• People with gout should be advised to:
• Aim for an ideal body weight — but avoid crash dieting and high protein/low carbohydrate diets.
• Eat sensibly — by restricting the amount of red meat and avoiding a high protein intake. Avoid foods rich in purines such as liver, kidneys, and seafood.
• Drink alcohol sensibly — by avoiding binge drinking and restricting alcohol consumption to 21 units per week for men and 14 units per week for women.
• Avoid dehydration by drinking water (up to 2 litres/day unless there is a medical contraindication).
• Take regular exercise — but avoid intense muscular exercise and trauma to joints.
• Stop smoking — refer for smoking cessation advice if the person is motivated to quit.
• Provide written information and patient support via the UK Gout Society. For more information, see www.ukgoutsociety.org.

These recommendations are based on published expert opinion, pragmatic advice, and the guideline produced by expert representatives of the British Society for Rheumatology (BSR). The evidence supporting the BSR recommendations is based on a systematic review of literature [Jordan et al, 2007]. There are no controlled trials (mainly observational studies and case studies) of the effect on lifestyle changes on the incidence of gout, but expert opinion is that lifestyle changes can be beneficial [Sutaria et al, 2006].

• Weight: there is evidence suggesting obesity is linked with gout. Gradual weight loss may improve uric acid levels and reduce the frequency of gout attacks, but weight loss should not involve diets that increase urate levels, such as high-protein diets or starvation regimens [Saag and Choi, 2006].
• Exercise: swimming and walking should be encouraged, but strenuous exercise or trauma to joints may precipitate attacks of gout.
• Diet: there is evidence that restricting dietary purines can improve serum uric acid levels. A low-purine diet may have some clinical benefit in reducing attacks of gout, and this is especially important in people with renal impairment [Choi, 2005].
• The diet should be nutritionally balanced, but purine intake limited. Foods which are very rich in purines such as liver, kidneys, red meat, yeast extracts, seafood (herring, sardines, and shellfish), and certain vegetables (asparagus, beans, cauliflower, lentils, mushrooms, oatmeal, and spinach), should be avoided. Soya foods are also high in purines but are less likely to lead to gout than meats and seafood. It is the quantity of purine-rich food consumed that is more important than the absolute purine content in each food. However, if the person is keen to measure quantities of food, they should aim for a maximum total daily purine intake of around 200 mg. People with diabetes should continue with their diabetic diet as this will help with lowering urate levels.
• Alcohol: the evidence suggests that drinking alcohol above the recommended limit (especially beer, stout, port, and fortified wines) is associated with a higher incidence of gout. Moderate consumption of wine (two glasses per day) was not associated with a significant increased risk [Choi, 2005].
• The aim of lifestyle advice is not only to reduce episodes of gout but to reduce overall cardiovascular risk, which is higher in people with gout. For more information, see the CKS topic on CVD risk assessment and management.