In practice
- Evidence suggests that low-fat dairy products may help to reduce the risk of gout and decrease the frequency of gout flare-ups.
- High-fat milk products have not been associated with an increase in gout risk.
What is gout?
Gout occurs when the concentration of a substance known as uric acid is high in the blood and forms a crystal deposit around a joint.1,2 Gout manifests itself intermittently when the body’s immune system attacks the uric acid crystals, thus causing severe pain and inflammation in the affected joint.1,2 Periods of active gout can vary in duration and intensity, with the condition generally becoming inactive between flare-ups.1
Factors, such as a genetic predisposition, certain medical conditions, and some medication, can increase the risk of developing gout.2 While the causes of gout vary, the underlying mechanisms are an overproduction of uric acid by the body and/or the insufficient excretion of uric acid by the kidneys, which then leads to an accumulation in the bloodstream.2 Our bodies naturally produce uric acid by breaking down a substance in our cells, known as purines. Purines are not only found in human cells; they are also present to varying extents in the other animal and plant cells that are found in the foods we eat.2
Combining positive lifestyle changes with appropriate medication prescribed by a qualified healthcare provider will generally keep gout in check and keep flare-ups at bay. Moreover, it can prevent the condition from progressing, thus avoiding potential complications such as permanent joint deterioration or kidney damage.2
The importance of lifestyle
Lifestyle recommendations for gout include engaging in regular physical activity and maintaining a healthy weight.2 Diet is particularly important for managing gout because the purines contained in our food impact the uric acid levels in our blood.2,3 Adhering to a nutritious, balanced diet is advised for its general health benefits.2
Certain eating patterns may even yield additional advantages. Notably, the Dietary Approaches to Stop Hypertension (commonly known as the DASH diet) is a dietary pattern that is rich in fruits and vegetables and includes 2-3 servings/d of milk products.4 While this diet was initially designed for its heart healthy properties, a study that followed 44 444 men over 26 years also linked the DASH diet to a lower risk of developing gout.5
In addition to making general dietary changes, recommendations for gout specifically target certain foods.3 For example, it is advised to limit purine-rich food and beverages such as sugary beverages (notably soft drinks), alcohol, shellfish and certain fatty fish (sardines and mackerel), red meat and organ meat such as liver.6-8 Conversely, certain foods, such as dairy and vegetables, have been associated with lower risks of gout and less frequent gout “attacks”.6,8
Dairy consumption has been linked to lower rates of gout
Milk products have been linked to a reduction in the risks of gout and hyperuricemia (high levels of uric acid in the blood). In 2018, a systematic review and meta-analysis revealed a decrease in the risks of gout and hyperuricemia with higher dairy consumption.7 This finding was reinforced by a 2024 systematic review and meta-analysis, which linked dairy intake to a 31% reduction in the risk of hyperuricemia.8 In particular, cheese intake has demonstrated promising protective effects on gout risk, as evidenced by a comprehensive retrospective study involving more than 47,000 participants, as well as a reduction in serum uric acid levels.9
In a 3-month clinical trial, participants experienced significant decreases in gout attacks after consuming a dairy-derived product (either lactose, skim milk powder, or a customized, enriched skim milk powder).10 Additionally, according to the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2018, including 41,230 participants, dairy and fruit intake were inversely associated with the risk of hyperuricemia.9
As a part of their dietary recommendations, the Arthritis Society (Canada) and the American College of Rheumatology recommend incorporating low-fat dairy products as part of a balanced diet.6,11
Several meta-analyses additionally support the link between all types of dairy and reduced gout risk.7,8
Dairy and gout: the potential mechanisms
Certain mechanisms have been proposed to explain dairy’s positive effects on gout.
- In addition to its naturally low purine content, milk may also stimulate the excretion of uric acid by the kidneys.3,12 It is speculated that milk proteins (casein and whey) and a component called uric acid may be responsible for this beneficial property.3,12
- Preliminary experimental research suggests that milk may also possess certain anti-inflammatory properties that can help attenuate the body’s immune reaction that is responsible for the flare-up.10,12
- A 2024 systematic review and meta-analysis suggested that the protective effects of dairy products against gout risk and hyperuricemia may be attributed to their abundance of whey protein, casein, lactose, calcium, magnesium, and phosphorus among many other micronutrients, which may potentially help reduce uric acid levels.8
References
- Government of Canada. 2020. Gout and other crystal arthropathies in Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/gout-crystal-arthropathies.html. Accessed May 27, 2021.
- Centers for Disease Control and Prevention. 2020. Gout. https://www.cdc.gov/arthritis/basics/gout.html. Accessed June 1, 2021.
- Kakutani-Hatayama M et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. American journal of lifestyle medicine 2015; 11 (4):321-329.
- Heart and Stroke Foundation of Canada. 2020. The DASH Diet to lower high blood pressure. https://www.heartandstroke.ca/healthy-living/healthy-eating/dash-diet. Accessed June 4, 2021.
- Rai et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ 2017. doi:10.1136/bmj.j1794.
- Arthritis Society. 2021. Gout and nutrition. https://arthritis.ca/living-well/optimized-self/eating-well/gout-and-nutrition. Accessed June 4, 2021.
- Li R et al. Dietary factors and risk of gout and hyperuricemia: A meta-analysis and systematic review. Asia Pacific Journal of Clinical Nutrition 2018;27(6):1344–1356.
- Chi X et al. Effects of dietary factors on hyperuricaemia and gout: a systematic review and meta-analysis of observational studies. International Journal of Food Sciences and Nutrition, 2024;1–21.
- Ou G et al. Dietary Factors and Risk of Gout: A Two-Sample Mendelian Randomization Study. Foods, 2024;13(8): 1269.
- Dalbeth N et al. 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. Ann Rheum Dis 2012;71(6):929-34.
- American College of Rheumatology. 2023. Gout. https://rheumatology.org/patients/gout. Accessed November 13, 2024.
- Dalbeth N and Palmano K. Effects of dairy intake on hyperuricemia and gout. Curr Rheumatol Rep 2011;13(2):132-7.
