Design: 12-week, open-label, active-comparator randomised trial, 1:1:1
Population: 102 men with overweight or obesity and hyperuricaemia
Primary outcome: change in serum urate from baseline to week 12
Effect: -0.89 mg/dL (carbohydrate-restricted), -0.79 (DASH), -0.50 (low-purine); P = 0.48 between groups

One hundred and two men with overweight or obesity and hyperuricaemia were randomised 1:1:1 to a carbohydrate-restricted diet, a DASH diet or a low-purine balanced diet, each prescribed at 20-25 kcal/kg ideal body weight for 12 weeks. Eighty-five (83.3%) completed follow-up. Mean weight loss was 8.47 kg, about 9.3% of body weight, with no difference between arms (P = 0.99). Adjusted serum urate fell 0.89 mg/dL on the carbohydrate-restricted diet, 0.79 mg/dL on DASH and 0.50 mg/dL on the low-purine diet, again without significant separation (P = 0.48).

The interesting result is not the comparison. Capillary urate monitoring picked up a transient rise in week 1 that coincided with the early peak in gout flares. That is the mechanism behind a complaint clinicians hear and usually attribute to coincidence: the patient starts the diet you prescribed and has a flare a few days later.

DASH was adhered to better than either of the others, and was associated with less loss of soft lean mass than the carbohydrate-restricted diet. Where a patient with hyperuricaemia needs to lose weight, that combination — equivalent urate benefit, better adherence, better body composition — is a reasonable basis for choosing DASH, and the low-purine diet has little to recommend it beyond familiarity.

Warn about a possible flare in the first week whenever you start a calorie-restricted diet in someone with hyperuricaemia.
Agree a flare plan in advance — colchicine or NSAID cover and when to use it — rather than after the patient rings.
Prefer DASH over a low-purine prescription when urate control and weight loss are both the goal.
A flare in week 1 is not a reason to abandon the diet; the urate fall is at 12 weeks.
Track weight and urate together; the urate benefit here tracked the weight loss, not the food restricted.

Why it matters

The flare that follows a prescribed diet is usually blamed on the patient's cooking; this says it is the diet working.

The statistics, in plain English

P = 0.48 across the three arms means the trial could not tell the diets apart on urate, not that they are equivalent — with 102 men randomised and 85 completing, only a large difference would have shown. The difference between -0.89 and -0.50 mg/dL could be real and this trial would still have missed it. The adherence and lean-mass findings were secondary and open-label, so the reported advantage of DASH is a reasonable signal rather than a settled result.