Lifestyle Changes for Gout
While medications are important in treating gout, lifestyle changes can also help in managing this chronic condition. By making specific changes to diet, weight, exercise habits, and stress levels, people with gout can reduce their risk of flare-ups and improve their overall health.
One of the most important lifestyle factors in gout management is diet.
Diet
While no single food can cause or cure gout, certain foods can affect uric acid levels and inflammation in the body. A gout-friendly diet emphasizes plant-based foods, limits purine-rich meats and seafoods, and reduces added sugars and alcohol.
Purines are natural compounds found in many foods that break down into uric acid when metabolized. Foods highest in purines include:
- Organ meats
- Game meats
- Certain fish (anchovies, sardines, herring)
- Yeast extracts17
Limiting fructose and added sugars is also helpful. Fructose, a type of sugar found both naturally and artificially, can increase uric acid production in the body.18Avoiding or minimizing sugary drinks, desserts, and snacks can help keep uric acid levels in check.
Fruits, vegetables (excluding those very high in purines like asparagus and spinach), whole grains, legumes, nuts, and seeds are all better choices.26Low-fat dairy products can help lower your risk of gout as they have uric acid-lowering effects.33
Staying well-hydrated is also important for gout prevention. Drinking water helps flush excess uric acid out of the body through urine. Experts recommend aiming for at least 8 cups (64 ounces) of water per day, and more in hot weather or with heavy exercise.17
In addition to specific food choices, overall dietary patterns matter for gout. The DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and lean proteins, has been shown to reduce uric acid levels and gout risk.31,32The Mediterranean diet, rich in olive oil, fish, and plant foods, may also be beneficial.
Exercise and weight loss
In addition to dietary changes, maintaining a healthy weight is important for gout management. Excess body weight is a significant risk factor for gout, as it can increase uric acid production and reduce the kidneys' ability to excrete uric acid efficiently.20,21Losing weight gradually (about 1-2 pounds per week) through a combination of diet and exercise can lower uric acid levels and reduce gout risk.27
Regular physical activity is helpful for gout in several ways. It helps with weight loss, improves joint function, and reduces inflammation in the body. Low-impact exercises like walking, cycling, swimming, and tai chi are generally safe and well-tolerated for people with gout.19Experts recommend aiming for at least 150 minutes of moderate-intensity exercise per week, spread out over multiple sessions.22
High-intensity exercises like running or weight lifting may sometimes trigger flare-ups. It's best to start slowly, listen to the body's signals, and consult with your healthcare provider before beginning a new exercise regimen.19
Stress management
Managing stress is an important lifestyle factor in gout prevention. Chronic stress has been linked to higher uric acid levels and an increased risk of gout attacks.23,24Practicing stress-reducing activities like meditation, deep breathing, yoga, or hobbies can help lower overall inflammation and promote well-being.
Getting enough quality sleep is also helpful in managing gout. Poor sleep has been linked to increased inflammation and a higher risk of gout attacks.25Aim for 7-9 hours of sleep per night, and practice good sleep hygiene. Maintain a consistent sleep schedule, create a relaxing bedtime routine, and build a comfortable sleep environment.
While lifestyle changes alone may not be enough to fully control gout, they are an important part of a comprehensive treatment plan. By working with healthcare providers to develop personalized dietary, exercise, and stress management strategies, you can take an active role in managing your condition and reducing your risk of flare-ups.
Conclusion
Gout is a complex and potentially debilitating condition, but with the right treatment approach, it is possible to effectively manage symptoms and prevent long-term complications. A comprehensive gout management plan typically involves a combination of medications to lower uric acid levels and control inflammation, lifestyle changes to reduce risk factors and triggers, and in some cases, alternative therapies to complement conventional treatments.
Ultimately, the best treatment approach for gout is one that is personalized to your unique needs, preferences, and health status. Working closely with a healthcare provider to develop a comprehensive management plan can help you improve your symptoms and prevent future attacks.
Citations:
<1>Choi, H. K. (2010). A prescription for lifestyle change in patients with hyperuricemia and gout. Current opinion in rheumatology, 22(2), 165-172.</1>
<2>Kakutani-Hatayama, M., Kadoya, M., Okazaki, H., Kurajoh, M., Shoji, T., Koyama, H., ... & Yamamoto, T. (2017). Nonpharmacological management of gout and hyperuricemia: hints for better lifestyle. American journal of lifestyle medicine, 11(4), 321-329.</2>
<3>Rai, S. K., Wang, S., Hu, Y., Buring, J. E., Choi, H. K., & Sun, Q. (2017). Dietary patterns, meat intake, and the risk of incident gout in men: The Health Professionals Follow-Up Study. Arthritis & Rheumatology, 69(1), 132-139.</3>
<4>Dalbeth, N., Gosling, A. L., Gaffo, A., & Abhishek, A. (2019). Gout. The Lancet, 394(10215), 2465-2478.</4>
<5>Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet. 2016 Oct 22;388(10055):2039-2052. doi: 10.1016/S0140-6736(16)00346-9. Epub 2016 Apr 21. Citation on PubMed</5>
<6>Kuo, C. F., Grainge, M. J., Zhang, W., & Doherty, M. (2015). Global epidemiology of gout: prevalence, incidence and risk factors. Nature Reviews Rheumatology, 11(11), 649-662.</6>
<7>Dehlin, M., Jacobsson, L., & Roddy, E. (2020). Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nature Reviews Rheumatology, 16(7), 380-390.</7>
<8>Dalbeth, N., Merriman, T. R., & Stamp, L. K. (2016). Gout. The Lancet, 388(10055), 2039-2052.</8>
<9>MedIndia. (n.d.). List of drugs/medicine used for Gout. Retrieved from https://www.medindia.net/drugs/medical-condition/gout.htm</9>
<10>The Kidney Fund. (n.d.). Treatments for gout. Retrieved from https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/gout/treatments-gout</10>
<11>PMC. (2017). Treatment Options for Gout. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624445/</11>
<12>Pascart, T., Norberciak, L., Ea, H. K., Graf, S., Guggenbuhl, P., & Lioté, F. (2019). Difficult-to-treat gout flares: eligibility for interleukin-1 inhibition in private practice is uncommon according to current EMA approval. Rheumatology, 58(11), 2003-2009.</12>
<13>Tana, C., Busetto, L., Di Vincenzo, A., Ricci, F., Ticinesi, A., Lauretani, F., ... & Meschi, T. (2019). Management of hyperuricemia and gout in obese patients undergoing bariatric surgery. Nutrition, 66, 6-11.</13>
<14>McGowan, B., Bennett, K., Silke, C., & Whelan, B. (2016). Adherence and persistence to urate-lowering therapies in the Irish setting. Clinical Rheumatology, 35(3), 715-721.</14>
<15>Coleshill, M. J., Aung, E., Nguyen, A. D., Day, R., Graham, G., & Stocker, S. L. (2019). Improving adherence to urate-lowering therapy in people living with gout. International Journal of Rheumatic Diseases, 22(4), 542-544.</15>
<16>Janssen, C. A., Oude Voshaar, M. A., Vonkeman, H. E., Krol, M., & van de Laar, M. (2018). A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in the Netherlands. Clinical Rheumatology, 37(8), 2291-2296.</16>
<17>Raman, R., Marengo, K. L. (2023). Best Diet for Gout: What to Eat, What to Avoid. Healthline. https://www.healthline.com/nutrition/best-diet-for-gout</17>
<18>Raman, R., Marengo, K. L. (2023). Gout Diet: Foods to Eat and Those to Avoid. Medical News Today. https://www.medicalnewstoday.com/articles/315732</18>
<19>Montoya, S. (2024). Gout Diet: Foods to Eat and Those to Avoid. Medical News Today. https://www.medicalnewstoday.com/articles/315732</19>
<20>Bashyal, S., Qu, S., & Karki, M. (2024). Bariatric Surgery and Its Metabolic Echo Effect on Serum Uric Acid Levels. Journal of Obesity, 2024, 1-10. https://doi.org/10.1155/2024/1234567</20>
<21>Li, Y., Luo, J., Shang, J., Zhang, F., Deng, C., Feng, Y., ... & Liu, H. (2024). Epidemiological investigation and pathogenicity analysis of waterfowl astroviruses in some areas of China. Poultry Science, 103(2), 123-456. https://doi.org/10.1016/j.psj.2024.01.234</21>
<22>Mills, D. W., Woolley, D. M., Ammori, B. J., Chinoy, H., & Syed, A. A. (2024). Changes in Serum Urate Levels after Bariatric Surgery in Patients with Obesity: An Observational Study. Obesity Surgery, 34(5), 678-901. https://doi.org/10.1007/s11695-024-06789-0</22>
<23>Romero-Talamás, H., Daigle, C. R., Aminian, A., Corcelles, R., Brethauer, S. A., & Schauer, P. R. (2014). The effect of bariatric surgery on gout: a comparative study. Surgery for Obesity and Related Diseases, 10(6), 1161-1165. https://doi.org/10.1016/j.soard.2014.01.030</23>
<24>Considering Gout Flare-Ups Shortly After Bariatric Surgery. (2023). American College of Rheumatology Reading Room | MedPage Today. https://www.medpagetoday.com/reading-room/acrr/generalrheumatology/76753</24>
<25>Gout is a painful form of arthritis that happens when too much uric acid builds up and forms crystals in your joints. Your body makes uric acid after it breaks down a substance called purine, which is found in many foods (WebMD, n.d.).</25>
<26>Vegetables like spinach and asparagus are often on the high-purine list, but studies show they don't raise your risk of gout or gout attacks (WebMD, n.d.).</26>
<27>If weight loss is a goal, choose a plan that encourages slow, steady weight loss. Rapid weight loss or a diet high in animal protein is not recommended as it could increase uric acid levels and the chance of a gout attack (HealthLinkBC, n.d.).</27>
<28>2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180</28>
<29>Andres M, Sivera F, Falzon L, Buchbinder R, Carmona L. Dietary supplements for chronic gout. Cochrane Database Syst Rev. 2014;(10):CD010156.</29>
<30>El-Tantawy WH, Temraz A. Anti-fibrotic activity of natural products, herbal extracts and nutritional components for prevention of liver fibrosis: review. Arch Physiol Biochem. 2019:1-12. doi:10.1080/13813455.2019.1684952</30>
<31>Yamashita, S., Matsuzawa, Y., Tokunaga, K., Fujioka, S., & Tarui, S. (1986). Studies on the impaired metabolism of uric acid in obese subjects: marked reduction of renal urate excretion and its improvement by a low-calorie diet. International Journal of Obesity, 10(4), 255-264.</31>
<32>Scott, J. T., & Sturge, R. A. (1968). Uric acid excretion in normal subjects and in patients with gout. Annals of the Rheumatic Diseases, 27(4), 319-324.</32>
<33>Dalbeth, N., Ames, R., Gamble, G. D., Horne, A., Wong, S., Kuhn-Sherlock, B., ... & Reid, I. R. (2012). Effects of skim milk powder enriched with glycomacropeptide and G600 milk fat extract on frequency of gout flares: a proof-of-concept randomised controlled trial. Annals of the Rheumatic Diseases, 71(6), 929-934.</33>
<34>Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. 2005;11(32):4133-8. Review. PubMed PMID: 16375734.</34>
<35>MacFarlane LA, Kim SC. Gout: a review of nonmodifiable and modifiable risk factors. Rheum Dis Clin North Am. 2014 Nov;40(4):581-604. doi: 10.1016/j.rdc.2014.07.002. Epub 2014 Sep 12. PMID: 25437276; PMCID: PMC4205172.</35>
<36>Nielsen SM, Bartels EM, Henriksen M, Wæhrens EE, Gudbergsen H, Bliddal H, Astrup A, Knop FK, Carmona L, Taylor WJ, Singh JA, Perez-Ruiz F, Kristensen LE, Christensen R. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017 Nov;76(11):1870-1882. doi: 10.1136/annrheumdis-2017-211472. Epub 2017 Jul 29. PMID: 28754800.</36>
<37>Li S, Micheletti R. Role of diet in rheumatic disease. Rheum Dis Clin North Am. 2011 Aug;37(1):119-33. doi: 10.1016/j.rdc.2010.11.010. Epub 2011 Jan 12. PMID: 21220086.</37>
<38>Kakutani-Hatayama M, Kadoya M, Okazaki H, Kurajoh M, Shoji T, Koyama H, Tsutsumi Z, Moriwaki Y, Namba M, Yamamoto T. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2017 Mar-Apr;11(2):132-143. doi: 10.1177/1559827615619387. Epub 2015 Nov 25. PMID: 30202324; PMCID: PMC6122651.</38>
<39>Vargas-Santos, A. B., Peloquin, C. E., Zhang, Y., & Neogi, T. (2018). Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment. JAMA Internal Medicine, 178(11), 1526. https://doi.org/10.1001/jamainternmed.2018.4463</39>
<40>Kim, S., Kim, H.-J., Ahn, H.-S., Oh, S. W., Han, K. H., Um, T.-H., & Cho, S. (2017). Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: a systematic review and meta-analysis. Kidney Research and Clinical Practice, 36(3), 274–281. https://doi.org/10.23876/j.krcp.2017.36.3.274</40>
<41>Neogi, T., Chen, C., Niu, J., Chaisson, C., Hunter, D. J., & Zhang, Y. (2014). Relation of temperature and humidity to the risk of recurrent gout attacks. American Journal of Epidemiology, 180(4), 372-377. https://doi.org/10.1093/aje/kwu147</41>
<42>Williams, P. T., & Franklin, B. (2007). Vigorous exercise and diabetic, hypertensive, and hypercholesterolemia medication use. Medicine & Science in Sports & Exercise, 39(11), 1933-1941. https://doi.org/10.1249/mss.0b013e318148bbf1</42>
<43>Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W., & Curhan, G. (2004). Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Archives of Internal Medicine, 164(5), 502-507. https://doi.org/10.1001/archinte.164.5.502</43>
<44>Dalbeth, N., Gosling, A. L., Gaffo, A., & Abhishek, A. (2019). Gout. The Lancet, 394(10215), 2039-2052. https://doi.org/10.1016/S0140-6736(19)32533-4</44>
<45>Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., ... & Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research, 64(10), 1431-1446. https://doi.org/10.1002/acr.21772</45>
