Gout Diet - Foods to Eat and to Avoid

Scratch These Food Items From Your Shopping List

mussels and fries
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A gout diet is recommended for people diagnosed with gout—one of the most painful types of arthritis. Gout is characterized by sudden, severe bouts of redness, swelling, warmth, pain, and inflammation in one or more joints. Along with diet, gout is typically treated with certain medications. Lifestyle modifications are usually suggested to gout patients as well. People with gout are advised to avoid alcohol or drink alcohol in moderation, drink plenty of water and fluids, maintain an ideal body weight, lose weight if overweight, but avoid fasting or quick weight loss schemes.

What to Eat If You Have Gout

While it's important for people with gout to avoid purine-rich foods, people really want to know what they should eat. Dietary guidelines have changed over time. The most current recommendations, according to UpToDate, suggest that people with gout eat or drink:

  • Low-fat dairy products
  • Foods made with complex carbohydrates, such as whole grains, brown rice, oats, and beans
  • A moderate amount of wine, up to two 5 ounce servings per day (Note: While it was once thought that wine was harmless for gout patients, study results in the January 2014 American Journal of Medicine concluded that "individuals with gout should limit alcohol intake of all types to reduce the risk of recurrent gout attacks."
  • Coffee (may lower serum uric acid levels)
  • Vitamin C (500 mg per day may mildly lower uric acid levels)

Dietary changes, without taking gout medication, are not thought to significantly lower blood uric acid levels.

Gout diet alone, even when followed strictly, lowers blood uric acid levels by only 15 percent to 20 percent.

In 2012, the American College of Rheumatology (ACR) updated guidelines for the treatment of gout. Part 1 focuses on foods that the ACR encourages or limits. Part 2 focuses on gout medications.

  • Gout Management: 2012 ACR Guidelines - Part 1
  • Gout Management: 2012 ACR Guidelines - Part 2

In the guidelines, low-fat and non-fat dairy products and vegetables are encouraged.

What Foods to AVOID if You Have Gout

Diets that are high in purines and high in protein have long been associated with an increased risk of gout, as was alluded to above. Uric acid levels can become elevated in three ways: by eating a lot of purine-rich foods, by the overproduction of uric acid in the body, or if the kidneys do not eliminate excess uric acid. In the body, excess uric acid can precipitate out and form crystals in the joints. It is the crystals in the joints that cause pain and inflammation which is associated with gout.

Foods High in Purines

Johns Hopkins lists the following foods as being higher in purines:

  • hearts
  • herring
  • mussels
  • yeast
  • smelt
  • sardines                     
  • sweetbreads

Foods Moderately High in Purines

  • anchovies
  • grouse
  • mutton
  • veal
  • bacon
  • liver
  • salmon
  • turkey
  • kidneys
  • partridge
  • trout
  • goose
  • haddock
  • pheasant
  • scallops

Interestingly, results from a well-known study led by Dr. Hyon K. Choi reported in The New England Journal of Medicine, offered an interesting twist with regard to purines and gout. Choi's research team followed 47,150 men with no prior history of gout over a 12-year period.

During that time, 730 men were diagnosed with gout. Study participants who consumed the highest amount of meat were 40 percent more likely to have gout than those who ate the least amount of meat. Study participants who ate the most seafood were 50 percent more likely to have gout.

In this specific study, though, not all purine-rich foods were associated with an increased risk of gout. There was no increased risk associated with a diet that included the following foods which are considered high in purines:

  • peas
  • beans
  • mushrooms
  • cauliflower
  • spinach

Choi's team also found that low-fat dairy products decrease the risk of gout, and overall protein intake had no effect.

Ultimately, diets shown to be connected to gout are similar to diets linked to cardiovascular disease.                                                                                                                                                                               

Recommendations for Seafood Should Be Individualized

At this point, it may seem confusing. Isn't seafood typically recommended as part of a diet which is healthy for the heart? Yet, research has revealed that there is a strong, undeniable link between seafood and gout. How did Choi reconcile what seems like conflicting information? He stated that "recommendations for seafood should be individualized."

Sorting Out the Myths

How can you begin to sort the myths from the facts and decide what to buy at the grocery store? According to the University of Washington, Department of Orthopedics:

  • Obesity can be linked to high uric acid levels in the blood. People who are overweight should consult with their doctor to decide on a reasonable weight-loss program. Fasting or severe dieting can actually raise uric acid levels and cause gout to worsen.
  • Usually, people can eat what they like within limits. People who have kidney stones due to uric acid may need to actually eliminate purine-rich foods from their diet because those foods can raise their uric acid level.
  • Consuming coffee and tea is not a problem, but alcohol can raise uric acid levels and provoke a gout attack. Drinking at least 10 to 12 eight-ounce glasses of non-alcoholic fluids every day is recommended, especially for people with kidney stones, to help flush the uric acid crystals from the body.

A Word From Verywell

While certain medications for gout have reduced the need for dietary restrictions, appropriate modifications to your diet can decrease the severity or frequency of gout attacks. Dietary modification may also be preferred by people who cannot tolerate gout medications.

Preventing gout attacks is important. Keeping your serum uric acid level in the normal range is also important for gout management. Some people are tempted to stray from their gout diet when they are between gout attacks. Try to avoid that temptation and always be mindful of what prevents gout attacks from recurring. Consider keeping a daily diary or log of your gout symptoms and your diet—simply to keep you on track!

Sources:

Becker, Michael A. MD. Patient Information: Gout (Beyond the Basics). UpToDate. Updated February 7, 2017.

Dietary Guidelines for Gout Patients. Gout & Uric Acid Society.

Gout. UW Medicine. Orthopaedics and Sports Medicine.

Khanna, D. et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care and Research. Volume 64 No. 10. October 2012.

Matsumoto, Alan MD. Gout. Johns Hopkins Arthritis. June 7, 2010.

Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men, The New England Journal of Medicine Volume 350:1093-1103, March 11, 2004.

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