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 August 16, 2021 Medically reviewed by Anita C. Chandrasekaran, MD, MPH Medically reviewed by Anita C. Chandrasekaran, MD, MPH on January 25, 2021 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 Review 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 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. 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 dietWomen 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. Frequently Asked Questions What is gout? Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint. Learn More: Causes and Risk Factors of Gout How is food linked to gout? Gout is caused by persistently high levels of uric acid in the blood, and uric acid is produced by the breakdown of an organic compound called purine. Purines are found in high concentrations in foods like beer, meat, seafood, and sugar-sweetened foods. A purine-rich diet is one of several risk factors for gout. Learn More: Foods That Increase Uric Acid Is fish bad for you if you have gout? Some fish may contribute to the onset of gout, particularly anchovies, herring, mackerel, and sardines. This doesn't mean you should avoid fish if you have gout; rather, you should eat them in moderation as the benefits of eating fish (especially to heart health) may outweigh the risks. What fish can I eat if I have gout? Low-purine fish include monkfish, sable, and eel. Those with moderate purine levels include cod, carp, flounder, halibut, haddock, pike, sea bass, and sole. Learn More: Foods to Eat If You Have Gout What fish should I avoid if I have gout? High-purine fish include anchovies, herring, ocean perch, mackerel, salmon, sardines, trout, and tuna. Moreover, roasting fish or eating fish raw (such as for sushi) is associated with increased blood uric acid levels versus steaming or poaching. Learn More: Foods to Avoid If You Have Gout Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 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. Burger Joanna, Gochfeld Michael. Mercury in canned tuna: white versus light and temporal variation. Environ Res. 2004;96(3):239-249. doi: 10.1016/j.envres.2003.12.001.x 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. 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. 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