Fish and Gout: What to Eat, What to Avoid

Nutritional value and purine content in fish

Certain fish dishes are great sources of heart-healthy omega-3 fatty acids, lean protein, and essential vitamins and minerals, including antioxidants in vitamins B2, B12, and vitamin D. However, eating seafood, including fish, is also a well-recognized risk factor for increased uric acid levels in the blood, which leads to a gout attack. All fish should be eaten in moderation if you have gout (also known as gouty arthritis) or are at risk of gout due to hyperuricemia.  

Purines

Purines are organic chemical substances found in the body and food. You need a healthy supply of purines in your diet, but if you have gout, purines accumulate into excess uric acid in the blood because you can’t efficiently excrete them. Uric acid then builds in joints and causes the pain, redness, and swelling associated with gout.

Some types of seafood and fish, including scallops, sardines, herring, anchovies, haddock, cod, and mackerel, may be better left off the menu altogether. Fish and seafood that are safe to eat should still be cooked with gout-friendly methods to reduce consumption of excess purines.

Fresh fish fillets for sale in seafood store

kali9 / Getty Images

Fish That Are OK to Eat

People with gout can still eat most fresh and canned fish to get a healthy dose of omega-3 fatty acids and other essential nutrients, but they should also consider the total purine content and mercury levels in fish, taking into account their overall dietary habits and purines from other foods. 

Mercury in Fish

Keep an eye on the amount of mercury in your fish choices. Larger fish that have more muscle mass and eat other fish contain higher amounts of mercury. Reducing your exposure means choosing fish with a lower mercury content like canned white tuna like skipjack, yellowfin, tongol, and canned mackerel.

Fish and seafood that are OK to eat when you have gout are those in the low-purine category, meaning they have less than 100 mg of total purines per 100 g serving. Suitable options include Japanese eel, sablefish, and monkfish meat.

Low-Purine Seafood
Japanese eel 92 mg
Sablefish 88 mg
Monkfish (meat only) 70 mg
Purine Content per 100 g.

These fish varieties can be eaten in many different ways, including fried, grilled, boiled, roasted, or barbequed. 

Omega-3 Fatty Acids and Gout

A relationship has been found between omega-3 polyunsaturated fatty acid (n-3 PUFA) consumption (dietary or supplemental) and risk of gout flare-ups. It is associated with a lower risk of recurrent gout flare-ups. 

Fish to Eat in Moderation

Fish and seafood that are best consumed in moderation include those in the moderate-purine category (with a purine content from 100 mg to 400 mg per 100 g serving). Most fish fit into this range, including carp, halibut, Japanese seabass, and yellow striped flounder.

Moderate-Purine Seafood
Halibut 133 mg
Japanese sea bass 119 mg
Yellow striped flounder 113 mg
Carp 103 mg
Purine Content per 100 g.

These fish are typically served boiled, fried, steamed, or baked. 

Fish to Avoid

When you have gout, you want to avoid fish in the high-purine categories (with a purine content of 400 mg or more per 100 g of fish). Studies have shown that fresh anchovies have the total highest purine content at just over 410 mg per 100 g serving. They can be eaten fresh, canned, or cured.

A single anchovy is around 4 grams and a typical 2 ounce weighs around 45 grams. These measurements can, however, vary by species of anchovy. 

Seafood in general, but especially salmon, shrimp, lobster, and sardines, is high in purines and can cause uric acid in the blood to increase. 

High-Purine Seafood
Anchovies 410 mg
Trout, unspecified 297 mg
Tuna in oil 290 mg
Tuna 257 mg
Sardine 210 mg
Halibut 178 mg
Salmon 170 mg
Crab 152 mg
Lobster 102 mg
Purine Content per 100 g.

The purine content above is approximate and can range between species and with cooking methods.

Cooking Tips

Different cooking methods affect the purine content of your fish dish. For example, researchers have found a significant positive relationship between the risk of hyperuricemia and raw (sashimi and sushi) or roasted fish consumption, but not boiled or fried fish consumption.

Boiling, poaching, or steaming in water can reduce the overall purine content of a fish dish. Other options include using plant-based oils rich in antioxidants to lightly fry, marinate, or flavor seafood. 

People with gout can benefit from the anti-inflammatory properties of the omega-3 fatty acids found in fatty fish like salmon, tuna, sardines, and mackerel, but should still not exceed weekly intake recommendations regardless of their cooking methods.

The U.S. Food and Drug Administration’s weekly intake recommendations are as follows:

  • At least 8 ounces of seafood (less for young children) per week based on a 2,000 calorie diet
  • Women who are pregnant, trying to conceive, or breastfeeding may consume between 8 and 12 ounces of seafood per week, from lower mercury options

Eating a 3- or 6-ounce serving of these fish two to four times a week is recommended for lowering inflammation and protecting the heart in people with gout.

A Word From Verywell

While people with gout need to be careful about the purine content found in fish, they can still benefit from the rich amount of omega-3 fatty acids and their anti-inflammatory properties by choosing the right varieties and consuming a safe amount. Dietary changes are the easiest way to avoid a gout flare-up and buildup of uric acids, and they can be implemented with careful planning.

People with gout should pick fish varieties with lower levels of total purines and mercury, eat fish and seafood in moderation, and cook these foods with a moist method like boiling, poaching, or steaming.

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Article Sources
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