Gout Diet: Foods to Eat and Avoid

What Purine Is and Why You May Need to Avoid It

mussels and fries
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The foods you eat can play a huge role in the frequency and severity of your gout symptoms. The main culprit is an organic substance known as purine found in many foods which, when oxidized, creates the uric acid that triggers a gout attack. While not a cure, a well-balanced gout diet may lower your risk of an attack and slow the progression of your joint damage.

Understanding Purine

For centuries, gout has been associated with the overindulgence of rich foods such as seafood, meat, and alcohol. As a result, people were commonly advised to avoid all of these things until symptoms resolved. With the discovery of purine in 1884, the practice was further endorsed, and people were routinely warned against consuming otherwise healthy foods such as fish, vegetables, and fruit.

In recent years, our understanding about the synthesis of uric acid has expanded considerably, and many of the foods once considered off-limits are today deemed safe for consumption. These include high-purine vegetables such as such as asparagus, spinach, peas, cauliflower, and mushrooms.

General Dietary Guidelines

As a rule, excluding entire food groups from your diet is never a good idea. When formulating your gout diet, you need to ensure that you maintain a balanced intake of the proteins, fats, and carbohydrates your body needs to function optimally.

Whether you have gout or not, you should aim for the following goals outlined by Center for Nutritional Policy and Promotion in Washington, D.C.:

  • Limit your daily protein intake from lean meat, fish, and poultry to between four to six ounces.
  • Add protein to your diet with low-fat dairy products (such a yogurt and skim milk) or other non-meat proteins.
  • Eat more fruits, vegetables, and whole grains.
  • Reduce your intake of sodium, saturated fat, and added sugar.
  • Drinking at least eight glasses of water (or roughly a half gallon) per day.
  • Reduce your caloric intake if you are overweight or obese.

Many of these changes alone can help improve your gout symptoms. Keeping well hydrated, for example, lowers the uric acid concentration in your blood. Similarly, the increased intake of low-fat dairy is associated with a reduction in uric acid levels, as is weight loss in general.

By ensuring a healthy, balanced diet, you are already well on your way to improving your gout symptoms.

What You Can Eat

Dietary guidelines have changed over time in regards to the management of gout. Current evidence suggests that following foods can be a valuable part of a gout diet:

  • Vegetables, including high-purine vegetables
  • Low-fat or non-fat dairy products
  • Tofu (as an alternative to meat protein)
  • Salmon (one of the oily fishes considered beneficial to reducing uric acid)
  • Moderate intake of beef, duck, lamb, pork, and ham
  • Moderate intake of crab, lobster, oysters, and shrimp
  • Moderate intake of legumes and beans
  • Complex carbohydrate foods, such as whole grain bread, brown rice, and oatmeal
  • Dark berries, especially cherries
  • Coffee (in moderation)

A daily intake of 500 milligrams of vitamin C may also be beneficial to reduce your uric acid levels. Speak with your doctor to see if vitamin supplementation is needed and whether it fits into your diet and medication plan.

What Not to Eat

A 2012 study from Boston University School of Medicine investigated the impact of purine-rich foods in 633 people with gout. What they found was that even when using anti-gout medications, the intake of these foods was associated with a five-fold increase in the risk of recurrent gout attacks. 

To this end, there are certain foods you will need to avoid if you suffer from gout, including:

  • Beer and alcohol
  • Oily fish such as tuna, anchovies, sardine, smelt, herring, haddock, mackerel, and fish roe
  • Scallops and mussels
  • Organ meats such as liver, sweetbreads, and kidneys
  • Game birds, including pheasant, partridge, and grouse
  • Turkey
  • Veal
  • Bacon
  • Venison
  • Yeast extract spreads such as Marmite (yeast breads are fine)
  • Meat extracts, consommé, and gravies

While alcohol is generally considered a no-no for a gout diet, the verdict is still out on whether wine is also on the list. As such, speak with your doctor to determine whether wine may be acceptable to your treatment plan.

Other Considerations

In addition to purines, you would need to avoid or limit your intake of high-fructose drinks and sodas which inhibit the excretion of uric acid from the body. While some have suggested that the excessive consumption of fruit may be also a problem (since they, too, contain fructose), they don't pose anywhere near the same risk as concentrated fructose drinks, especially those made with corn syrup.

Ketogenic diets (a low-carb dietary routine intended to treat epilepsy in children but popularized for weight loss) should also be avoided as they impair the kidneys' ability to excrete uric acid. This is mainly because ketones and uric acids are excreted in the same way, and the competition between the two essentially "backs up" the outward flow from the kidneys.

How to Plan Your Diet

Working out which foods are safe for you can be a process of trial and error. While some people, for example, will have no problem consuming moderate amounts of red meat, others may experience an attack with only a scant helping.

To find your right balance, work with your doctor or a nutritionist experienced in the management of gout. Most will advise you to keep a food diary so that you can begin to pinpoint the specific food triggers that place you at greatest risk.

If you plan to lose weight, avoid crash diets. By losing weight too quickly, you risk increasing the concentration of uric acid in your blood and may end up triggering an attack.

As with all dietary plans, a slow and steady approach is better for your health and something you'll better able to maintain over the long run.

Sources:

Center for Nutritional Policy and Promotion. (2015) "Chapter 1: Key Recommendation: Components of Healthy Eating Patterns." 2015-2020 Dietary Guidelines for Americans (Eighth Edition). Washington, D.C.: U.S Department of Agriculture.

Fischer, E. "Ueber die Harnsauer. 1 [On Uric Acid. 1]." Berichte der Deutschen Chemischen Gesellschaft. 1884: 17:328-338. DOI: 10.1002/cber.18980310304.

Tuhina, N.; Jansen, T.; Dalbeth, L. et al. "2015 Gout Classification Criteria An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative." Arthritis Rheumatol. 2015; 67(1):2557-68. DOI: 10.1002/art.39254.

Zhang, Y.; Chen, C.; Choi, H. et al. "Purine-rich foods intake and recurrent gout attacks." Ann Rheum Dis. 2012; 71(9):1448-53. DOI: 10.1136/annrheumdis-2011-201215.