Mediterranean diet and gout - the uric acid studies

This second page about the Mediterranean diet and gout, was last reviewed or updated on 20 January 2015

This is the second of two pages about the Mediterranean diet and gout. To visit the first introductory page, which also describes some Med diet shortcomings  please click here.


There have been three published studies, all in recent years,  that delivered reasonably encouraging gout-related results for the use of the Mediterranean diet, but they were not among gout sufferers. However, uric acid levels were lowered among many participants and that is good for gout.

These studies were conducted in Greece and Spain. All were analyses of the diets of large populations and their effect on uric acid.

What did they find ?

With better commitment to a Mediterranean diet, all studies (except one set of results among women, (see further on), found much less likelihood of hyperuricemia. This is high uric acid, at levels that might trigger gout attacks. It is defined as 7.0 mg/dL and above in men, and 6.0 mg/dL and above in women.

But there was one exception to the generally gout positive results from these studies. The exception was that in one study in Greece (1), whereas serum (blood) uric acid rose or fell according to the degree of adherence (more adherence i.e. more Med foods eaten = lower; fewer  = higher) in elderly men, it did not amongst 281 elderly women. Med diet eating had no effect in this study on the elderly women’s uric acid. But among the men, more adherence to the diet meant lower uric acid.

Better news for women was that in a later study, (2) also in Greece and this time among a larger population of women, (total population, men and women 2,380 much higher than in study (1), and with the same definition of hyperuricemia (uric acid: 7+ or 6+ mg/dL), and the same method of dietary assessment (the Med diet score), there was what scientists call “inverse association” among the women, as well as the men. “Inverse association” meant that with better adherence to the diet uric acid was lower; worse and it was higher. The study summary called the association ‘significant,’ a strong correlation.

In a third Mediterranean diet for gout study (3) this one in Spain, research scientists also found that higher adherence to the Med diet was associated with less hyperuricemia, among both men and women. This study was among an even larger study population of 4,449 elderly participants (with a high risk of heart disease).

Those who did best had been eating more Med diet food before the study began. The uric acid benefits did not require weight loss or physical activity advice. In fact three variations of the Med diet were trialed in this study, and all had similar positive effects on uric acid. Just about twice as many participants managed to reverse their hyperuricemia, as those who developed it.

And more adherence to these foods meant a good chance of reversing hyperuricemia.

These results were the case even if patients were overweight, hyper-tense, drank alcohol, smoked or didn't smoke, exercised or didn't exercise. And despite their age.  It found over-eating meat, and fish (seafood) more likely to raise uric acid (more eaten) or lower it (less eaten). Same for drinking 7 or more glasses of wine a week.

However, as mentioned above, it was not all plain sailing in study (3). A quarter of those who didn't have hyperuricemia at the beginning developed it over a five year period, despite Med diet adherence. On the other hand, 44% of those that did have hyperuricemia at the start, managed to reverse it with Med diet foods demonstrating again you can get uric acid down by a diet.

The study also came out with a number of positive non gout-related Med diet findings. e.g. weight control and the prevalence of diabetes.


So what can we say to anyone thinking of trying the Mediterranean diet for gout?

If you need to lose weight, as do so many people with gout, the Med diet probably isn’t for you at first. Not until the excess weight is lost. Even if you lowered your uric acid, but not your weight, on a Med diet, as some non-gouty participants did, with excess weight, there is a risk of uric acid rising again.

The studies are really saying that Med diet foods are good for gout, so getting them onto a gout diet, which is going to lose you weight first, is a good idea as long as they don’t interfere with the weight loss principles of the diet you use. And although in one study (3) the uric acid benefit did not require weight loss or physical activity advice, that may not be true for you.

Olives, a Mediterranean food staple

Generally in these studies results were encouraging, but participants were not gout patients. We need more studies about  the Mediterranean diet, especially among gout patients and the middle aged with hyperuricemia who may develop gout later; and among those who are genetically disposed to gout because relatives have suffered it.

Note that two of the diets were successful with elderly people.

Related pages 

Visit the first page about the Mediterranean diet for gout

Purine amounts vary across a cow's body. So which are the best beef cuts for gout ?

Visit our page about olives for gout.

Nuts are widely eaten around the Mediterranean. How good are they for gout?

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Mediterranean diet and gout study references

(1) Abstract Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: the Ikaria study. Chrysohoou C, Skoumas J, Pitsavos C, Masoura C, Siasos G, Galiatsatos N, Psaltopoulou T, Mylonakis C, Margazas A, Kyvelou S, Mamatas S, Panagiotakos D, Stefanadis C. Maturitas  Volume 70, Issue 1, Pages 58-64, September 2011.

NB. Hyperuricaemia, with an "a", is the British English spelling.

 (2) Abstract Adherence to the Mediterranean diet and serum uric acid: the ATTICA study. Kontogianni MD, Chrysohoou C, Panagiotakos DB, Tsetsekou E, Zeimbekis A, Pitsavos C, Stefanadis C. Scand J Rheumatol. 2012;41(6):442-9. doi: 10.3109/03009742.2012.679964.

(3) Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk Marta Guash-Ferre, Mònica Bulló, Nancy Babio, Miguel A. Martínez-González, Ramon Estruch, María-Isabel Covas ,Julia Wärnberg, Fernando Arós, José Lapetra, Lluís Serra-Majem, Josep Basora and Jordi Salas-Salvadó Gerontol A Biol Sci Med Sci(2013) 68 (10): 1263-1270.doi: 10.1093/gerona/glt028



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