“Gout has been synonymous with diet and lifestyle in popular culture for centuries,” wrote Jennifer Liddle and colleagues in Rheumatology: Advances in Practice. “However, it is only recently that the associations between dietary factors and gout incidence have been confirmed in large epidemiological studies. Higher levels of consumption of meat, seafood, sugar-sweetened soft drinks, fructose, alcohol (particularly beer) and Western dietary patterns (higher intake of red and processed meats, sugar-sweetened beverages, sweets, desserts, French fries and refined grains) are associated with hyperuricemia and an increased risk of developing gout, whereas dairy products, coffee, vitamin C and Dietary Approaches to Stop Hypertension dietary patterns are associated with reduced risk.”

Understanding Whether, Why & How Patients Choose Diet Changes

For their paper, the study team conducted an inductive thematic secondary analysis of qualitative data from interviews and focus groups with participants with gout who participated in two previous qualitative studies, with the goal of better understanding whether, why, and how they choose to modify their diets after developing gout. Among participants, dietary changes were commonly initiated as part of a self-management strategy for gout. “Analysis resulted in eight superordinate themes,” explained the study authors in Rheumatol Adv Pract: “desperation and desire for control (T1); perception that successful management of gout through dietary modification is possible (T2); weight loss not a central aim (T3); experimenting and following self-imposed dietary rules (T4); successful management with [uratelowering therapy (ULT)] removes perceived need for dietary modification (T5); dietary modifications perceived as unrealistic, unmanageable, unproven or irrelevant (T6); contradicting and confusing information (T7); and dietary modification as a patient-led process (T8).” Feelings of desperation and a willingness to “try anything” (T1) often resulted from the intensity and frequency of flares experienced by participants. Motivations for dietary modification tended to be centered around beliefs that dietary intake had the potential to explain and/or modify flare timing and frequency (T2), as opposed to dietary factors predisposing to hyperuricemia and intervention-lowering urate. Although patients with gout were often aware of the link between overweight and gout, as a whole, they did not make dietary changes with the goal of losing weight specifically to manage gout (T3). “Participants described a range of approaches, including experimenting and looking for patterns systematically or by ‘trial and error’, aiming for ‘moderation’, and following advice or information from other sources (T4),” noted Liddle and colleagues. “Participants who had positive experiences of ULT and believed this was controlling their gout successfully were less likely to report trying or continuing with dietary modifications (T5). The perception that dietary modifications were unrealistic, unmanageable or irrelevant was another common concept (T6).” While some participants expressed the perception that information sources were contradictory or confusing (T7), there was an overall strong view that patients were responsible themselves for seeking information about gout and diet, as opposed to this being a topic that general practitioners proactively discussed (T8).

To Change or Not to Change

Patients with gout reported that they modified their diets by adding, increasing, removing, or reducing particular foods and drinks, introducing supplements and herbal remedies, or a combination of these (Sidebar). Those who did not make changes to their diet or did so and then reverted back to previous diets did so for a few reasons. “They believed urate-lowering therapy was successfully managing their gout; medication allowed normal eating; they did not find ‘proof’ that diet would be an effective treatment; or the dietary advice they found was unrealistic, unmanageable or irrelevant,” wrote Liddle and colleagues. Although dietary modification was, on the whole, led by patients, participants stated that they would have preferred the support of a healthcare professional. And while patients gained a sense of control over their condition through thoughts that diet could potentially explain and modify the timing of flares, the study team noted that “the belief that gout could be controlled through dietary modification appeared to be a barrier to acceptance of management with urate-lowering therapy.”

Improving Patient Experiences

Liddle and colleagues concluded that “Perceptions about gout and diet play a large role in the way patients make decisions about how to manage gout in their everyday lives. Addressing the reasons why patients explore dietary solutions, promoting the value of urate-lowering therapy and weight loss and drawing on strong evidence to communicate clearly will be crucial in improving long-term clinical management and patient experience.”