Managing gout means tackling two separate problems: stopping the intense pain of a flare and keeping uric acid low enough to prevent the next one. The American College of Rheumatology recommends a target uric acid level below 6 mg/dL for people on long-term therapy. Reaching that target requires a combination of medication, dietary changes, and lifestyle adjustments that work together over time.
What to Do During a Flare
A gout flare typically hits fast, often overnight, and the priority is reducing inflammation as quickly as possible. Anti-inflammatory medications are the first line of defense. Naproxen (500 mg twice daily for five days) and short courses of oral steroids (taken for about five days) are equally effective at resolving a flare. Your doctor will choose based on your other health conditions. Colchicine is another option, though it commonly causes diarrhea and needs to be used cautiously if you have kidney problems.
Ice helps. Cold packs applied to the affected joint for 20 minutes, twice a day, significantly reduce pain and swelling compared to heat. In fact, heat application often makes gout symptoms worse and should be avoided during a flare. Keep the joint elevated and avoid putting weight on it when possible. Tight shoes, heavy blankets, or anything pressing on the joint will amplify the pain.
Lowering Uric Acid Long Term
Flare management is short-term relief. The real goal is lowering the uric acid that causes crystals to form in your joints in the first place. Urate-lowering medications work by blocking the enzyme that produces uric acid. Your doctor will start at a low dose and gradually increase it, checking your uric acid levels periodically until you reach the target of below 6 mg/dL. For people with severe gout (visible deposits called tophi, or frequent flares), the target may be set even lower, at below 5.9 mg/dL.
One important safety note: if you’re of Southeast Asian descent (including Han Chinese, Korean, or Thai heritage) or African American, the ACR recommends genetic testing for a specific gene variant called HLA-B*5801 before starting allopurinol, the most commonly prescribed urate-lowering drug. Carrying this variant puts you at higher risk for a rare but serious allergic reaction. An alternative medication that works through the same mechanism can be used instead, and it doesn’t require dose adjustment for mild to moderate kidney disease.
Starting urate-lowering therapy can paradoxically trigger flares in the first few months, as shifting uric acid levels destabilize existing crystals. Your doctor will typically prescribe a low-dose anti-inflammatory to take alongside the new medication during this transition period.
Foods That Raise and Lower Your Risk
Diet alone rarely controls gout, but it makes a meaningful difference alongside medication. The foods that matter most are those high in purines, compounds your body breaks down into uric acid.
The biggest offenders to limit or avoid:
- Organ meats like liver, kidney, and sweetbreads, which have the highest purine levels
- Certain seafood including anchovies, sardines, shellfish, and codfish
- Red meat in large portions (beef, lamb, and pork should be eaten in smaller servings)
- Foods with high-fructose corn syrup, which can include cereals, baked goods, salad dressings, and canned soups
One common worry you can set aside: high-purine vegetables like asparagus, spinach, and green peas don’t actually raise gout risk. Studies consistently show they’re safe to eat freely. Good protein alternatives include lean poultry, low-fat dairy, and legumes like beans, chickpeas, and lentils. Fruits, whole grains, and plenty of water round out a gout-friendly diet.
Why Alcohol and Sugar Are Especially Problematic
Alcohol raises uric acid through two mechanisms at once: it increases uric acid production by accelerating the breakdown of energy molecules into uric acid precursors, and it decreases uric acid excretion through the kidneys. Beer is the worst offender because it contains not only alcohol but also high levels of guanosine, a purine that the body absorbs readily.
The numbers are striking. Drinking more than one to two servings of wine in a 24-hour period more than doubles the risk of a recurrent gout attack. Two to four beers raise the risk by 75%. Liquor carries a similar pattern, with two to four servings raising attack risk by 67%. During a flare, alcohol should be avoided entirely. Between flares, limiting intake, especially beer, is one of the most impactful changes you can make.
Fructose, whether from high-fructose corn syrup or excess sugar of any kind, triggers a similar metabolic pathway that increases uric acid production. Sweetened beverages are a particularly concentrated source.
The Role of Weight Loss
Carrying excess body fat directly raises uric acid levels, and losing fat brings them down in a predictable way. Research in Korean men found that every kilogram (about 2.2 pounds) of fat mass lost was associated with a 9% increase in the odds of reaching the therapeutic uric acid target. For people who already had elevated uric acid, each kilogram of fat loss increased the odds of normalizing levels by 13%.
The key is gradual weight loss. Crash dieting or fasting can temporarily spike uric acid levels and trigger a flare. A steady reduction through sustainable dietary changes and regular physical activity is safer and more effective. Even modest fat loss of 5 to 10 kilograms can meaningfully shift your uric acid numbers.
Cherries and Tart Cherry Juice
Cherries are one of the few foods with genuine clinical evidence behind them for gout. A large study found that eating cherries for two or more days was associated with a 35% lower risk of gout attacks. In a separate trial, people who ate cherries had fewer flares on average (1.54 versus 1.91 in those who didn’t). One clinical trial found that drinking about one cup (240 mL) of tart cherry juice daily reduced uric acid levels by 19.2%.
The benefits likely come from natural compounds in cherries that reduce inflammation and may help the body excrete uric acid. Whether you choose whole cherries, tart cherry juice, or cherry juice concentrate, consistency matters more than the form. Cherries are not a replacement for medication in most cases, but they’re a worthwhile addition to a broader management plan.
Tracking Uric Acid at Home
Home uric acid meters work similarly to blood glucose monitors, using a fingertip blood sample and a test strip. Validation studies show they’re reasonably accurate: one widely studied device had 93.2% accuracy within a 20% margin of laboratory values, and its readings correlated highly with standard lab tests. The average difference between the home meter and lab results was only about 0.14 mg/dL.
These devices are most useful once you’re on urate-lowering therapy and want to track your progress between doctor visits. They’re sensitive enough to detect whether you’re above or below the 6 mg/dL target, with about 89% sensitivity and specificity at that threshold. They’re not a substitute for periodic lab work, but they can help you see how your levels respond to dietary changes, weight loss, or medication adjustments in real time.