AUTHORITY NUTRITION

Best Diet for Gout: What to Eat, What to Avoid

Written by Ryan Raman, MS, RD on September 26, 2017

Gout is a type of arthritis, an inflammatory condition of the joints. It affects an estimated 8.3 million people in the US alone (1).

People with gout experience sudden and severe attacks of pain, swelling and inflammation of the joints (2).

Fortunately, gout can be controlled with medications, a gout-friendly diet and lifestyle changes.

This article reviews the best diet for gout and what foods to avoid, backed by research.

Oats, Almonds and Berries

Gout is a type of arthritis that involves sudden pain, swelling and inflammation of the joints.

Nearly half of gout cases affect the big toes, while other cases affect the fingers, wrists, knees and heels (3, 4, 5).

Gout symptoms or "attacks" occur when there is too much uric acid in the blood. Uric acid is a waste product made by the body when it digests certain foods.

When uric acid levels are high, crystals of it can accumulate in your joints. This process triggers swelling, inflammation and intense pain (5).

Gout attacks typically occur at night and last 3–10 days (6).

Most people who have the condition experience these symptoms because their bodies can't remove the excess uric acid efficiently. This lets uric acid accumulate, crystallize and settle in the joints.

Others with gout make too much uric acid due to genetics or their diet (7, 8).

Summary: Gout is a type of arthritis that involves sudden pain, swelling and inflammation of the joints. It happens when there is too much uric acid in the blood, causing it to deposit in the joints as crystals.

If you have gout, certain foods may trigger an attack by raising your uric acid levels.

Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product (9).

This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.

However, people with gout can't efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack (5).

Fortunately, research shows that restricting high-purine foods and taking the appropriate medication can prevent gout attacks (10).

Foods that commonly trigger gout attacks include organ meats, red meats, seafood, alcohol and beer. They contain a moderate-to-high amount of purines (11, 12).

However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks (13).

And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though they’re not purine-rich (14).

Instead, they may raise uric acid levels by accelerating several cellular processes (15, 16).

For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout (17).

On the other hand, research shows that low-fat dairy products, soy products and vitamin C supplements may help prevent gout attacks by reducing blood uric acid levels (11, 18).

Full-fat and high-fat dairy products don't seem to affect uric acid levels (13, 19).

Summary: Foods can either raise or lower your uric acid levels, depending on their purine content. However, fructose can raise your uric acid levels even though it is not purine-rich.

If you’re susceptible to sudden gout attacks, avoid the main culprits — high-purine foods.

These are foods that contain more than 200 mg of purines per 3.5 ounces (100 grams) (20).

You should also avoid high-fructose foods, as well as moderately-high-purine foods, which contain 150–200 mg of purines per 3.5 ounces. These may trigger a gout attack.

Here are a few major high-purine foods, moderately-high-purine foods and high-fructose foods to avoid (6, 11, 20):

  • All organ meats: These include liver, kidneys, sweetbreads and brain
  • Game meats: Examples include pheasant, veal and venison
  • Fish: Herring, trout, mackerel, tuna, sardines, anchovies, haddock and more
  • Other seafood: Scallops, crab, shrimp and roe
  • Sugary beverages: Especially fruit juices and sugary sodas
  • Added sugars: Honey, agave nectar and high-fructose corn syrup
  • Yeasts: Nutritional yeast, brewer's yeast and other yeast supplements

Additionally, refined carbs like white bread, cakes and cookies should be avoided. Although they are not high in purines or fructose, they are low in nutrients and may raise your uric acid levels (21).

Summary: If you have gout, you should avoid foods like organ meats, game meats, fish and seafood, sugary beverages, refined carbs, added sugars and yeast.

Although a gout-friendly diet eliminates many foods, there are still plenty of low-purine foods you can enjoy.

Foods are considered low-purine when they have less than 100 mg of purines per 3.5 ounces (100 grams).

Here are some low-purine foods that are generally safe for people with gout (20, 22):

  • Fruits: All fruits are generally fine for gout. Cherries may even help prevent attacks by lowering uric acid levels and reducing inflammation (23, 24).
  • Vegetables: All vegetables are fine, including potatoes, peas, mushrooms, eggplants and dark green leafy vegetables.
  • Legumes: All legumes are fine, including lentils, beans, soybeans and tofu.
  • Nuts: All nuts and seeds.
  • Whole grains: These include oats, brown rice and barley.
  • Dairy products: All dairy is safe, but low-fat dairy appears to be especially beneficial (11, 18).
  • Eggs
  • Beverages: Coffee, tea and green tea.
  • Herbs and spices: All herbs and spices.
  • Plant-based oils: Including canola, coconut, olive and flax oils.

Foods You Can Eat in Moderation

Aside from organ meats, game meats and certain fish, most meats can be consumed in moderation. You should limit yourself to 4–6 ounces (115–170 grams) of these a few times per week (20).

They contain a moderate amount of purines, which is considered to be 100–200 mg per 100 grams. Thus, eating too much of them may trigger a gout attack.

  • Meats: These include chicken, beef, pork and lamb.
  • Other fish: Fresh or canned salmon generally contains lower levels of purines than most other fish.
Summary: Foods you should eat with gout include all fruits and vegetables, whole grains, low-fat dairy products, eggs and most beverages. Limit your consumption of non-organ meats and fish like salmon to servings of 4–6 ounces (115–170 grams) a few times weekly.

Eating a gout-friendly diet will help you relieve the pain and swelling, while preventing future attacks.

Here is a sample gout-friendly menu for one week.

Monday

  • Breakfast: Oats with Greek yogurt and 1/4 cup (about 31 grams) berries.
  • Lunch: Quinoa salad with boiled eggs and fresh veggies.
  • Dinner: Whole wheat pasta with roasted chicken, spinach, bell peppers and low-fat feta cheese.

Tuesday

  • Breakfast: Smoothie with 1/2 cup (74 grams) blueberries, 1/2 cup (15 grams) spinach, 1/4 cup (59 ml) Greek yogurt and 1/4 cup (59 ml) low-fat milk.
  • Lunch: Whole grain sandwich with eggs and salad.
  • Dinner: Stir-fried chicken and vegetables with brown rice.

Wednesday

  • Breakfast: Overnight oats — 1/3 cup (27 grams) rolled oats, 1/4 cup (59 ml) Greek yogurt, 1/3 cup (79 ml) low-fat milk, 1 tbsp (14 grams) chia seeds, 1/4 cup (about 31 grams) berries and 1/4 tsp (1.2 ml) vanilla extract. Let sit overnight.
  • Lunch: Chickpeas and fresh vegetables in a whole wheat wrap.
  • Dinner: Herb-baked salmon with asparagus and cherry tomatoes.

Thursday

  • Breakfast: Overnight chia seed pudding — 2 tbsp (28 grams) chia seeds, 1 cup (240 ml) Greek yogurt and 1/2 tsp (2.5 ml) vanilla extract with sliced fruits of your choice. Let sit in a bowl or mason jar overnight.
  • Lunch: Leftover salmon with salad.
  • Dinner: Quinoa, spinach, eggplant and feta salad.

Friday

  • Breakfast: French toast with strawberries.
  • Lunch: Whole grain sandwich with boiled eggs and salad.
  • Dinner: Stir-fried tofu and vegetables with brown rice.

Saturday

  • Breakfast: Mushroom and zucchini frittata.
  • Lunch: Leftover stir-fried tofu and brown rice.
  • Dinner: Homemade chicken burgers with a fresh salad.

Sunday

  • Breakfast: Two-egg omelet with spinach and mushrooms.
  • Lunch: Chickpeas and fresh vegetables in a whole wheat wrap.
  • Dinner: Scrambled egg tacos — scrambled eggs with spinach and bell peppers on whole wheat tortillas.
Summary: A gout-friendly diet has plenty of options for a healthy and delicious menu. The chapter above provides a sample gout-friendly menu for one week.

Aside from your diet, there are several lifestyle changes that can help you lower your risk of gout and gout attacks.

Lose Weight

If you have gout, carrying excess weight can increase your risk of gout attacks.

That's because excess weight can make you more resistant to insulin, leading to insulin resistance. In these cases, the body can't use insulin properly to remove sugar from the blood. Insulin resistance also promotes high uric acid levels (25, 26).

Research shows that losing weight can help reduce insulin resistance and lower uric acid levels (27, 28).

That said, avoid crash dieting — that is, trying to lose weight very fast by eating very little. Research shows that rapid weight loss can increase the risk of gout attacks (29, 30, 31).

Exercise More

Regular exercise is another way to prevent gout attacks.

Not only can exercise help you maintain a healthy weight, but it can also keep uric acid levels low (32).

One study in 228 men found that those who ran more than 5 miles (8 km) daily had a 50% lower risk of gout. This was also partly due to carrying less weight (33).

Stay Hydrated

Staying hydrated can help reduce the risk of gout attacks.

That's because adequate water intake helps the body remove excess uric acid from the blood, flushing it out in the urine (34, 35).

If you exercise a lot, then it's even more important to stay hydrated, because you may lose a lot of water through sweat.

Limit Alcohol Intake

Alcohol is a common trigger for gout attacks (36, 37).

That's because the body may prioritize removing alcohol over removing uric acid, letting uric acid accumulate and form crystals (38).

One study including 724 people found that drinking wine, beer or liquor increased the risk of gout attacks. One to two beverages per day increased the risk by 36%, and two to four beverages per day increased it by 51% (39).

Try a Vitamin C Supplement

Research shows that vitamin C supplements may help prevent gout attacks by lowering uric acid levels (40, 41, 42).

It seems that vitamin C does this by helping the kidneys remove more uric acid in the urine (42, 43).

However, one study found that vitamin C supplements had no effect on gout (44).

Research on vitamin C supplements for gout is new, so more studies are needed before strong conclusions can be made.

Summary: Losing weight, exercising, staying hydrated, limiting alcohol and possibly taking vitamin C may also help prevent gout attacks.

Gout is a type of arthritis involving sudden pain, swelling and inflammation of the joints.

Fortunately, a gout-friendly diet can help relieve its symptoms.

Foods and drinks that often trigger gout attacks include organ meats, game meats, some types of fish, fruit juice, sugary sodas and alcohol.

On the other hand, fruits, vegetables, whole grains, soy products and low-fat dairy products may help prevent gout attacks by lowering uric acid levels.

A few other lifestyle changes that can help prevent gout attacks include maintaining a healthy weight, exercising, staying hydrated, drinking less alcohol and possibly taking vitamin C supplements.

An evidence-based nutrition article from our experts at Authority Nutrition.

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