Diet for Gout: Foods to Eat & Avoid, Foods to Eat in Moderation if You Have Gout

Overview of Gout

Gout is a kind of painful arthritis, which is an inflammatory condition of the joints. It is estimated that gout affects nearly 8.3 million people in the United States alone. (1,2,3) People who have gout tend to experience severe and sudden attacks of swelling, inflammation of the joints, and pain. Almost half of all gout cases tend to affect the big toe, while other people are affected in the wrists, fingers, heels, and knees. (4,5) Gout is caused by the buildup of uric acid in the bloodstream, which forms crystals in the joints of the body. It is this accumulation of crystals in your joints that trigger swelling and intense pain. Your body produces uric acid after breaking down a substance known as purine, which can be found in many foods. (6,7,8) Gout episodes or attacks tend to occur at night and can last for three to ten days. (9)

Most people with gout experience the symptoms and flare-ups because their bodies are not able to remove the excess built-up uric acid in the bloodstream. This allows the uric acid to continue building up, crystallize, and settle in between the joints. In some cases, you may also get gout if your body starts producing too much uric acid because of genetics or your diet. (10,11)

Reducing the intake of purine-rich foods can help you manage the flare-ups and symptoms of gout. However, it is important to keep in mind that while your diet can impact the amount of uric acid being produced by your body, the effects of this are small as compared to taking medication for gout. Therefore, Gout can be controlled with medications, lifestyle changes, and following a gout-friendly diet.

Can Your Diet Really Affect Gout?

If you have been diagnosed with gout, certain foods may trigger a flare-up or attack of gout as it increases the levels of uric acid. These trigger foods are usually high in purines, which is a substance naturally found in some foods. And when you digest purines, your body produces uric acid as a waste product. (12) In healthy people, though, this is not a concern since they are able to efficiently remove the excess uric acid from the body through urine.

However, people who have gout are not able to effectively remove the excess uric acid. This is why a diet rich in purine can lead to the buildup of uric acid and bring about a gout attack.

Nevertheless, research shows that limiting the intake of high purine foods and also taking the right medication as prescribed by your doctor can prevent these gout attacks. (13)

Foods that are commonly associated with triggering gout attacks include red meats, organ meats, seafood, beer, and alcohol. These foods contain moderate to high amounts of purines. (14,15) However, research shows that there is an exception to this rule, which is that consumption of purine-rich vegetables does not trigger gout flare-ups. (16)

Furthermore, sugar-sweetened beverages and fructose can also increase your risk of gout and gout flare-ups, even though they are not rich in purine. (17) This is because these foods and beverages may increase the levels of uric acid by boosting various cellular processes in the body. (18)

For example, a study carried out on over 125,000 participants discovered that people who had a high to very high intake of fructose had a 62% higher risk of having gout. (19)

Research also shows that consuming soy products, low-fat dairy products, and vitamin C supplements can help prevent gout flare-ups as they help lower the levels of uric acid in the bloodstream. (20)

At the same time, high-fat and full-fat dairy products do not seem to have any impact on the uric acid levels in the blood.

While no specific eating plan is going to completely prevent the gout attacks, but following a good gout diet will help you in the following:

  • Restrict the intake of foods with purines.
  • Add foods that will naturally help control the levels of uric acid.
  • Set and follow healthy eating habits.
  • And reach a healthy weight.

Food To Avoid If You Have Gout

If you are prone to getting sudden gout flare-ups, you need to avoid the main culprit responsible, which is high-purine foods. These are foods that contain over 200 milligrams (mg) of purines per 100 grams (3.5 ounces). (21)

It is also necessary to avoid foods that are high in fructose, along with moderately high purine foods. Moderately high purine foods contain 150-200 mg of purine for every 100 grams. Unfortunately, these may also trigger a gout flare-up.

Here are some of the main purine-rich foods, moderately high purine foods, as well as high fructose foods that you should avoid when you have gout:

  • Game meats like veal, venison, and pheasant
  • All organ meats like kidneys, liver, brain, and sweetbreads
  • Fish like mackerel, tuna, sardines, trout, herring, haddock, anchovies, and more
  • Other seafood like crab, shrimp, scallops, and roe
  • Added sugars like agave nectar, honey, and high fructose corn syrup
  • Sugary drinks like sugary sodas and even fruit juices
  • Yeasts, including brewer’s yeast, nutritional yeast, and any other yeast supplements.

You should also avoid eating too many refined carbohydrates like white bread, cookies, and cakes. Even though these foods are not high in fructose or purines, they are low in nutrients and can increase your uric acid levels. (22)

Food To Have If You Have Gout

Though a gout-friendly diet does eliminate many foods, but there are still many low-purine foods that you can continue to have when you have gout. Foods are considered to be low in purine if they contain less than 100 mg of purines per 100 grams (3.5 ounces).

Here are some low-purine foods that are considered to be safe for people who have gout. (23)

  • All types of fruits are usually considered to be fine for people with gout. Cherries are even said to help prevent flare-ups as they help reduce inflammation and lower uric acid levels in the bloodstream. (24,25)
  • All vegetables can be had, including peas, potatoes, eggplants, mushrooms, and dark leafy green vegetables.
  • All legumes can be had, including soybeans, beans, lentils, and tofu.
  • All nuts and seeds.
  • All dairy products are safe, but taking low-fat dairy products is known to be especially beneficial.
  • Whole grains like brown rice, barley, and oats.
  • Eggs
  • All herbs and spices.
  • Plant-based oils like coconut, olive, canola, and flaxseed oils.
  • Beverages like tea, coffee, and green tea.

Foods To Eat In Moderation When You Have Gout

Apart from game meats, organ meats, and some types of fish, you can consume most meats, but in moderation. You should restrict yourself to 4 to 6 ounces (115-117 grams) of these a couple of times in a week.

These foods contain a moderate amount of purines, which is said to be between 100 to 200 mg per 100 grams. However, due to this, consuming too much of these may also trigger a gout attack.

  • These include all other meats like beef, chicken, lamb, and pork.
  • Other fish like canned or fresh salmon, which are considered to have lower levels of purines than other fish.

Other Lifestyle Changes To Make When You Have Gout

Apart from modifying your diet to restrict the consumption of high purine foods, there are many other lifestyle changes that can also help reduce the risk of gout and gout flare-ups. These include:

1. Lose Weight: If you have gout, being overweight or obese can increase the risk of having gout attacks. This happens because the extra weight can make you become more resistant to insulin, which may cause insulin resistance. In such cases, the body is no longer able to use insulin properly to remove sugar from the bloodstream. Insulin resistance can also increase the levels of uric acid in the blood. (26,27) Research has shown that losing weight can help lower the risk of insulin resistance and also reduce the levels of uric acid. (28,29) However, losing weight through crash dieting, meaning trying to lose weight by reducing your diet, cannot help. In fact, rapid weight loss can further increase the risk of gout flare-ups. (30,31)

2. Exercise Regularly: Regular exercising can help prevent gout flare-ups. Exercise will also help you maintain a healthy weight while keeping your uric acid levels down. (32) A study found that amongst 228 men, the participants who ran more than eight kilometers (5 miles) daily had a 50% lesser risk of gout. This was also found to be partly because of being able to maintain your weight. (33)

3. Stay Well Hydrated: Staying hydrated can also reduce the risk of gout flare-ups. This is because consuming adequate water helps the body get rid of the excess uric acid from the blood as the body flushes it out with your urine. (34,35) Furthermore, if you exercise a lot, it is all the more important to remain hydrated since you will end up losing a lot of water through sweat.

4. Take a vitamin C Supplement: Research has found that taking a supplement of vitamin C can help prevent gout flare-ups as it helps decrease the levels of uric acid. (36,37,38) Vitamin C helps lower uric acid levels by helping the kidneys get rid of more uric acid through the urine. (39) However, one study has also found that taking vitamin C supplements does not have any effect on gout. (40) Research on this field is still new, so more research is still needed before any confirmed conclusion can be made.

5. Restrict Your Intake Of Alcohol: Alcohol is a well-known trigger for gout flare-ups. (41) This is because the body starts to prioritize the removal of alcohol over the removal of uric acid. This allows uric acid to buildup and form crystals. A study on 724 participants found that drinking beer, wine, or liquor significantly increased the risk of gout flare-ups. Taking one to two drinks a day increased this risk by 36 percent, while two to our drinks a day increased the risk by 51%. (42)

Conclusion

Gout is a form of painful arthritis that can cause swelling, inflammation of the joints, and sudden and intense pain. However, following a gout-friendly diet can help alleviate the symptoms of this condition. A gout-friendly diet focuses on the intake of low purine foods. At the same time, you need to restrict the consumption of high-purine foods. Beverages and foods that are known triggers for gout flare-ups include game meats, organ meats, certain types of fish, sugary sodas, fruit juices, and alcohol.

At the same time, vegetables, fruits, soy products, whole grains, and low-fat dairy products can all help prevent gout flare-ups by reducing the levels of uric acid in the blood.

Along with a gout-friendly diet, you should also make certain healthy lifestyle changes that can further help prevent gout flare-ups, including regular exercise, maintaining a healthy weight, drinking less alcohol, staying well hydrated, and taking vitamin C supplements after consulting your doctor.

References:

  1. Zhu, Y., Pandya, B.J. and Choi, H.K., 2011. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis & Rheumatism, 63(10), pp.3136-3141.
  2. Terkeltaub, R.A., 2003. Gout. New England Journal of Medicine, 349(17), pp.1647-1655.
  3. Emmerson, B.T., 1996. The management of gout. New England Journal of Medicine, 334(7), pp.445-451.
  4. Schlesinger, N., 2010. Diagnosing and treating gout: a review to aid primary care physicians. Postgraduate medicine, 122(2), pp.157-161.
  5. Roddy, E., 2011. Revisiting the pathogenesis of podagra: why does gout target the foot?. Journal of foot and ankle research, 4(1), pp.1-7
  6. Choi, H.K., Mount, D.B. and Reginato, A.M., 2005. Pathogenesis of gout. Annals of internal medicine, 143(7), pp.499-516.
  7. Eggebeen, A.T., 2007. Gout: an update. American family physician, 76(6), pp.801-808.
  8. Becker, M.A., Meyer, L.J. and Seegmiller, J.E., 1973. Gout with purine overproduction due to increased phosphoribosylpyrophosphate synthetase activity. The American journal of medicine, 55(2), pp.232-242.
  9. Topics, H., 2021. Gout. [online] National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: <https://www.niams.nih.gov/health_info/gout/> [Accessed 29 April 2021].
  10. Yang, Q., Guo, C.Y., Cupples, L.A., Levy, D., Wilson, P.W. and Fox, C.S., 2005. Genome-wide search for genes affecting serum uric acid levels: the Framingham Heart Study. Metabolism, 54(11), pp.1435-1441.
  11. Chen, L.X. and Schumacher, H.R., 2008. Gout: an evidence-based review. JCR: Journal of Clinical Rheumatology, 14(5S), pp.S55-S62.
  12. So, A. and Thorens, B., 2010. Uric acid transport and disease. The Journal of clinical investigation, 120(6), pp.1791-1799.
  13. Zhang, Y., Chen, C., Choi, H., Chaisson, C., Hunter, D., Niu, J. and Neogi, T., 2012. Purine-rich foods intake and recurrent gout attacks. Annals of the rheumatic diseases, 71(9), pp.1448-1453.
  14. Shulten, P., Thomas, J., Miller, M., Smith, M. and Ahern, M., 2009. The role of diet in the management of gout: a comparison of knowledge and attitudes to current evidence. Journal of Human Nutrition and Dietetics, 22(1), pp.3-11.
  15. Singh, J.A., Reddy, S.G. and Kundukulam, J., 2011. Risk factors for gout and prevention: a systematic review of the literature. Current opinion in rheumatology, 23(2), p.192.
  16. Choi, H.K., Atkinson, K., Karlson, E.W., Willett, W. and Curhan, G., 2004. Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine, 350(11), pp.1093-1103.
  17. Choi, H.K. and Curhan, G., 2008. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. Bmj, 336(7639), pp.309-312.
  18. Fox, I.H. and Kelley, W.N., 1972. Studies on the mechanism of fructose-induced hyperuricemia in man. Metabolism, 21(8), pp.713-721.
  19. Jamnik, J., Rehman, S., Mejia, S.B., de Souza, R.J., Khan, T.A., Leiter, L.A., Wolever, T.M., Kendall, C.W., Jenkins, D.J. and Sievenpiper, J.L., 2016. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ open, 6(10).
  20. Garrel, D.R., Verdy, M., PetitClerc, C., Martin, C., Brule, D. and Hamet, P., 1991. Milk-and soy-protein ingestion: acute effect on serum uric acid concentration. The American journal of clinical nutrition, 53(3), pp.665-669.
  21. Kaneko, K., Aoyagi, Y., Fukuuchi, T., Inazawa, K. and Yamaoka, N., 2014. Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biological and Pharmaceutical Bulletin, pp.b13-00967.
  22. Juraschek, S.P., McAdams‐Demarco, M., Gelber, A.C., Sacks, F.M., Appel, L.J., White, K.J. and Miller III, E.R., 2016. Effects of lowering glycemic index of dietary carbohydrate on plasma uric acid levels: the omnicarb randomized clinical trial. Arthritis & Rheumatology, 68(5), pp.1281-1289.
  23. Mayor, S., 2017. Diet high in vegetables, fruit, and whole grains may reduce risk of gout. BMJ: British Medical Journal (Online), 357.
  24. Jacob, R.A., Spinozzi, G.M., Simon, V.A., Kelley, D.S., Prior, R.L., Hess-Pierce, B. and Kader, A.A., 2003. Consumption of cherries lowers plasma urate in healthy women. The Journal of nutrition, 133(6), pp.1826-1829.
  25. Zhang, Y., Neogi, T., Chen, C., Chaisson, C., Hunter, D.J. and Choi, H.K., 2012. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis & Rheumatism, 64(12), pp.4004-4011.
  26. Fam, A.G., 2002. Gout, diet, and the insulin resistance syndrome. The Journal of rheumatology, 29(7), pp.1350-1355.
  27. Barskova, V.G., Eliseev, M.S., Nasonov, E.L., Iakunina, I.A., Zilov, A.V. and Il’inykh, E.V., 2004. Insulin resistance syndrome in patients with gout and its influence on formation of clinical characteristics of the disease. Terapevticheskii arkhiv, 76(5), pp.51-56.
  28. Dessein, P.H., Shipton, E.A., Stanwix, A.E., Joffe, B.I. and Ramokgadi, J., 2000. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Annals of the rheumatic diseases, 59(7), pp.539-543.
  29. Scott, J.T. and Sturge, R.A., 1977. The effect of weight loss on plasma and urinary uric acid and lipid levels. In Purine Metabolism in Man—II (pp. 274-277). Springer, Boston, MA.
  30. Pi-Sunyer, F.X., 1993. Short-term medical benefits and adverse effects of weight loss. Annals of internal medicine, 119(7_Part_2), pp.722-726.
  31. Pahl, M.V., Vaziri, N.D., Akbarpour, F., Afrasiabi, A. and Friis, R., 1988. Effect of rapid weight loss with supplemented fasting on serum electrolytes, lipids, and blood pressure. Journal of the national medical association, 80(7), p.803.
  32. Huang, L.L., Huang, C.T., Chen, M.L. and Mao, I.F., 2010. Effects of profuse sweating induced by exercise on urinary uric acid excretion in a hot environment. Chin J Physiol, 53(4), pp.254-261.
  33. Williams, P.T., 2008. Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. The American journal of clinical nutrition, 87(5), pp.1480-1487.
  34. Marangella, M., 2005. Uric acid elimination in the urine. Hyperuricemic syndromes: pathophysiology and therapy, 147, pp.132-148.
  35. Ferrari, P. and Bonny, O., 2004. Diagnosis and prevention of uric acid stones. Therapeutische Umschau. Revue therapeutique, 61(9), pp.571-574.
  36. Choi, H.K., Gao, X. and Curhan, G., 2009. Vitamin C intake and the risk of gout in men: a prospective study. Archives of internal medicine, 169(5), pp.502-507.
  37. Gao, X., Curhan, G., Forman, J.P., Ascherio, A. and Choi, H.K., 2008. Vitamin C intake and serum uric acid concentration in men. The Journal of rheumatology, 35(9), pp.1853-1858.
  38. Juraschek, S.P., Miller III, E.R. and Gelber, A.C., 2011. Effect of oral vitamin C supplementation on serum uric acid: a meta‐analysis of randomized controlled trials. Arthritis care & research, 63(9), pp.1295-1306.
  39. Shen, L. and Ji, H.F., 2011. Potential of vitamin C in the prevention and treatment of gout. Nature Reviews Rheumatology, 7(6), pp.368-368.
  40. Stamp, L.K., O’Donnell, J.L., Frampton, C., Drake, J.M., Zhang, M. and Chapman, P.T., 2013. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial. Arthritis & Rheumatism, 65(6), pp.1636-1642.
  41. Choi, H.K., Atkinson, K., Karlson, E.W., Willett, W. and Curhan, G., 2004. Alcohol intake and risk of incident gout in men: a prospective study. The Lancet, 363(9417), pp.1277-1281.
  42. Neogi, T., Chen, C., Niu, J., Chaisson, C., Hunter, D.J. and Zhang, Y., 2014. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American journal of medicine, 127(4), pp.311-318.