low purine diet, alcohol and gout

Last edited 06/2022 and last reviewed 03/2023

Uric acid is a product of the breakdown of DNA from body cells and food. The more nucleoprotein there is in food, the larger the quantity of DNA.

A low purine diet is occasionally used in patients suffering from gout. The principle sources of purines are:

• fish - anchovies, crab, fish roes, herrings, mackerel, sardines, shrimps, sprats, and whitebait
• meat - liver, heart, kidney, and sweetbreads
• meat extracts - OXO, Bovril, Broth, stock

In general, vegetables contain relatively low levels of DNA, although asparagus and pulses are above average.

The relationship of alcohol intake to development of gout occurs in a number of ways:

• alcohol metabolism to lactate contributes to urate retention
• port, some red wines and stouts contain purines or oxypurines, which lead to an increased purine load
• alcohol may contribute to obesity which is associated with underexcretion of uric acid

Patients with a history of gout are advised to drink plenty of fluid, approximately 2 litres per day (non-alcoholic).

The British Society of Rheumatology states (2):

• "..In overweight patients, dietary modification to achieve a gradual reduction in body weight and subsequent maintenance should be encouraged. Diet and exercise should be discussed with all patients with gout, and a well-balanced diet low in fat and added sugars, and high in vegetables and fibre should be encouraged: sugar-sweetened soft drinks containing fructose should be avoided; excessive intake of alcoholic drinks and high purine foods should be avoided; and inclusion of skimmed milk and/or low fat yoghurt, soy beans and vegetable sources of protein, and cherries in the diet should be encouraged.."

NICE state (3):

• there is not enough evidence to show that any specific diet prevents flares or lowers serum urate levels
  • advise them to follow a healthy, balanced diet
• advise people with gout that excess body weight or obesity, or excessive alcohol consumption, may exacerbate gout flares and symptoms

Reference:

1. Prescriber (2002), 13 (13), 22-30.
2. Hui M et al. for the British Society for Rheumatology Standards, Audit and Guidelines Working Group, The British Society for Rheumatology Guideline for the Management of Gout, Rheumatology (2017), 56 (7): 1056-1059, https://doi.org/10.1093/rheumatology/kex150
3. NICE (June 2022). Gout: diagnosis and management