‘Trying not to overdo it’: What to tell patients about gout flares and holiday feasts

The holidays for many people represent a time of indulgence in food and drink, but for patients with gout, these feasts can be veritable minefields that can trigger painful flares.

What’s worse, there is often a social pressure to take part.

And although data illustrating the connection between diet and many rheumatic diseases is sparse, there is an undeniable connection between gout and the food people consume.

Healio sat down with Kenneth Saag, MD, the division director of clinical immunology and rheumatology at the University of Alabama at Birmingham, to discuss the biggest dangers related to food for patients with gout during the holiday season, and offer insight into counseling patients on how to mitigate the risks for flares.

Healio: How can a person’s diet impact rheumatic diseases?

Saag: Diet has some minimal impact on rheumatic diseases, particularly gout. Diets that are high in purines can influence a risk for developing gout flares. It is very common for people to indulge in a high-purine diet and to experience a flare in their gout. That is probably the most consistent association.

The other effects of diet on rheumatic diseases are slightly more circumspect. There is interest, for example, in various anti-inflammatory products like fish oil as potentially having some mild immunomodulatory effects in conditions like rheumatoid arthritis, but the data is more sparse. Also, the quantities that would need to be consumed are quite substantial to see any sort of mediating effect.

Healio: Other than gout, are there any other diseases where diet may have an impact?

Saag: Not really. I would just use rheumatoid arthritis as an example of a systemic, inflammatory illness where very potent anti-inflammatory food products, such as high concentrations of fish oil, could have a benefit. I would not generalize that, though.

Healio: What holiday foods spring to mind as items patients with gout should avoid indulging in?

Saag: The most common holiday food product that people indulge in is alcohol, and that is a clear risk factor for developing gout flares. Overindulgence in beer, liquor and perhaps even wine, can precipitate gout attacks.

Healio: What about shrimp and other types of shellfish? Are there other foods patients should be aware of?

Saag: Those are good ones. Foods that are rich in purines, which include seafood and meat, are the ones that can potentially contribute to gout attacks. The associations that patients report in studies confirm that associations are quite profound around things like shellfish and substantial intake of meat products.

Healio: What do you tell patients who are seeking counseling on this topic around the holidays?

Saag: I would tell them about the specific foods, but also about the quantities. The holidays tend to be a time of some overindulgence. Trying to not overdo it is probably the main thing to keep in mind. Weight gain is also a risk factor for developing gout, ultimately, and exacerbating things like osteoarthritis.

Healio: What would you tell other rheumatologists who are counseling patients on diet and gout flares around the holidays?

Saag: This is counseling they likely do all the time. Patients often bring this more to rheumatologists than rheumatologists bring to patients. They are often very tuned in to different dietary factors and are concerned about what impact that might have on their rheumatic diseases. With the exception of gout, that data is a little sparse about what actually helps or hurts various rheumatic diseases.

Healio: Do you believe food counseling is something that should be brought up by rheumatologists to discuss with their patients?

Saag: Making sure that people are consuming a general, healthy diet is important. Patients with many inflammatory diseases are also at risk of accelerated cardiovascular disease, so heart-healthy diets can be of some benefit. Maintaining a healthy weight through a healthy diet is of a general health benefit as well. In patients who are overweight, the risk for osteoarthritis may increase, putting stress on joints that are enflamed.

Healio: If a flare occurs during the holidays, what should a patent do to alleviate their symptoms?
Saag: People with gout flares should follow the advice of their physicians regarding how to manage those. Treatment approaches are personalized to individual patients based on their other medical conditions. Anti-inflammatory drugs or backing off of the dangerous activity would be the starting point for those things.