Gout is a type of arthritis that develops when someone has too much uric acid in the body. This condition, called hyperuricemia, occurs when uric acid builds up and leads to joint pain.
While there are a range of possible causes, including genetic influences and underlying medical conditions, your diet can have a direct impact on gout and its severity. Foods high in purines tend to result in more gout symptoms and problems.
If you have gout you should avoid foods high in sugars, red and organ meats, processed foods, and alcohol. You should eat low-purine foods like whole grains and vegetables, low-fat dairy, and foods rich in vitamin C.
This article tells you what purines are and what they do. It will help you to know the foods to avoid with gout, and how to identify foods that may limit your gout flare-ups.
How Foods Can Lead to Gout
Researchers in both the United Kingdom and the United States have identified gout as the most common type of inflammatory arthritis affecting their populations.
These findings point to the role that diet plays in the development of the disease. Higher rates of gout tend to be found in cultures known for having high amounts of red meat, processed foods, sugars, and other foods high in purines as part of their cuisine.
Purines are chemical compounds found naturally in foods and in your body. When they come from the foods you eat, they are called exogenous purines, meaning that they come from outside your body.
Purines that come from the foods you eat are broken down by your digestive system. Uric acid is created as a byproduct during this process. Your body then reabsorbs most of the uric acid, with the rest excreted, or passed from the body, in your urine and feces.
When purine levels are too high, your body is unable to fully process it. Uric acid then builds up in the blood. This hyperuricemia can happen on its own because of high-purine foods, but it also may be more likely if you eat these foods when you have certain underlying health conditions.
Some of these medical conditions include:
- Chronic kidney disease
- Hypertension (high blood pressure)
- Psoriatic arthritis
- Recent infection, injury, or surgery
Foods to Avoid
If you have hyperuricemia or gout, ask your healthcare provider if you should avoid or limit high-purine foods. These foods include the following.
- Sugars and fruit high in fructose
- Sugary beverages
- Processed foods
- Red meat and organ meat
- Certain fish and seafood
Cutting these out of your diet can help prevent and manage gout flare-ups.
Sugars and Fruit
Sugar, including fructose, seems to increase uric acid levels in your blood.
Fructose is a natural form of sugar found in some foods. It's added to many products as high-fructose corn syrup. Avoiding or limiting high-fructose foods may help lessen gout symptoms.
Some fruits are naturally high in fructose. The association between fruit and gout is unclear, though.
If you have gout, you don’t have to avoid all fruit. But it might help to:
- Avoid or limit some fruit juices
- Only eat one serving of fruit at a time
- Pay attention to how it affects your gout symptoms
Cherries are an exception; they may actually reduce uric acid levels, as we'll see below.
Sugar in Beverages
Sodas and sugary drinks are considered empty-calorie foods. They contain no beneficial nutrients but can add a lot of calories to your diet. They also may add to your risk of gout flare-ups.
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One 2020 research review explored several studies of sugar-sweetened beverages, looking at the relationship between the fructose in them and gout development. It found the drinks were significantly associated with an increased risk of gout and hyperuricemia.
It may help to avoid these beverages, including:
- Energy drinks
- Sports drinks
The modern Western diet is often high in processed foods and refined carbohydrates. These elements have been linked to a higher risk of gout as well as other health conditions, including:
- Type 2 diabetes
- Heart disease
- Weight gain and obesity
By avoiding highly processed and refined-carb foods and beverages, you can help to limit the development of gout and its symptoms. Foods to avoid include:
- Baked goods, including white bread
- Chips and crackers
- Ice cream
- Some frozen meals
Red Meat and Organ Meat
Red meat and organ meats are high-purine foods. Researchers have demonstrated that these foods can raise the risk of high uric acid levels and gout episodes.
To limit your risk, keep your intake of these red meats and organ meats low. These meats include:
- Venison and other wild game
Chicken has moderate purine levels and may be eaten in moderation. Keep in mind that many meat-based soups, gravies, and processed meats like salami and pepperoni can raise the risk of gout flare-ups.
Fish and Seafood
Certain types of seafood are high in purines. These should be avoided on a gout-friendly diet, although other types of seafood may be included. They have moderate levels of purine and can be limited to less than 6 ounces per day in your meal plans.
Fatty fish, such as tuna and salmon, are good sources of omega-3 fatty acids and generally thought of as healthy. However, they also are high-purine foods. Some research suggests that fish high in omega-3 fatty acids (but not omega-3 supplements) are linked to a lower risk of gout flare-ups. More research is needed to understand these findings.
Alcohol use has long been associated with gout, and it's recommended that you avoid alcohol when following a low-purine diet. Beverages to avoid include:
- Hard liquor
- Other grain alcohols
Wine has long been associated with lower purine levels and considered “safe” in moderation for people with a history or risk of high uric acid levels.
However, a study of 724 people with a history of gout who consumed alcohol found that wine, beer, and hard liquor were each associated with a higher risk of gout flare-up. This was true even with potentially moderate amounts, although more so in people who ate high-purine foods and were on certain medications.
Certain yeasts and yeast extracts are high in purines. You should avoid foods and supplements that contain them. Yeast extract is found in some foods, such as:
- Some soy sauces
- Canned soups and stews
- Frozen dinners
- Salty snacks
Foods to Eat
Some foods can help lower uric acid levels, which can relieve gout flare-ups and prevent future attacks.
The following foods may help to ease gout by lowering uric acid levels or reducing purine intake:
- Foods high in vitamin C (e.g., oranges, spinach, kale)
- Low-purine foods (e.g., whole grains, vegetables, plant-based protein like nuts and legumes)
- Low-fat dairy
Cherries have been studied for their role in preventing and managing gout. Their deep red color is due to natural compounds called anthocyanins, which contain antioxidant and anti-inflammatory properties.
Research has shown that cherry consumption may help reduce uric acid levels, thus decreasing inflammation and lowering the risk of future gout attacks. Tart cherries are the most commonly studied type for gout. More specifically, Montmorency or Balaton varieties.
Fresh, frozen, juice or extract forms are commonly consumed. However, there are no defined amounts to eat per day for gout prevention. Studies vary widely in the amounts of cherries researched, such as servings of 1/2 cup of fresh cherries or 1 cup of cherry juice per day.
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For cherry extract supplements, it is best to follow the suggested dose amount on the label.
High-Vitamin C Foods
Vitamin C is a well-known antioxidant, but it is lesser-known for its potential role in the treatment of gout. The means by which it may help is by lowering blood uric acid levels.
A prospective study published in 2009 followed nearly 47,000 men for 20 years and examined their risk of gout in relation to their vitamin C intake. The researchers concluded that higher vitamin C intake was associated with a lower risk of developing gout, with up to a 45% lower risk when consuming 1,500 milligrams or more of vitamin C per day.
A 2011 analysis of 13 randomized controlled clinical trials in people with high blood uric acid levels found that vitamin C supplementation with a median dose of 500 milligrams per day for a median duration of 30 days modestly reduced serum uric acid levels. Whether this amount is significant or not in reducing the risk of gout needs to be further studied.
Foods high in vitamin C include:
- Citrus fruits like oranges, lemons, and grapefruit
- Sweet bell peppers
If you have an increased risk for kidney stones (particularly calcium oxalate stones), it is not recommended to consume high doses of supplemental vitamin C on a regular basis.
Being one of the most widely consumed beverages in the world, coffee has been studied for its various effects on health. Early studies suggest that coffee may decrease the risk of gout. However, research shows that it may vary based on sex.
A 2015 review of studies found that in men who drank 4 to 5 cups of coffee per day had a 40% decreased risk of gout, and those who drank 6 cups or more per day had a 59% lower risk, when compared with no coffee consumption
In women who drank 1 to 3 cups of coffee daily, the risk of gout was 22% lower, and in those who drank 4 or more cups daily the risk was 57% lower, compared with no coffee consumption. From this review, the researchers concluded that drinking 4 or more cups of coffee per day lowers uric acid levels and decreases the incidence of gout.
However, no research has explored the effects of coffee intake on the risk of recurrent gout attacks.
One of the most widely accepted and recommended dietary approaches in managing gout is to reduce purine intake from foods. By choosing to eat low-purine foods instead of those higher in purines, you can help prevent your blood uric acid levels from getting too high.
Additionally, the DASH diet, which encourages many low-purine foods, has been associated with a lower risk of gout.
Low-purine foods include:
- Certain fruits, like cherries and citrus fruits
- Low-fat dairy
- Plant-based protein foods such as nuts, seeds, and legumes
- Whole grains
Many plant-based foods are low in purines, making them an excellent choice for a gout-friendly diet. They also contain numerous health-promoting nutrients, including vitamins, minerals, and fiber. Plant-based foods include:
- Beans and other legumes
- Nut and vegetable-based oils
- Soy-based protein, such as tofu
- Whole grains
Plant-based vegetarian diets have been shown to decrease the risk of gout, according to two separate prospective cohort studies.
Some vegetables are higher in purines. However, the body processes plant-based purines differently. Research shows that plant-based purines do not increase the risk of gout and may actually decrease risk.
A 2019 review of plant-based diets and their association with gout suggested that reasonable consumption of higher purine plant foods as a part of a plant-based diet may be safely tolerated in healthy people.
Researchers noted that additional studies are needed in people with high uric acid levels, especially those who suffer from chronic kidney disease.
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Dairy products have been found to decrease the risk of gout. In particular low-fat or non-fat dairy may be protective against recurrent gout flares.
Low-fat dairy may decrease uric acid levels and contain certain anti-inflammatory properties that decrease the inflammatory response to monosodium urate crystals within the joint.
The Dietary Guidelines for Americans suggest three servings of dairy per day for healthy adults. This includes low-fat milk, yogurt, cheese, or cottage cheese.
Staying hydrated is key for people with gout. A 2017 prospective study looked at the association between water intake and uric acid levels.
After examining the data, researchers determined that water intake has an association with lower uric acid levels in people with gout, possibly due to increased uric acid excretion with higher water intake. However, more research is needed to look at a more direct effect of water intake on gout.
A review in the American Journal of Lifestyle Medicine found that excess sweating, such as after exercise or sauna bathing, decreased urinary excretion of uric acid, leading to an increase in uric acid levels. Therefore, researchers recommend drinking plenty of water to avoid increased serum uric acid levels after activities that cause heavy sweating.
Additionally, researchers also found that adequate water consumption in the 24-hour period before a gout flare was associated with a significant decrease in recurrent gout attacks.
Water is the best source of hydration, but other beverages such as coffee, and foods such as some fruits and vegetables, contain water and can contribute to your overall hydration status. Drinking to thirst is best, but some experts suggest drinking half of your body weight in ounces each day for optimal hydration.
Sample Meal Plan
It's not always easy to change your diet or know where to begin. One option is to learn the principles of the DASH diet and build your meal choices and menus around the foods that are included.
That's exactly the approach used in a study of menu plans for people with gout living in Baltimore, Maryland. Their grocery lists were approved by dietitians, ordered, and then delivered to their homes, with researchers evaluating the foods they ate and any changes in their uric acid levels.
The 49 people included in this study stayed on meal plans that included:
- 5–7 servings per day of healthy grains
- 4 servings per day of fruit
- 4 servings per day of vegetables
- 1–2 servings per day of lean poultry (chicken, turkey) or fish
- 2 servings per day of low fat dairy, such as milk or cheese
- A limited amount of nuts, seeds, and legumes each day
The meals also limited sodium (salt), cholesterol, and fats, while restricting high-purine foods. Results showed some reduction of uric acid levels, but also found that 80% of the group found the diet easy to follow.
Three-fourths of the participants said they were likely to continue eating in a new way after the study, indicating that they had a positive experience with their changes in diet and behavior.
Some foods contain natural chemicals called purines. Purines raise uric acid levels, which leads to a type of inflammatory arthritis called gout. So the risk of gout flare-ups is strongly influenced by the choices you make about diet.
These choices also affect related health conditions, such as high blood pressure and kidney disease. A low-purine diet restricts foods such as red meat, alcohol, processed foods, sugary foods, and some seafood.
A Word From Verywell
Keep in mind that the foods that lead to gout flare-ups will depend on each individual. You'll want to keep in touch with your healthcare provider as you make changes in your diet, and set yourself up with small, encouraging “wins” as you follow your dietary journey.