Gout Diet: Foods to Eat and Avoid

If you have gout, you should avoid foods high in purines like red meat, alcohol, and certain types of fish and shellfish. These foods can raise your uric acid levels, causing a painful buildup of uric acid in your joints.

If you have gout you should eat low-purine foods like whole grains and vegetables, low-fat dairy, and foods rich in vitamin C.

This article discusses purines, foods to avoid and foods to eat with gout, and ways to get gout symptoms under control.

How Foods Affect Gout

Gout is a type of arthritis that develops when someone has hyperuricemia, or high levels of uric acid in the body. Researchers in both the United Kingdom and the United States have identified gout as the most common type of inflammatory arthritis affecting their populations.

While there are a range of possible causes, including genetic influences and underlying medical conditions, your diet can have a direct impact on gout and its severity.

Higher rates of gout tend to be found in cultures that eat a lot of red meat, processed foods, sugars, and other foods high in purines.

Purines are chemical compounds found naturally in foods and in your body.

Purines come from the foods you eat. When your digestive system breaks these foods down, uric acid is created as a byproduct. Your body reabsorbs most of the uric acid, with the rest excreted, or passed from the body, in your urine and feces.

Your body isn't able to fully process very high levels of purines. This causes uric acid to build up in the body. Hyperuricemia can happen on its own when you eat high-purine foods, but it is more likely if you eat high-purine foods when you have underlying health conditions, such as:

• Chronic kidney disease
• Diabetes
• Hypertension (high blood pressure)
• Psoriatic arthritis
• Recent infection, injury, or surgery
  

What Foods Should You Avoid With Gout?

If you have hyperuricemia or gout, ask your healthcare provider if you should avoid or limit high-purine foods. These include:

• Sugars and fruit high in fructose
• Sugary beverages
• Processed foods
• Red meat and organ meat
• Certain fish and shellfish
• Alcohol
• Yeasts

Removing these foods and drinks from your diet can help prevent and manage gout flare-ups.

Sugars and Fruit

Sugar, including fructose, seems to increase uric acid levels in the blood.

Fructose is a natural form of sugar found in some foods. It's added to many products as high-fructose corn syrup. Avoiding or limiting high-fructose foods may help lessen gout symptoms.

Fruit juices and sugar-sweetened beverages have been associated with hyperuricemia and gout. Some fruits are naturally high in fructose, but more research is needed to determine if they have the same effect as fruit juices and sweet drinks.

If you have gout, you don’t have to avoid all fruit, but it might help to:

• Avoid or limit fruit juices
• Limit fruits high in fructose, such as apples, pears, mangoes, figs, watermelon, and dried fruit
• Pay attention to how these changes affect your gout symptoms

Sugar in Beverages

Sodas and sugary drinks are considered empty-calorie foods. They contain no beneficial nutrients but can add a lot of calories to your diet. They also may add to your risk of gout flare-ups.

One 2020 research review analyzed several studies looking at the relationship between fructose in sugar-sweetened beverages and gout development. It found these drinks are significantly associated with an increased risk of gout and hyperuricemia.

Along with fruit juices, it may help to avoid these types of beverages:

• Soda
• Energy drinks
• Sports drinks
• Sweet coffee drinks

Processed Foods

The modern Western diet is often high in processed foods and refined carbohydrates. These foods have been linked to a higher risk of gout as well as other health conditions, including:

• Type 2 diabetes
• Heart disease
• Weight gain and obesity

By avoiding highly processed and refined-carb foods and beverages, you can help to limit the development of gout and its symptoms. Foods to avoid include:

• Candy
• Baked goods, such as muffins, pastries, cookies, and cakes
• White bread
• Chips and crackers
• Ice cream
• Some frozen meals
• Fast food

Red Meat and Organ Meat

Red meat and organ meats are high-purine foods. Researchers have demonstrated that these foods can raise the risk of high uric acid levels and gout episodes.

To limit your risk, keep your intake of these red meats and organ meats low:

• Beef
• Bison
  
• Venison and other wild game
• Liver
• Heart
• Sweetbreads
• Tongue
• Kidney

Keep in mind that many meat-based soups, gravies, and processed meats like salami and pepperoni can raise the risk of gout flare-ups too. Chicken has moderate purine levels and may be eaten in moderation.

Fish and Seafood

Certain types of seafood are high in purines. These should be avoided on a gout-friendly diet, while other types of seafood can be included. Some types of fish and shellfish have moderate levels of purine and should be limited to less than 6 ounces per day.

Fatty fish, such as tuna and salmon, are good sources of omega-3 fatty acids and are generally thought of as healthy. However, they are high in purines. Some research suggests that fish high in omega-3 fatty acids (but not omega-3 supplements) are linked to a lower risk of gout flare-ups. More research is needed to understand these findings.

Alcohol

Alcohol use is associated with gout, so it's recommended you avoid alcohol when following a low-purine diet. Beverages to avoid include:

• Beer
• Hard liquor
• Other grain alcohols

Wine has long been associated with lower purine levels and is considered "safe" in moderation for people with a history or risk of high uric acid levels.

However, a study of 724 people with a history of gout who consumed alcohol found that wine, beer, and hard liquor were each associated with a higher risk of gout flare-ups. This was true even with potentially moderate amounts, although more so in people who ate high-purine foods and were on certain medications.

Yeasts

Certain yeasts and yeast extracts are high in purines. You should avoid foods and supplements that contain them. Yeast extract is found in foods such as:

• Some soy sauces
• Canned soups and stews
• Frozen dinners
• Salty snacks

What Foods Can You Eat With Gout?

Some foods can help lower uric acid levels, which can relieve gout flare-ups and prevent future attacks.

The following foods may help to ease gout by lowering uric acid levels or reducing purine intake:

• Cherries
• Foods high in vitamin C (e.g., oranges, spinach, kale)
• Coffee
• Low-purine foods (e.g., whole grains, vegetables, plant-based protein like nuts and legumes)
• Low-fat dairy
• Water

Cherries

Cherries have been studied for their role in preventing and managing gout. Their deep red color is due to natural compounds called anthocyanins, which contain antioxidant and anti-inflammatory properties.

Although cherries are high in naturally occurring fructose, research has shown that cherry consumption may help reduce uric acid levels, thus decreasing inflammation and lowering the risk of future gout attacks. Tart cherries like Montmorency or Balaton are the most commonly studied type for gout.

Fresh, frozen, juice, or extract forms are commonly consumed. However, there are no defined amounts to eat per day for gout prevention. Studies vary widely in the serving of cherries studied, such as 1/2 cup of fresh cherries vs 1 cup of cherry juice per day.

For cherry extract supplements, it is best to follow the suggested dosage on the nutrition label.

High-Vitamin C Foods

Vitamin C is a well-known antioxidant, but it is lesser known for its potential role in the treatment of gout by lowering blood uric acid levels.

A prospective study published in 2009 followed nearly 47,000 men for 20 years and examined their risk of gout in relation to their vitamin C intake. The researchers concluded that higher vitamin C intake was associated with a lower risk of developing gout, with up to a 45% lower risk when consuming 1,500 milligrams or more of vitamin C per day.

A 2011 analysis of 13 randomized controlled clinical trials in people with high blood uric acid levels found that vitamin C supplementation with a median dose of 500 milligrams per day for a median duration of 30 days modestly reduced serum uric acid levels. Whether this amount is significant or not in reducing the risk of gout needs to be further studied.

Foods high in vitamin C include:

• Citrus fruits like oranges and grapefruit
• Kiwifruit
• Strawberries
  
• Cantaloupe
• Sweet bell peppers
• Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts, and cabbage)
  
• Baked potatoes
  
• Tomatoes

If you have an increased risk for kidney stones (particularly calcium oxalate stones), it is not recommended to consume high doses of supplemental vitamin C on a regular basis.

Coffee

Coffee is one of the most widely consumed beverages in the world and has been studied for its various effects on health. Early studies suggest that coffee may decrease the risk of gout. However, research shows that it may vary based on sex.

A 2015 review of studies found that men who drank four to five cups of coffee per day had a 40% decreased risk of gout, and those who drank six cups or more per day had a 59% lower risk when compared to no coffee consumption

In women who drank one to three cups of coffee daily, the risk of gout was 22% lower, and in those who drank four or more cups daily, the risk was 57% lower, compared to no coffee consumption. From this review, the researchers concluded that drinking 4 or more cups of coffee per day lowers uric acid levels and decreases the incidence of gout.

However, no research has explored the effects of coffee intake on the risk of recurrent gout attacks.

Low-Purine Foods

One of the most widely accepted and recommended dietary approaches in managing gout is to reduce purine intake from foods. By choosing to eat low-purine foods instead of those higher in purines, you can help prevent your blood uric acid levels from getting too high.

Additionally, the DASH diet, which encourages many low-purine foods, has been associated with a lower risk of gout.

Low-purine foods include:

• Certain fruits, like cherries, berries, and citrus fruits
• Nonfat and low-fat dairy (milk, cheese, yogurt)
• Plant-based protein foods such as nuts, peanut butter, seeds, and legumes
• Eggs (in moderation)
• Whole grain bread and pasta, rice, potatoes
• Vegetables

Plant-Based Foods

Many plant-based foods are low in purines, making them an excellent choice for a gout-friendly diet. They also contain numerous health-promoting nutrients, including vitamins, minerals, and fiber. Plant-based foods include:

• Beans and other legumes
• Fruit
  
• Nuts
• Nut and vegetable-based oils
• Seeds
• Soy-based proteins, such as tofu, tempeh, soy nuts, and soy milk
  
• Vegetables
• Whole grains

Plant-based diets have been shown to decrease the risk of gout, according to two separate prospective cohort studies.

Some vegetables are higher in purines. However, the body processes plant-based purines differently. Research shows that plant-based purines do not increase the risk of gout and may actually decrease risk.

A 2019 review of plant-based diets and their association with gout suggested that reasonable consumption of higher purine plant foods as a part of a plant-based diet may be safely tolerated in healthy people.

Researchers noted that additional studies are needed in people with high uric acid levels, especially those who suffer from chronic kidney disease.

Low-Fat Dairy

Dairy products have been found to decrease the risk of gout. In particular low-fat or non-fat dairy may be protective against recurrent gout flares.

Low-fat dairy may decrease uric acid levels and contain certain anti-inflammatory properties that decrease the inflammatory response to monosodium urate crystals within the joint.

The Dietary Guidelines for Americans suggest three servings of dairy per day for healthy adults. This includes low-fat milk, yogurt, cheese, and cottage cheese.

Water

Staying hydrated is key for people with gout. A 2017 prospective study looked at the association between water intake and uric acid levels.

After examining the data, researchers determined that water intake has an association with lower uric acid levels in people with gout, possibly due to increased uric acid excretion with higher water intake. However, more research is needed to find a more direct effect of water intake on gout.

A review in the American Journal of Lifestyle Medicine found that excess sweating, such as after exercise or sauna bathing, decreased urinary excretion of uric acid, leading to an increase in uric acid levels. Therefore, researchers recommend drinking plenty of water to avoid increased serum uric acid levels after activities that cause heavy sweating.

Researchers also found that adequate water consumption in the 24-hour period before a gout flare was associated with a significant decrease in recurrent gout attacks.

Water is the best source of hydration, but other beverages such as coffee, and foods such as some fruits and vegetables, contain water and can contribute to your overall hydration status. Drinking to thirst is best, but some experts suggest drinking half of your body weight in ounces each day for optimal hydration.

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Sample Meal Plan

It's not always easy to change your diet or know where to begin. One option is to learn the principles of the DASH diet and build your meal choices and menus around the foods included.

That's the approach used in a study for people with gout living in Baltimore, Maryland. Dietitians approved participants' grocery lists and then ordered and delivered the food to their homes. Researchers evaluated the foods they ate and any changes in their uric acid levels.

The 49 study participants followed meal plans that included:

• 5–7 servings per day of healthy grains
• 4 servings per day of fruit
• 4 servings per day of vegetables
• 1–2 servings per day of lean poultry (chicken, turkey) or fish
• 2 servings per day of low-fat dairy, such as milk or cheese
• A limited amount of nuts, seeds, and legumes each day
  

The meals also limited sodium (salt), cholesterol, and fats, while restricting high-purine foods. Results showed some reduction of uric acid levels and that 80% of the participants found the diet easy to follow.

Three-fourths of the participants said they were likely to continue eating in a new way after the study, indicating that they had a positive experience with their changes in diet and behavior.

Summary

The risk of gout flare-ups is strongly influenced by the foods and beverages you choose. Some foods contain natural compounds called purines, which can raise uric acid levels, leading to a type of inflammatory arthritis called gout.

These food choices also affect other health conditions, such as high blood pressure and kidney disease. A low-purine diet restricts foods such as red meat, alcohol, processed foods, sugary foods, and some seafood.

Keep in mind that the foods that lead to gout flare-ups will depend on each individual. You'll want to keep in touch with your healthcare provider as you make changes to your diet and set yourself up with small, encouraging "wins" as you follow your dietary journey.