of healthy men from an average of 5.0 mg/dl to 3.0 mg/dl [50
]. In general, dietary restriction of purine-rich foods lowers urinary excretion of uric acid by about 200–400 mg/day and decreases mean serum urate levels by about 1–2 mg/dl [52
]. Thus, reducing intake of purine-rich foods, particularly those of animal origin such as red meat, is recommended in the prevention and management of hyperuricemia and gout. Red meat is also the main source of saturated fats, which are positively associated with insulin resistance [53
], which in turn is closely associated with gout. These fats also increase low-density lipoprotein cholesterol more than HDL-cholesterol, resulting in an overall negative health effect. Increased consumption of red meat and saturated fats has been linked to major disorders such as coronary artery disease, type 2 diabetes, and certain types of cancer. Thus, it is important for patients with gout to limit red meat consumption, as is indicated by the new Healthy Eating Pyramid recommendations for the general public (Fig. ) [49
Figure 2 Dietary influences on the risk for gout and their implications within a Healthy Eating Pyramid. Data on the relationship between diet and the risk for gout are primarily derived from the recent Health Professionals Follow-Up Study [15,32,33]. Upward solid (more ...)
For cardiovascular benefit, instead of consuming fish, patients with gout could consider taking plant-derived ω3 fatty acids or eicosapentanoic acid and docosahexanoic acid supplements. Experimental evidence also suggests that diets enriched with γ-linolenic acid and eicosapentaenoic acid significantly reduce urate crystal induced inflammation; however, the effect of such a diet on the clinical course of gout has not yet been studied [55
The recent recommendations on dairy consumption for the general public may be applicable in most patients with gout or hyperuricemia, and may offer additional benefit to those individuals with hypertension, diabetes, and cardiovascular disorders [32
]. Further risk-benefit assessments in specific clinical contexts would be helpful. Daily consumption of nuts and legumes, as recommended by the Harvard Healthy Eating Pyramid [49
], may also provide important health benefits without increasing the risk for gout [32
]. New data on the incidence of gout suggest that a daily glass of wine might provide health benefits without raising the risk for gout, as opposed to beer or liquor consumption [33
]. However, reducing or eliminating alcohol – particularly purine-rich beverages such as beer and certain liquors – is generally recommended due to the significant effect on uric acid levels.
Several studies have suggested that high doses of vitamin C have a uricosuric effect [58
]. For example, one study [61
] showed that ingestion of 4.0 g ascorbic acid led to a twofold increase in fractional clearance of uric acid up to 6 hours after ingestion, and that ingestion of 8.0 g ascorbic acid for 3–7 days reduced serum uric acid by up to 3.1 mg/dl as a result of sustained uricosuria. A recent trial indicated that taking 500 mg/day vitamin C for 2 months reduced serum uric acid by 0.5 mg/dl [62
]. Because vitamin C is generally considered safe, its uricosuric effect may provide a potentially useful option for the prevention and management of hyperuricemia and gout.