Gout is one of the oldest recognized forms of arthritis, with a medical history dating back to the Middle Ages. It was originally known as “rich man’s disease” because it was associated with rich foods and alcohol that were generally unavailable to the lower classes.
Today it affects people of all socioeconomic statuses. The types of foods you eat can have a direct impact on gout symptoms and severity. More specifically, foods high in purines tend to result in more symptom flare-ups.
Among people with gout, acute purine intake increased the risk of recurrent gout attacks by nearly fivefold, according to a 2014 study.
What Is Gout?
Gout is a form of inflammatory arthritis that normally affects one joint at a time, commonly the big toe joint. It occurs when there is too much uric acid in the blood, causing a buildup of uric acid crystals in joints, fluids and tissues throughout the body—often causing severe swelling, redness, and pain.
What Are Purines?
Purines are chemical compounds found naturally in foods, as well as in your body. Natural purines in your body are called endogenous purines, whereas purines found in foods you eat are called exogenous purines. Exogenous purines are broken down in the body by the digestive system.
Uric acid is created as a byproduct when either exogenous and endogenous purines are processed by the body. The majority of uric acid is reabsorbed by the body, with the remainder being excreted in the urine and feces.
If the amount of purines in the body is more than it can process, uric acid builds up in the blood, called hyperuricemia. Hyperuricemia results in a buildup of uric acid crystals in the body, often leading to kidney stones or gout, but some people have no signs or symptoms at all.
It’s recommended that people with hyperuricemia or gout avoid or limit eating foods that are high in purines to help reduce the purine load in the body. Foods high in purines include some sugary foods, red meats, organ meats, seafood, yeasts, and alcoholic beverages.
Sugar seems to increase uric acid levels. Fructose is a natural form of sugar found in some foods. Fructose, as well as the high fructose corn syrup added to some foods, can increase serum uric acid levels. Avoiding or limiting foods high in these sugars may help lessen the symptoms of gout.
Some fruits are naturally high in fructose, though the association between fruit and gout is unclear. If you have gout, you don’t have to avoid all fruit. However, some fruit juices may need to be avoided or limited.
Be sure to consume only 1 serving of fruit at a time, such as 1 small apple or orange, 4 ounces (1/2 cup) of juice, 1 ounce (a palm full) of dried fruit, or 1/2 cup of fresh fruit. Gout triggers can be individual, so pay attention to the fruits (and amounts) you eat and if they seem to set off a gout attack.
Sugar-sweetened beverages can increase uric acid levels in the blood. A 2020 review of studies found that consumption of sugar-sweetened beverages was significantly associated with an increased risk of gout and hyperuricemia in adults. Avoid sugar-sweetened beverages, such as soft drinks or soda, energy drinks, and sports drinks.
Sodas and Sugary Drinks
Sodas and sugary drinks are considered empty-calorie foods because they contain no beneficial nutrients while contributing a lot of calories to your diet.
For example, a 12 ounce can of cola contains about 150 calories and 40 grams, or about 9.5 teaspoons, of added sugars. In addition, sugar-sweetened beverages have been associated with increased risk of heart disease, type 2 diabetes, weight gain, and dental caries.
Processed Foods and Refined Carbs
The modern Western diet is often high in processed foods and refined carbohydrates. Additionally, processed foods and refined carbohydrates have been linked to an increased risk of type 2 diabetes, heart disease, and weight gain.
A 2017 study looked at gout incidence in people who followed either a Western diet, or the Dietary Approaches to Stop Hypertension (DASH) diet. The researcher found that the DASH diet was associated with a lower risk of gout, whereas the Western diet was associated with a higher risk of gout.
To help prevent gout symptoms, it’s best to limit highly processed foods and beverages and foods high in refined carbohydrates, such as sweets, baked goods and pastries, chips, crackers, cookies, candies, soda, ice cream, white breads, and some pre-made frozen meals.
Eating highly processed foods and refined carbohydrates in moderation will not only help with your gout, but your overall health, as well.
Red Meat and Organ Meat
Red meat and organ meats are high in purines. Eating these foods increases the uric acid levels in the blood and the risk of gout and gout attacks.
Keep your red meat (including beef, venison, bison) and organ meats (including liver, heart, sweetbreads, tongue, and kidney) intake low. Chicken has moderate amounts of purines, and therefore should be eaten in moderation.
Protein is important for the body, and though you may need to limit protein from some animal sources, you can still get protein from other sources. Low-fat dairy seems to decrease the risk of gout and is a good source of protein in the diet. Other protein foods you can eat include eggs, nuts and nut butters, beans ,and tofu.
Meats to avoid:
- Beef, porkm and chicken livers
- Other organ meats, such as kidney or heart
- Wild game
Meats to limit:
- Red meat (beef, pork, lamb)
- Meat-based soups and gravies
- Processed meats, such as salami and prosciutto
Fish and Seafood
Certain types of seafood are high in purines, and therefore should be avoided on a gout-friendly diet. Other seafood are moderate in purines and should be limited to 1 to 2 servings (2 to 3 ounce) servings daily.
Fatty fish, such as tuna and salmon, are generally considered a healthy, nutritious addition to the diet, mostly due to the heart-healthy omega-3 fatty acids in them. However, due to their higher purine content, it is currently recommended to limit these foods with gout.
With that said, a 2019 study found that eating fish high in omega-3 fatty acids was associated with lower risk of recurrent gout flares, however supplemental omega-3 fatty acids were not. More research is needed to clarify these effects.
Seafood to avoid:
- Jack mackerel
Seafood to limit:
Beer and Liquor
Alcohol consumption has long been associated with gout, thus it has been recommended to avoid alcohol with gout. In particular beer, hard liquor and other grain alcohols.
Frequent alcohol intake is known to cause chronic hyperuricemia, increasing the risk of gout and gout attacks. Because of this, it is recommended to avoid some alcohol, such as beer, altogether and others, like wine, only in moderation.
Alcohol to avoid:
- Hard liquor
- Other grain alcohols
Alcohol to limit:
Gout and Wine
Though it was previously thought to avoid all types of alcohol with gout, recent research has shown that wine, in moderation, may not contribute to increased risk of gout.
A study looking at the effect of wine on gout found that wine, when consumed with meals and in moderation, did not cause chronic hyperuricemia. Moderate wine consumption is considered 1 (5-ounce) drink per day for women and 2 drinks per day for men.
Certain yeasts and yeast extracts are high in purines and should be avoided with gout. Supplements and foods with these should be avoided to keep uric acid levels down. Yeast extract can sometimes be found in foods, such as some soy sauces, canned soups and stews, frozen dinners, and salty snacks.
High Purine Vegetables Are OK
Some vegetables and plant foods, such as peas, beans, lentils, spinach, mushrooms, oats, and cauliflower, are high in purines. However, several studies have shown that they do not increase the risk of gout.
In fact, the opposite seems to be true, with a vegetable-rich diet being associated with a lower risk of gout compared with the lower consumption of vegetables. Therefore, you do not need to limit or avoid any vegetables on a gout-friendly diet.
Besides reducing gout symptom flare-ups, following a gout-friendly diet may have other health benefits, as well. Following a diet with less processed foods, sugar and alcohol, and rich in vegetables, whole grains and other plant-based foods may help you reach and/or maintain a healthy weight.
Research published in Annals of the Rheumatic Diseases suggested that a higher body mass index was a risk factor for gout and people who were overweight and obese were at significantly higher risk of incident gout. Additionally, people with diabetes and/or high cholesterol were at higher risk of incident gout and of gout flares in those with prevalent gout.
Being at a healthy weight may also be less taxing on your joints, therefore slowing the progression of joint damage. If you desire to lose weight, a slow and steady approach is best for your health, as you’ll be more likely to maintain this healthy lifestyle change over the long run.
A Word From Verywell
Following a gout-friendly diet may seem difficult or unrealistic to some people, especially if the foods to avoid are ones you frequently consume. Work with your healthcare providers, and start by making small changes to help you to feel more empowered.
Remember that gout triggers can be individual and what causes a flare-up for one person may not make noticeable difference to another. Have patience and keep your long-term goal of living a healthy life free of gout symptoms in mind.