What foods should I avoid if I have gout?

High-Purine Foods: 4 Foods to Avoid Eating with Gout

If you have gout, a common and painful form of arthritis, there’s a good chance you’ve been told to avoid eating purines in your diet. But what exactly are purines — and does avoiding them actually help manage gout symptoms?

What Causes Gout?

To understand how purines can impact a person with gout, it first helps to understand how gout occurs. Gout develops when uric acid builds up in your body. “Excess levels of uric acid, or hyperuricemia, appear to be the main cause of gout,” says Sophia Kamveris, MS, RD, LDN, a Boston-based nutritionist and author of the 28-Day Gout Diet Plan.

Typically uric acid dissolves in your blood, your kidneys filter it out and then flush it from the body through the urine. When this process doesn’t work, that extra uric acid can accumulate in joints to form sharp crystals, which can create extreme discomfort in the joints and also cause kidney stones.

How Do Purines Play a Role in Gout?

Purines are compounds found in certain foods. When you eat foods that contain purines, your body breaks them down into uric acid. So it makes sense that a low-purine diet has long been recommended as a defense against gout attacks.

Uric acid that comes from high-purine foods, however, only makes up about 15 percent of the uric acid in your body. The rest is found naturally in your body’s tissues, and your genes play a big role in determining how much uric acid your body creates. It’s extremely unlikely, say experts, to manage gout strictly through diet changes — that’s why medication is crucial.

What you eat, however, can often help tip the odds in your favor.

“When a patient has a good diet it can definitely help decrease their risk for gout flares, ”says Randall N. Beyl Jr., MD, a rheumatologist in Albertville, Alabama. And while researchers continue to explore the best diet for those with gout, purines remain of interest.

People with gout who ate a high-purine diet were about five times as likely to have a gout attack as people who ate the lowest-purine diet, according to a study of more than 600 people with gout from Boston University published in the journal Annals of the Rheumatic Disease. Purine intake was linked with more gout attacks regardless of people’s alcohol intake or which medications they took.

If your doctor recommends you follow a low-purine diet to help manage your gout, these are some of the high-purine foods you should stay away from.

High-Purine Foods to Avoid with Gout

1. Liver

If you have gout, dishes like chopped liver and liver and onions are best avoiding, along with other organ meats like kidney, heart, sweetbread, and tripe, since they’re high in purines.

Instead: Other meats like poultry and beef contain fewer purines, so you can safely eat them in moderation. You can also try a vegetarian pate recipe made from mushrooms and walnuts that simulates the flavor of liver but is made with with ingredients that don’t seem to aggravate gout symptoms in the same way.

2. Soft Drinks

The sugar fructose in soft drinks is not high in purines itself; however your body breaks it down to form purines. Drinking sodas made with high-fructose corn syrup has been linked with an increased risk of gout; men who drank two or more servings of sodas per day had an 85 percent higher risk of gout than those who had less than one per month in a study from the journal BMJ.

Instead: Diet sodas do not seem to be connected with gout in the same way and can help you transition off the sugary stuff. It’s not a good idea for your health generally to drink diet soda in abundance either. Try water flavored with lemon and lime slices, or unsweetened seltzer in yummy flavors like passion fruit and vanilla.

3. Seafood

Certain types of seafood — anchovies, mussels, crab, shrimp, sardines, herring, trout, mackerel, and more — have moderate to high levels of purines. Men who ate the most seafood were more than 50 percent more likely to have high levels of uric acid compared with those who ate the least, in a study from Vanderbilt University Medical Center in Nashville.

Instead: Since fish is a heart-healthy food, it makes sense to keep it in your diet. One option is to try fish like sole and cod that are lower in purines. You can also experiment with smaller servings of higher-purine fish — around the size of your palm — balanced out with a big serving of vegetables like sautéed zucchini or broccoli and a generous squeeze of lemon, since lemon juice may help to neutralize uric acid.

4. Alcohol

Beer in particular gets a bad rap when it comes to gout attacks; unfortunately, it seems any type of alcoholic beverage is high in purines and may be just as risky. Consuming wine, beer, or liquor was each linked with increased risk of a gout attack, according to a 2014 study from Boston University School of Medicine. The more alcohol a person drank, the greater their risk, found the researchers.

Instead: The truth is that no alcohol is your best bet for preventing gout attacks. But since quantity does count, less alcohol is more. If you enjoy drinking alcohol, try capping it at no more than one (women) to two (men) servings per day.

Keep Reading

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  • This Study Shows Why Lowering Your Uric Acid Levels If You Have Gout Could Save Your Life
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Lifestyle changes to reduce the risk of gout attacks

Lifestyle measures, such as dietary changes, can help lower levels of uric acid, the chemical that deposits in joints and causes gout. However, for most people, changes in diet alone are not enough to prevent gout. To reduce uric acid levels enough to stop attacks, medication is usually needed. Still making changes in what you eat can lead to fewer gouty flares.

In the past, doctors often handed their patients a list of foods high in purines and instructed them not to eat those foods. By itself, that hasn’t been shown to be particularly helpful.

More recently, experts have begun thinking about diet differently. Instead of trying to figure out which individual foods you should avoid, the focus is on following a healthy diet and trying to lose weight if you’re overweight or obese. Just losing weight can lower uric acid levels. Drinking plenty of fluids is also helpful. But limit sweetened drinks and alcohol, which can increase uric acid levels.

In general, a healthy diet emphasizes plant-based foods, such as vegetables, fruits, and legumes. Whole grains are preferred over processed grains. Intake of fat, especially saturated fat (found in red meat), should be reduced. Lean sources of protein, including chicken, turkey, fish, and tofu, are better choices than beef or pork.

Fish, which contains omega-3 fatty acids, is part of a healthy diet. But some seafood also contains high amounts of purines. People with gout don’t have to steer completely clear of fish. But try to limit the amount of shellfish, sardines, and anchovies you eat, because they have the highest amounts of purines. A better choice is flaky white fish, such as cod, tilapia, or flounder.

One pattern of healthy eating is the DASH (Dietary Approaches to Stop Hypertension) diet. A study published in Arthritis & Rheumatology in 2016 found that people who followed the DASH diet for 30 days lowered their uric acid levels 0.35 mg/dL on average. The higher the starting uric acid level, the greater the decline.

There are a few foods people with gout should limit as much as possible or avoid entirely. And some foods may be beneficial. For example, multiple studies have found lower uric acid levels among people who consume low-fat dairy products. So these products, which contain calcium, may help lessen gout attacks as well as protect your bones.

Studies have found that vitamin C may lower uric acid levels. People with gout may be helped by adding citrus fruits and other foods rich in vitamin C (such as strawberries and peppers) to their diet. Some evidence suggests that eating cherries can reduce gout attacks and improve pain. These findings are not conclusive, but there’s no harm in adding cherries to your diet.

Remember: You aren’t to blame for gout because you overdid the steak and lobster dinners or drank too much alcohol. Gout is a chronic form of arthritis caused by the effects of too much uric acid in the bloodstream. Certain factors can raise your risk of gout and contribute to triggering gout attacks. These include certain foods and alcohol. But just eliminating purine-rich foods and alcohol is not enough for most people with gout to prevent attacks. Medications are used to treat an acute attack, and you can take other medications over the long term to prevent further attacks. When it comes to diet, focus on an overall healthy eating pattern, plenty of fluids, and losing excess weight.

To learn more about the causes of gout and ways to prevent it, read All About Gout, and online guide from Harvard Medical School.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Diet and Gout

Topic Overview

Purines (specific chemical compounds found in some foods) are broken down into uric acid. A diet rich in purines from certain sources can raise uric acid levels in the body, which sometimes leads to gout. Meat and seafood may increase your risk of gout. Dairy products may lower your risk.

Foods to limit (very high in purines):

  • Organ meats, such as liver, kidneys, sweetbreads, and brains
  • Meats, including bacon, beef, pork, and lamb
  • Game meats
  • Any other meats in large amounts
  • Anchovies, sardines, herring, mackerel, and scallops
  • Gravy
  • Beer

Foods to eat occasionally (moderately high in purines, but may not raise your risk of gout):

  • Fish and seafood (other than high purine seafood)
  • Oatmeal, wheat bran, and wheat germ

Foods that are safe to eat (low in purines):

  • Green vegetables and tomatoes
  • Fruits
  • Breads and cereals that are not whole-grain
  • Butter, buttermilk, cheese, and eggs
  • Chocolate and cocoa
  • Coffee, tea, and carbonated beverages
  • Peanut butter and nuts

Dairy products that may lower your risk of gout:

  • Low-fat or nonfat milk
  • Low-fat yogurt

If you have experienced a gout attack or have high uric acid in your blood (hyperuricemia), it may help to reduce your intake of meat, seafood, and alcohol.footnote 1

Changing your diet may help lower your risk of having future attacks of gout. Doctors recommend that overweight people who have gout reach and stay at a healthy body weight by getting moderate exercise daily and regulating their fat and caloric intake.

Gout and diet

How is gout affected by diet?

Gout is a type of arthritis that is associated with elevated levels of uric acid in the blood. High levels of uric acid can cause crystals to form in the joints, causing pain and swelling. Uric acid is a normal waste product formed from the breakdown of food, particularly compounds called purines. It is believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks.

A healthy, balanced diet may help reduce the risk of gout attacks.

Can losing weight help gout?

If you are overweight, gradual weight loss can help lower uric acid levels and reduce the risk of gout attacks. However, it is important to avoid fasting or ‘crash’ dieting, where you go without adequate food for long periods and lose weight rapidly. This type of dieting can actually increase uric acid levels and trigger a gout attack. A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely. Talk to your doctor or see a dietitian for advice.

Do certain foods cause gout?

There are many misconceptions about diet and gout. For example it is commonly thought that foods such as citrus foods cause gout. There is no evidence that this is true. However several studies have shown that people with gout are more likely to eat certain foods. These foods tend to contain high levels of purines, a substance that can be made into uric acid in the body. Purine-rich foods include:

  • meat – particularly red meat and offal, such as liver, kidneys and heart
  • seafood – particularly shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
  • foods containing yeast – such as Vegemite and beer.

Should I cut out purine-rich foods?

There is very little scientific proof that avoiding the purine-rich foods listed above can successfully reduce gout attacks. You may miss out on important nutrients and vitamins by completely cutting these foods from your diet.

If you notice certain foods trigger your gout attacks, you may benefit from cutting down the amounts of those foods in your diet. However not all purine-rich foods are thought to cause gout. For example, a number of vegetables (asparagus, mushrooms, cauliflower and spinach) are also rich in purines but appear less likely to cause gout than diets containing meat and shellfish.

Dairy foods, which can contain purines, actually appear to lower the risk of gout. For most people with gout, a healthy balanced diet is all that is needed, alongside medicines to reduce uric acid levels. Most people taking medicines to reduce uric acid levels find they can still eat purine-rich foods without attacks of gout by being careful with the quantity they eat.

Does fructose cause gout?

Fructose is a sugar that is found in fruits and vegetables. It is also found in high levels in foods sweetened with corn syrup, such as bread, cereal, soft drinks (not Australian-made soft drinks) and fruit juices. An American study found that men who drank five to six servings of fructose-sweetened soft drinks per week were more likely to have gout. However there is no research showing that fructose actually causes gout. Cutting down the amount of food artificially sweetened with high fructose corn syrup may be beneficial for your overall health. However naturally occurring fructose in fruit and vegetables also provides general health benefits and should not be completely avoided without advice from your doctor or dietitian.

Can I drink alcohol?

Drinking alcohol can increase your risk of a gout attack as it can raise the level of uric acid in your blood. While it is possible to control gout attacks without completely cutting out alcohol, try to reduce the amount of alcohol you drink and avoid binge drinking (drinking a lot of alcohol at one time). Talk to your doctor or read the Australian government guidelines on recommended alcohol intake.

Are some types of alcohol better than others?

It seems that gout attacks are more common in beer and spirits drinkers than in people who drink wine. Many beers contain large amounts of purines, which can lead to elevated uric acid levels in the blood. However, there is no scientific proof that only certain types of alcoholic drinks can lead to gout attacks.

Should I drink lots of water?

Dehydration (not drinking enough water) may be a risk factor for gout although this is not well proven in research. Drinking 1 – 1.5 litres of fluids a day is recommended for general health benefits. However if you are taking diuretics (also known as ‘water pills’ or tablets which help the body get rid of water) or have heart or kidney problems, talk to your doctor about the right amount of fluids for you to drink.

Where can I get advice about my diet?

An accredited practising dietitian (APD) can provide you with personalised advice to give you the confidence to eat in a way that is best for you. APDs are university-qualified experts in nutrition and dietetics and are committed to the Dietitians Association of Australia’s (DAA) Code of Professional Conduct, continuing professional development and providing quality services.

To learn about healthy eating, read the Australian Dietary Guidelines or visit Nutrition Australia.

CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION AND SUPPORT SERVICES.

To find a dietitian, talk to your doctor, contact the Dietitians Association of Australia on 1800 812 942 or use the ‘find a dietitian’ service at www.daa.asn.au

Broccoli for Gout

Gout is a rheumatologic disorder characterized by pain and inflammation in the joints. An attack is brought on by increased uric acid in the body which is a byproduct of purine breakdown. Following a low-purine diet may help prevent attacks or alleviate symptoms. Broccoli is classified as a food that is low in purines.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Gout

Gout is a form of arthritis that can come on suddenly in a severe, painful attack. The intense joint pain and discomfort often occurs in the big toe, but can occur in other joints as well. Gout is caused by the accumulation of urate crystals in the joint due to high uric acid levels in the blood. High blood pressure, excessive alcohol consumption and a family history of gout can increase the risk of developing gout. Chronic conditions, such as diabetes, are associated with gout, and some medications can increase uric acid levels. In general, men have higher uric acid levels than women, and levels increase in women after menopause.

Purines

When your body breaks down purines, uric acid is formed and is excreted by the kidneys. Purines occur naturally in the body as well as in some foods. Foods high in purines include:

  • organ meats
  • gravies
  • yeast
  • anchovies
  • herring
  • mackerel
  • scallops
  • alcoholic beverages

Beer is especially high in purines because of the yeast content. Legumes, mushrooms, asparagus, spinach and cauliflower contain a moderate amount of purines.

Broccoli and Gout

Broccoli is rich in vitamin C and fiber, and it is a good source of folic acid and potassium. The American Dietetic Association identifies broccoli as a functional food because it is rich in bioactive compounds, such as sulforaphane 34. The ADA classifies a functional food as one that provides additional health benefits and may reduce disease risk because of the nutrients or substances it contains. Broccoli is a smart addition to a healthy diet, and you can eat it if you have gout because it is low in purines. According to the publication “Gout” by Drs. Grahame, Simmonds and Carrey, broccoli is categorized as having a low purine level, specifically grouped with foods that contain 50 to 100 mg of purine per 100 g of the food. High-purine foods have 150 to 1,000mg purines per 100 g of the food.

General Gout Diet

The body produces purines, so altering the diet is only one part of the therapy for gout. Take any medications your doctor prescribes and try to reach a healthy weight. of meat, fish and poultry per day, and abstain form alcohol. During remission, the ADA recommends the same fluid intake, continue abstinence from alcohol and follow a well-balanced diet, avoiding high-protein diets for weight loss.

The Wrap Up

Gout is a rheumatologic disorder characterized by pain and inflammation in the joints. In general, men have higher uric acid levels than women, and levels increase in women after menopause. Broccoli is a smart addition to a healthy diet, and you can eat it if you have gout because it is low in purines. According to the publication “Gout” by Drs. Take any medications your doctor prescribes and try to reach a healthy weight.

Research has shown that losing weight and increasing water intake can help reduce gout symptoms. However, there is another way patients with gout can reduce their symptoms: avoiding certain types of foods and drinks that can trigger flares.
When dispensing gout medications such as colchicine, pharmacists can take the opportunity to educate patients about common dietary triggers of gout.
Here are a few examples of food and drinks that may worsen gout symptoms:
1. Certain meat
Meat, especially organ meat, should be avoided if possible, as it is rich in purine.
Purine compounds can raise uric acid levels, which then build up in the joints and cause painful gout symptoms.
Examples of meats that gout patients should avoid are bacon, turkey, goose, veal, venison, and organ meats such as liver, kidneys, or sweetbreads.
Meatlovers should try to stick to chicken and duck, instead. In addition, leg meat is a preferred option over breast meat with skin.
2. Certain seafood
Cutting back on seafood during a gout flare-up can be helpful. Even during remission, certain seafood intake should be limited.
Previous research has suggested that patients with gout should avoid shellfish, anchovies, sardines, herring, mussels, scallops, codfish, trout, tuna, and haddock.
Shrimp, lobster, eel, and crab are safer seafood choices for patients with gout.
3. Vegetables and fungi high in purines
Asparagus, cauliflower, spinach, and mushrooms are high in purines, so patients with gout should not consume large amounts of these foods.
However, patients tend to be able to excrete purines from vegetables better than they do from meat, so consumption of these vegetables and fungi does not have to be as limited as meat intake.
4. Alcohol
In terms of drinks, alcohol is known to be high in purine, so experts recommend that gout patients avoid all types of alcoholic beverages.
Nevertheless, beer is specifically cited as an alcohol to avoid because it increases patients’ uric acid levels and reduces the body’s ability to clear the substance from its system.
If a patient must consume alcohol, then the best option is wine, according to clinical guidelines. Abstaining from alcohol entirely is advised during gout flare-ups.
Other drinks like sugary sodas and fruit drinks should also be avoided because the body reacts to these beverages by stimulating uric acid production.
What Gout Patients Should Eat and Drink:
Low-fat dairy foods, complex carbohydrates, coffee, and fruits (especially citrus) are more healthful alternatives for patients with gout.
In addition, drinking plenty of fluids from a variety of sources such as water, non-sweetened juice, tea, and coffee is beneficial.
The Mayo Clinic provided this example of a good diet for a patient with gout:
Breakfast
– Whole-grain, unsweetened cereal with skim or low-fat milk
– 1 cup fresh strawberries
– Coffee
– Water
Lunch
– 2 ounces of roasted chicken breast slices on a whole-grain roll with mustard
– Mixed green salad with balsamic vinegar and olive oil dressing
– Skim or low-fat milk
– Water
Afternoon snack
– 1 cup fresh cherries
– Water
Dinner
– 3 to 4 ounces of roasted salmon
– Roasted or steamed green beans
– ½ cup whole grain pasta with olive oil and lemon pepper
– Water
– Low-fat yogurt
– 1 cup fresh melon
– Caffeine-free beverage, such as herbal tea

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