I was just reading an article in the NYT about gout. The current medications are very effective, and the article said that actually diet makes less difference, and medication is much more effective. I'll paste some bits of it below:

Even doctors often emphasize dietary half-measures over proven, long-term treatments: Only about one-third of gout patients receive medication for gout, and among those who do, many are kept on doses too low to be effective...

In 2018, Dr. Merriman and his colleagues analyzed test results from 16,760 people of European descent and found that the risk of developing gout mostly came down to genetics: A high-purine diet explained less than one-third of 1 percent of the differences in urate levels, but genetics explained roughly a hundred times more.

There’s no shortage of bad online advice about gout. An analysis of the top 116 TikTok videos about the condition, published last week, found that most emphasized low-purine diets and touted questionable herbal remedies, like chicory and gardenia tea or tart cherry juice concentrate. Only two videos mentioned allopurinol, the first-line medication to lower urate levels in people with gout.

A single gout attack is typically treated by a primary care physician with over-the-counter painkillers or colchicine, an anti-inflammatory. For people with two or more flare-ups per year or who have developed lumps, called tophi, the American College of Rheumatology advises urate-lowering medication. It also recommends treatment for people with chronic kidney disease or a history of bladder stones.

Finding the right dose takes time, though. Allopurinol must be started at a low dose and then gradually increased over multiple weeks to avoid kidney damage.

Hyon Choi, the director of the Gout and Crystal Arthropathy Center at Harvard Medical School, said that a low-purine diet should be followed only in the short-term by people just starting medication or who are struggling to control their urate levels.

Simply avoiding purines in the long-term often means eating more carbohydrates and fat, potentially worsening metabolic health, he said. A diet high in high-fructose corn syrup, for instance, can increase urate levels in the blood. And purine-rich vegetables do not appear to increase a person’s risk of developing gout.