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Gout is a form of inflammatory arthritis marked by sudden attacks of painful, inflamed joints, usually the big toe, but the feet, ankles, knees, hands and wrists can also be affected.

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Historically, gout was a disease of wealthy aristocrats who ate rich foods and drank alcohol to excess. Today, however, gout is common, due in part to rising rates of obesity and hypertension.

A diet full of red meat, sugary drinks and alcoholic beverages is also to blame.

It’s clear that the foods you eat – and the ones you don’t – can lower the risk of developing gout and, if you have it already, reduce the severity and frequency of future attacks.

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What is gout?

Gout is a form of inflammatory arthritis marked by sudden attacks of painful, inflamed joints, usually the big toe, but the feet, ankles, knees, hands and wrists can also be affected. Symptoms include intense pain, swelling, redness and heat.

It occurs when too much uric acid builds ups in the bloodstream, causing needle-like crystals to accumulate in joints. The body makes uric acid when it breaks down purines, compounds found in the body and also in certain foods.

Not everyone with a high uric acid level, though, will develop gout. Having a genetic predisposition is thought to play a role.

The standard prescription for managing the condition includes dietary modifications and medication that lowers uric acid in the bloodstream. Diet can’t cure gout, but research suggests that specific foods and beverages can help lower the odds of an attack.

Building a gout-friendly diet

Purine-rich foods. Organ meats, game meats, mussels, scallops, haddock, turkey, veal and bacon are high in purines. Avoid them or eat them sparingly.

Trout, herring, sardines, anchovies and mackerel are good sources of omega-3 fats but also high in purines. Still, the heart benefits from eating them may outweigh the gout risk. If you do consume them, keep portion sizes small.

You should also limit portion sizes of moderate-purine foods such as beef, pork, lamb, chicken, duck, fish and shrimp to 3 to 6 ounces and only once each day.

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High-purine plant foods including beans, lentils, mushrooms, asparagus and spinach do not trigger gout attacks and do not need to be avoided.

High-fructose foods, drinks. When the body breaks down fructose, purines are formed. Avoid sugar-sweetened beverages (e.g., soft drinks) and pure fruit juice, which are high in fructose. You should also stay clear of high-fructose sweeteners such as honey, agave syrup and corn syrup, as well as foods made with high-fructose corn syrup (fructose-glucose).

Alcoholic beverages. Alcohol prevents uric acid from leaving the body. Beer, high in purines, is the worst for increasing gout risk, but spirits can trigger an attack, too. Avoid or limit both. A moderate wine intake has not been shown to increase risk.

Low-fat dairy. Drinking two eight-ounce servings of low-fat milk each day has been shown to reduce the risk of gout in men. Proteins in dairy are thought to promote uric acid excretion. High-fat dairy products don’t seem to affect uric acid levels.

DASH diet. Following this healthy eating pattern for one month has been shown to lower uric acid levels. Hallmark DASH diet foods include fruits, vegetables, low-fat dairy, nuts, beans and lentils and whole grains.

Vitamin C. Higher intakes of vitamin C from foods and supplements have been associated with lower uric acid levels and a lower risk of gout. Foods rich in vitamin C include citrus fruit, strawberries, kiwifruit, cantaloupe, red and green bell peppers, broccoli, cauliflower and Brussels sprouts. Avoid vitamin C supplements if you have calcium oxalate or uric acid kidney stones.

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Cherries. Eating sweet cherries and drinking tart cherry juice have been shown to reduce uric acid levels. Two small trials have also demonstrated that drinking tart cherry juice concentrate, about one tablespoon twice daily, significantly reduced gout attacks over the study periods. These findings aren’t conclusive, but cherries have antioxidant and anti-inflammatory properties that may be beneficial.

Water. Dehydration can trigger a gout attack. Drink at least 2 to 3 litres of water each day to help your body excrete uric acid.

Control weight. Losing excess weight can lower uric acid, reduce the number of gout flares and ease pressure on joints.

Leslie Beck, a Toronto-based private practice dietitian, is Director of Food and Nutrition at Medcan.

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