Arthritis Gout Fish and Gout: What to Eat, What to Avoid Nutritional value and purine content in fish By Michelle Pugle Michelle Pugle Facebook LinkedIn Twitter Michelle Pugle is an expert health writer with nearly a decade of experience contributing accurate and accessible health information to authority publications. Learn about our editorial process Updated on March 05, 2023 Medically reviewed by Anita C. Chandrasekaran, MD, MPH Medically reviewed by Anita C. Chandrasekaran, MD, MPH LinkedIn Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Fish That Are OK to Eat Fish to Eat in Moderation Fish to Avoid Cooking Tips Omega-3 Fatty Acids While the nutrients in certain fish are beneficial for heart health, fish high in purines can raise uric acid levels and trigger a gout flare. This article provides a breakdown of which high-purine fish a person with gout may want to avoid. It also covers some gout-friendly fish options that can provide omega-3 fatty acids, lean protein, and other important nutrients. kali9 / Getty Images Fish That Are OK to Eat When you have gout, look for fish that's in the "low-purine category." This means they have less than 100 milligrams of total purines per 100-gram serving. The best options for low-purine fish include Japanese eel, monkfish meat, and sailfin sandfish. The purine content of catfish, flounder, red snapper, salmon, sole, and tilapia skew slightly higher but are good options, too. Low-Purine Seafood Japanese eel 92 mg Monkfish (meat only) 70 mg Sailfin sandfish 99 mg Caviar 95 mg Botan shrimp 53 mg Japanese scallop 77 mg Squid 60 mg Red king crab 99 mg Purine Content per 100 g. These fish varieties can be eaten fried, grilled, boiled, roasted, or barbecued. All fish should be eaten in moderation if you have gout, also known as gouty arthritis. You should also limit fish if you're at risk of gout due to hyperuricemia, a condition defined by having too uric acid in the blood. Excess uric acid (which your body cannot excrete) turns to uric acid crystals that build up in the joints and surrounding tissues and trigger the painful symptoms of gout. Fish to Eat in Moderation Fish and seafood that are best consumed in moderation include those in the "moderate-purine category," or those with a purine content from 100 to 200 milligram per 100-gram serving). Most types of fish fit into this range. They include carp, cod, flounder, haddock, halibut, pike, sea bass, and sole. Moderate-Purine Seafood Halibut 133 mg Japanese sea bass 120 mg Yellow striped flounder 113 mg Carp 103 mg Tuna 157 mg Rainbow trout 181 mg Salmon 119 mg Lobster 102 mg Crab 152 mg Oyster 185 mg Purine Content per 100 g. These fish are typically served boiled, fried, steamed, or baked. Eating raw fish (such as sushi) is associated with increased blood uric acid levels. Fish to Avoid When you have gout, you should avoid fish in the "high-purine category," or those with a purine content of 200 milligrams or more per 100 grams of fish. Some of the most popular types of fish are, unfortunately, high in purines. They include crab, lobster, trout, and tuna. Other fish with high purine levels include herring, ocean perch, mackerel, sardines, scallops, and trout. They all can trigger what the Centers for Disease Control and Prevention calls a "gout flare." High-Purine Seafood Anchovies (dried) 1,109 mg Jack mackerel 246 mg Bonito 211 mg Sardines 306 mg Purine Content per 100 g. The purine content above is approximate and can range between species and with cooking methods. Cooking Tips Avoiding certain types of fish may be the ideal, but it may not always be practical. (Think of a wedding or anniversary dinner where fish headlines the menu.) In this case, it might be good to know that cooking methods affect the purine content of fish so that you can order accordingly. Boiling, poaching, or steaming in water can reduce the overall purine content of a fish dish. Cooking doesn't always lead to the best outcome, however. Researchers have found a significant positive relationship between the risk of hyperuricemia (high uric acid level) and eating raw (sashimi and sushi) or roasted fish. Steam On Steaming is a fast cooking method, and it's also healthy because it there is no need for oil, butter, or other fats. As culinary scientist Jessica Gavin says, "...perhaps best of all, steaming keeps all those valuable nutrients inside the food, instead of in the cooking liquid." Omega-3 Fatty Acids The good news for gout patients (and fish lovers) kept rolling in when a (small) study found a relationship between consuming omega-3 acids and the risk of gout flare-ups. Specifically, consuming omega-3 fatty acids was found to decrease the number of gout flare-ups. Omega-3 fatty acids were already highly regarded for their presumed ability to improve heart health and reduce the risk of heart attack or stroke. This is why the American Heart Association recommends eating two servings of fish per week. Fish like anchovies, herring, mackerel, black cod, salmon, sardines, bluefin tuna, striped bass, and whitefish are high in omega-3 fatty acids. It would appear that a green light could not be flashing brighter if you have gout and you're concerned about heart health. But it always pays to be certain, especially when you realize that the study was a small one (and could breed false hope). Plus, gout differs from one patient to another. Summary If you have gout, you probably know that you have to be careful about the types of fish you eat. You want to keep your purine levels low so that you do not trigger a gout attack. Some types of fish are OK to eat, some should be eaten in moderation, and others are best avoided. While you learn, mastering alternative cooking methods may help. Boiling, poaching, or steaming fish in water can help lower purine content. A Word From Verywell According to the Arthritis Foundation, if you have gout, try to limit purines and pay attention to which foods aggravate your condition. You may also try talking with a nutritionist, who can guide you to the right foods and create a diet that suits your tastes and needs. Pork and Gout: What to Eat, What to Avoid 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Centers for Disease Control and Prevention. Gout. Arthritis Foundation. Which foods are safe for gout? Kaneko K, Aoyagi Y, Fukuuchi T, Inazawa K, Yamaoka N. Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull. 2014;37(5):709-21. doi:10.1248/bpb.b13-00967. Ren Z, Huang C, Momma H, et al. The consumption of fish cooked by different methods was related to the risk of hyperuricemia in Japanese adults: A 3-year follow-up study. Nutr Metab Cardiovasc Dis. 2016 Sep;26(9):778-85. doi:10.1016/j.numecd.2016.05.009. Jessica Gavin. Steaming 101. Zhang M, Zhang Y, Terkeltaub R, Chen C, Neogi T. Effect of dietary and supplemental omega-3 polyunsaturated fatty acids on risk of recurrent gout flares. Arthritis Rheumatol. 2019;71(9):1580-1586. doi:10.1002/art.40896.x. American Heart Association. Fish and omega-3 fatty acids. By Michelle Pugle Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies