How risky is occasional seafood when it comes to gout care?

DEAR DR. ROACH »

About three months ago, I had an attack of gout. I believe it was my first, but I may have had one a few months earlier that was diagnosed as a foot infection.

The symptoms lasted well over a month.

My last uric acid reading was 5.1, but it was 8.6 in February 2021. I am watching my diet — I have not eaten red meat in over 30 years — and have basically eliminated shellfish, which I love. I also take 100 mg of allopurinol.

Is occasional shellfish a real risk? How likely is this that it is a one-time event? Is gout now likely to be a lifelong concern?

— B.

DEAR READER »

Gout is caused by deposits of uric acid crystals in various tissues of the body. One of the most common places for these deposits is the joint of the big toe. An acute attack of gout can be extremely painful and can damage the joint. Uric acid crystals can also damage the kidney, so preventing gout attacks is the goal. In people who have gout, this is achieved by making lifestyle changes (weight control; avoiding excess alcohol — especially beer and spirits; and dietary restrictions) and by medications.

Far too many people with gout take medications that are known to increase gout risk. For example, the blood pressure agents thiazide diuretics (such as HCTZ) and beta blockers.

Diet has been associated with gout for centuries. Animal protein, including from fish and shellfish, is known to increase gout flares, while plant-based protein reduces the risk. Dairy products also reduce gout risk.

However, the risk of getting a flare from occasional fish or shellfish is small when you are on treatment. I certainly think it’s reasonable to try your favorite meal and see whether it causes a flare. I think it’s unlikely to do so.