More than 5 million Americans have suffered at least one attack of gout. Gout occurs when the level of uric acid becomes so high that it precipitates in bodily fluids, forming small sharp crystals. When these uric acid crystals form in the joints such as that of the big toe, they can cause severe pain and inflammation. Uric acid is made in the body when purines are broken down. Meat and seafood are high in purines, and eating more of each can raise uric acid production in the body. Heavy intake of meat and seafood has long been believed to trigger attacks of gout. A recent 12-year prospective study found that the more meat and seafood people ate, the greater their risk of developing gouty arthritis. By contrast, consuming more nonfat milk or yogurt was associated with a reduced risk of gout, perhaps because these products have very low levels of purines and so do not increase the production of uric acid in the body. Also a higher protein intake increases the excretion rate of uric acid, so consuming nonfat dairy products lowers blood uric acid levels. This may explain the significant reduction in episodes of gout when more nonfat milk and yogurt was consumed. While high purine intake from meat and seafood greatly increased the risk of gout, this was not the case with purine-rich vegetables such as beans, cauliflower, spinach, peas and mushrooms.1Another study of this same group of men examined the long-suspected impact of alcoholic beverages in promoting gout. This study found that even moderate consumption of beer or distilled beverages increased the risk of gout, but that even 2-4 drinks of wine daily did not.2Bottom Line: People with gout should be encouraged to:• avoid eating red meat• limit seafood to 10-12 ounces per week; choose those high in omega-3s• eat plenty of nonfat dairy products or fruits, vegetables, whole grains and beans• abstain from beer and spirits• enjoy wine in moderationBy James Kenney, PhD, RD, LD, FACN.1. N Engl J Med 2004;350:1093-1032. Lancet 2004;363:1277-81