Ask Dr. Gourmet

What can I eat with gout?

I am a 48 year old male who has suffered with gout for some years now, and I have gotten to the point where I am so discouraged and depressed with all of the controversy over certain food and beverage items, such as coffee and various protein types. Is alkalyzing the blood important or does it just complicate gout?

I am confused about what I can eat or not eat for breakfast, lunch or supper. Are noodles OK? What seasonings can I use? Salt? Peppers? Curries? Can I have any protein? All I really know is that organ meat and shellfish are bad - or am I wrong about that? What about baking soda treatment?

Dr. Gourmet Says...

So far there has not been a comprehensive study of using alkaline foods or such things as baking soda to prevent gout. We do have some small studies that show alkalinizing the urine (usually using oral baking soda) can help prevent uric acid kidney stones. In medicine, you can't make that leap of faith that just because the kidney stones are better, gout flares will be as well. Certainly no large scale trial has been done to show us if alkalinizing the urine for kidney stones really is effective.

You'd want to be careful with oral baking soda because high doses of baking soda could be a problem for some health conditions. Likewise, there's a lot of sodium in that baking soda. This is not something that I would ever recommend to my patients.

There is more good evidence, however, that coffee can help lower uric acid levels and possibly help prevent gout. I wrote a Nutrition Bite about it: Gout? Drink Coffee!

Although coffee is good, soda is bad (in oh, so many ways): Soft Drinks and Gout.

We have very good evidence that foods high in purine can and do increase gout flares. Here's some general information and a list of purines in foods.

You are right to ask about these protein "types" and the list above can help you sort that out. Interestingly, there's recent research showing that use of purine rich vegetables causes fewer problems than animal proteins high in purines. Here is the conclusion from the abstract of a study in the New England Journal of Medicine in 2004 (N Engl J Med 2004;350:1093-103). This study found that the main risk for gout sufferers has to do with consumption of purine rich proteins from animal sources.

"Higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk. Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout."

So you can have a major impact on your gout with a healthier diet that's lower in animal protein and high in vegetables. Avoid too much alcohol and soda. Season your food any way you like, as that doesn't seem to have any effect on gout. You'll be able to eat well and avoid a gout flare.

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet