Gout is the most common and the most painful form of inflammatory arthritis. The root cause of gout is elevated levels of uric acid that the body produces. Excess uric acid in the blood, and the buildup of uric acid crystals, can lead to an increased risk for gout attacks.
There are many things that can lead to increased levels of uric acid.
While dietary and lifestyle changes are often recommended for a person managing gout, they can only reduce the extra uric acid production by so much.
In fact, dietary changes alone have been shown to reduce high uric acid levels by only 1.0 to 2.0 mg/dL, so even a low purine diet is not enough to decrease the risk of gout flares or avoid use of daily serum uric acid (sUA)-lowering medications.
That said, anyone with gout symptoms should seek professional medical advice for lifestyle and diet changes to improve their overall health.
For example, people with gout may be encouraged to follow a healthy, balanced and anti inflammatory diet. They may be asked to limit consumption of foods that are high in purines.
What Are Purines?
Purines are common chemical compounds, produced naturally and made up of nitrogen and carbon and are essential to all life forms.
There are two purine types: Exogenous purines, which are absorbed by the body through foods you eat, and endogenous purines, which are made directly by the body itself.
Purines break down to become uric acid in the liver and digestive system. Uric acid, at normal concentrations, dissolves in the blood and passes through the kidneys, where it is eventually eliminated through urine. A portion of uric acid is also eliminated through the bowels.
When the body’s ability does not allow for uric acid to be properly eliminated and it accumulates, uric acid levels can rise, leading to a point where it no longer dissolves in the blood. This elevated uric acid, or hyperuricemia, leads to gout and other health conditions such as kidney stones and chronic kidney disease.
High Purine Foods to Avoid with Gout
Anyone who has gout should avoid ingesting large amounts of purine-containing food, at least until their condition has been well-controlled on the proper treatments. Because of this, a reduced or low purine diet is recommended, otherwise the food you eat may raise uric acid levels.
The following high purine food options are recommended only in moderate consumption. This will help lower uric acid levels for a decreased risk of recurrent gout attacks.
High purine foods:
- Certain meats (red meat, lamb, pork and organ meats)
- Certain seafood (shellfish, shrimp, lobster, sardines)
- Alcoholic beverages (especially beer and grain alcohol)
- High fructose corn syrup and sugary foods (Sweet fruit juices, sugary cereals, store-bought baked goods, soft drinks and ice cream and candy)
- Processed foods
Foods to Eat on a Low Purine Diet
How much purine consumption is too much? A lot depends on how much uric acid is in your blood, as too much uric acid is what leads to a gout attack.
Those who are overweight are at higher risk for gout and should work with their doctor to lose weight through dietary and lifestyle changes.
Ideal Diet Options for Gout
There is no such thing as a “gout diet,” but there are healthy recommendationsfor a low purine diet, such as minimizing high fructose corn syrup and limiting alcohol consumption (especially beer).
A diet with only moderate consumption of purine-containing foods is an important consideration.
If you have gout, following a low purine diet and eating certain foods and beverages (while being sure to avoid alcohol, particularly beer) can help you reduce the level of uric acid and reduce the frequency of gout attacks:
- Lean proteins (fish, chicken and other foods are fine in moderation—e.g., 4 to 6 oz. per day)
- Low-fat and nondairy products (e.g., low fat milk when dairy is consumed)
- Fresh fruits/whole fruits (especially those high in vitamin C; cherry consumption will not hurt, but it is a myth that drinking cherry juice can lower uric acid enough to make a difference)
- Vegetables
- Nuts, nut butter and healthy grains
Gout-Friendly Diet Recommendations to Follow
While again, there is no such thing as a “gout diet,” there are certain moderate purine foods a part of a reduced or low purine diet that are a part of recommendations that many experts and academic research institutions recommend to reduce gout symptoms or gout attacks.
The DASH Diet
The DASH diet is short for “Dietary Approaches to Stop Hypertension.” It is a diet that is not high in purines. The focus of this plan is to eat food that helps to lower blood pressure, such as those low in sodium and saturated fat.
It’s also important to focus on foods and beverages rich in magnesium, potassium and calcium.
The typical American diet can include up to 3,400 milligrams of sodium per day or more. The DASH diet limits sodium to around 2,300 milligrams per day, about the amount in one teaspoon of salt. A lower sodium version restricts it to only 1,500 mg per day.
What’s in the DASH Diet?
While limiting fatty meats and full-fat dairy products in order to limit saturated fat, the DASH diet includes the following foods:
- Vegetables
- Fruits
- Whole grains
- Fat-free or low-fat dairy products
- Fish
- Poultry
- Beans and Nuts
To further limit sodium, consider:
- Using sodium-free seasonings
- Choosing low- or no-salt-added options
- Choosing plain fresh, frozen or low-sodium canned vegetables
- Choosing fresh or frozen skinless poultry, fish and lean cuts of meat
- Not adding salt when cooking rice, pasta or hot cereal
The Mediterranean Diet
The Mediterranean diet is similar to the DASH diet, relying on fruits, vegetables, whole grains and heart-healthy fats. This is a low purine diet option.
It is based on the traditional food that people from France, Spain, Greece and Italy. This diet can lower the risk of several chronic conditions.
Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, herbs, spices, fish, seafood and extra virgin olive oil are encouraged as part of the Mediterranean diet.
Poultry, eggs, cheese and yogurt should be eaten in moderation. Red meat, sugar-sweetened beverages, processed meat, refined grains, refined oils and other highly processed foods should be eaten rarely as part of the Mediterranean Diet.
A Plant-Based Diet
It’s been said that a plant and grain-based diet, also low in purines, is good for overall health.
This includes cardiovascular health; improvements to the gastrointestinal system; reduction of risks connected to obesity and gout (e.g., diabetes and kidney disease or kidney stones, which occur when there are issues with how the kidneys filter uric acid).
A plant-based diet that is low in purines helps to reduce gout flares, too!
Other Steps to Control Gout
Those who have gout should make other lifestyle changes in order to avoid future flares and other health conditions, such as diabetes, kidney stones/kidney failure, heart attack/stroke, and more.
Anyone suffering with the disease should schedule regular appointments with their rheumatologist or gout specialist, and get their uric acid checked every six months. Levels for someone with gout should be below 6.0 mg/dL, or even lower, depending on symptoms and flares.
Your doctor will work with you to collect personal data and information to determine the best possible treatment regimen. While the body breaks down uric acid on its own, most of the time, daily uric acid-lowering medications are needed to control gout and will most likely be needed to be taken for life.
If you have gout, the following lifestyle changes may be recommended:
- Exercise regularly: Adults should engage in moderate-intensity physical activities for at least 30 minutes most days of the week, according to the Centers for Disease Control and Prevention. This could include walking briskly or swimming laps, mowing the lawn, dancing, or more. Always check with your physician before starting any new or vigorous exercise programs.
- Maintain a healthy body weight: An obese person is three times more likely to develop gout than someone with a normal body weight.
- Avoid crash diets: Fast or extreme weight loss can increase the amount of uric acid in the body. High-proteins diets that contain high purine foods may also be a problem.
- Stay hydrated: Many dieticians recommend consuming at least 64 ounces of water daily, or more if you are exercising regularly. Water helps the body transport nutrients and waste; regulates body temperature; and cushions joints and tissues. Research also suggests that drinking enough water may guard against kidney stones and constipation.
- Take vitamins: Risk appears to be lower for those who take daily vitamins. Vitamin C may be a useful supplement in the 500 to 1,000 mg per day range.
- Keep track of healthy benchmarks: In addition to knowing your uric acid level, aiming for below 6.0 mg/dL, you should also keep track of other healthy benchmarks, such as LDL (bad) cholesterol; HDL (good) cholesterol; blood sugar; blood pressure; and heart rate.
Key Takeaway
When it comes to managing gout, controlling purines, and making other dietary and lifestyle changes are important—but they aren’t everything. Talk to your doctor about the best treatment plan for you.
Want to learn more about purines and what to eat when you have gout? For trustworthy health information and resources, including fact sheets that address myths about diet, visit gouteducation.org.
Note: The Gout Education Society has strict sourcing guidelines and links to reputable sites with unbiased information and resources.
