The Uric Acid Dilemma: A Nutritional Odyssey

Gout prevalence continues to rise worldwide, with an estimated 53.9 million cases in 2019, representing a 22% increase in age-standardized prevalence compared to 1990. Although urate-lowering pharmacotherapy remains the cornerstone of management, dietary factors constitute a critical modifiable determinant of hyperuricemia and gout. This review summarizes contemporary evidence regarding dietary contributors, protective nutritional patterns, and barriers to implementing dietary counseling in clinical practice. High-purine foods (such as seafood, organ meats, and red meat), sugar-sweetened beverages, and alcohol are consistently linked to elevated serum urate and gout risk. Conversely, adherence to structured dietary patterns such as the dietary approaches to stop hypertension or Mediterranean diet—often accompanied by weight loss—has been associated with modest reductions in serum urate (approximately 0.5–1.0 mg/dL in randomized controlled trials) and fewer gout flares. Despite these findings, dietary modification is underutilized due to inconsistent counseling, variable adherence, and the perception of limited efficacy. Integrating individualized dietary guidance with pharmacologic urate-lowering therapy may enhance long-term outcomes and improve patient engagement.