One reason why there are no high quality evidence studies for gout is due to the fact that the complexities of effective management make it difficult to treat. In Dr. Purdy's community of southern Louisiana, I am certain that primary physicians see lots of gout. Their lack of aggressiveness is not from a lack of understanding the disease, but from the difficulty of getting patients to abstain from the obvious, namely beer. Beer has guanine in it which is rapidly metabolized into uric acid. Beer is the major culprit. So when a patient has a six-pack on Saturday night, you can almost predict that the patient will be in your office or in the emergency room on Monday.
Patients also eat shellfish (namely mud-bugs and shrimp) as well as organ meat, and lots of red meat. Forget about high-purine vegetables - it turns out they are not a problem. Dairy products tend to decrease uric acid to some extent. This is all relatively new data that has come out in the literature.
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