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Anti-gout Diet

Foods to Eat, Foods to Avoid, and More

Author:Maria Emfietzoglou, MD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is gout?

Gout is inflammatory arthritis in which monosodium urate crystals deposit in a joint, causing erythema, warmth, tenderness, and swelling within hours. When this happens, it is typically called a “gout attack.” Gout commonly affects the first metatarsal joint at the base of the big toe. The underlying cause of gout is hyperuricemia or increased uric acid levels in the blood. Uric acid is created during the metabolism of purines, which are key components of nucleic acids like DNA and RNA. When cells, along with the nucleic acids in those cells, are broken down throughout the body, purines are converted into uric acid, which can be filtered out of the blood and excreted in the urine. Hyperuricemia occurs when uric acid levels in the blood exceed the rate of its solubility and excretion, which is about 6.8 mg/dL, forming monosodium urate crystals, which typically deposit in the joints, but also deposit in the kidneys, forming kidney stones

Hyperuricemia can result from increased consumption of foods high in purines, like shellfish, anchovies, red meat, or organ meats (e.g., liver, kidneys). Nonetheless, hyperuricemia can also result from increased production of purines; for example, high-fructose corn syrup, found in soda, packaged sweets, and fruit jams, can increase purine synthesis and cause hyperuricemia. When there is decreased uric acid clearance from the body, which can result from dehydration or consuming alcoholic beverages, uric acid may accumulate. Additionally, having obesity or diabetes mellitus also increases the risk of gout. Other risk factors include being assigned male at birth, hypertension, and dyslipidemia. Hyperuricemia can also develop due to a hematologic disorder with increased cell turnover (e.g., myeloproliferative disorders) and chemotherapy or radiation treatment since cells turnover faster. Also, some individuals have a genetic predisposition to overproduce uric acid, while others with chronic kidney disease may be unable to excrete the uric acid adequately. Finally, there are medications, like thiazide diuretics and low-dose aspirin, which can also increase uric acid levels and increase the risk of developing gout. 

Over time, repeated gout flares can develop into chronic gout, a type of arthritis with joint tissue destruction and permanent joint deformity. Individuals with chronic gout are also at an increased risk for developing uric acid kidney stones, as well as urate nephropathy, which is when urate crystals deposit in the interstitium of the kidney.

Some medications can help reduce uric acid levels, which include xanthine oxidase inhibitors (e.g., allopurinol), and uricosuric medications (e.g., probenecid), which improve the kidneys' ability to remove uric acid. During gout attacks, treatment usually includes nonsteroidal anti-inflammatory medications (NSAIDS), such as ibuprofen, and occasionally corticosteroids and colchicine.

Great toe with inflammation and redness at the base.

What is an anti-gout diet?

An anti-gout diet is typically a low-calorie diet that focuses on reducing or eliminating foods high in purines, like red meat and seafood, reducing soda and alcohol consumption, and maintaining good hydration to prevent gout flares. 

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How does an anti-gout diet improve gout?

Research has shown that the anti-gout diet can induce positive changes in the disease progression. More specifically, it can limit uric acid production and increase its elimination in the urine. In addition, an anti-gout diet can help manage other conditions associated with gout, including obesity and diabetes mellitus. As a result, an anti-gout diet can help decrease the risk of gout attacks, decrease the severity of gout flares, slow the progression of joint destruction, and reduce the risk of kidney damage. 

What foods are best on an anti-gout diet?

An anti-gout diet recommends eating fruits (e.g., strawberries, cherries, melon), vegetables, and whole grains containing complex carbohydrates. More specifically, fruits low in fructose are preferred, such as berries, apricots, and nectarines, while fruits high in fructose, like apples and pears, may be avoided. Studies have shown that even vegetables high in purines, like asparagus and spinach, do not increase the risk of gout or flares. 

The proteins recommended in an anti-gout diet include lean red meat; fish rich in omega-3 fatty acids (e.g., mackerel, salmon, herring); poultry (e.g., chicken); and lentils, in small quantities. It is also suggested to avoid saturated fats from red meat, fatty poultry, and high-fat dairy products. In small quantities, low-fat dairy products (e.g., skim or low-fat milk, low-fat yogurt) can also be included in the diet. Nuts (e.g., almonds, walnuts), tofu, and soy protein meat substitutes are adequate protein alternatives. 

It is typically recommended that individuals with gout avoid alcohol consumption, specifically beer, as alcohol is likely to cause gout attacks. 

Hydration and physical activity are also necessary components of the anti-gout diet. Appropriate diet and lifestyle changes can strengthen the effort to lose weight. There is also evidence that vitamin C may help reduce uric acid levels in the blood; therefore, fruits and vegetables containing vitamin C (e.g., oranges, grapefruit, broccoli) or a vitamin C supplement could be added to an anti-gout diet. Moderate amounts of coffee have also been shown to reduce the risk of gout. 

What foods should be avoided on an anti-gout diet?

Foods that should be avoided on an anti-gout diet include high purine foods, like organ meats (e.g., liver, kidneys, calves’ sweetbreads) and specific types of seafood (e.g., anchovies, mussels, sardines, shrimps, lobster, scallops, tuna). Additionally, it is recommended to limit the consumption of red meat (e.g., beef, lamb, pork, bacon). Foods and drinks with high-fructose corn syrup and naturally sweet fruit juice are typically advised to be avoided when following the anti-gout diet. Additionally, the sugar content in processed snacks, baked goods, and soft drinks can increase uric acid levels. Therefore, processed snacks (e.g., cakes, candy, sweetened yogurt, ice creams with excess sugar, and sugary drinks) should be avoided. 

What are the most important facts to know about an anti-gout diet?

Gout is a type of inflammatory disease where uric acid precipitates to form monosodium urate crystals, which deposit in joints, leading to inflammation, pain, redness, warmth, and edema. Uric crystals can also deposit in kidney tubules forming kidney stones. Overtime, chronic gout can lead to joint destruction and kidney failure. Diet can improve the management of gout by reducing uric acid levels and, thus, the frequency and severity of gout attacks. The anti-gout diet is a low-calorie diet that suggests avoiding foods and drinks that are high in purines. Examples of foods to avoid include organ meats, red meat, seafood, and foods containing high-fructose corn syrup. In contrast, the diet suggests eating fruits and vegetables, low-fat dairy products in small quantities, lean red meat, poultry; legumes; and whole grain products. 

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Related links

Gout
Gout and pseudogout: Pathology review
Purine and pyrimidine synthesis and metabolism disorders: Pathology review
Antigout medications

Resources for research and reference

Arthritis Foundation. Gout diet: Dos and Don’ts. Retrieved 16/10/2022 from https://www.arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/gout-diet-dos-and-donts  

Cleveland clinic. Gout Low Purine Diet. Retrieved 16/10/2022 from https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet

Everyday Health. Your anti-gout food plan. Retrieved 16/10/2022 from https://www.everydayhealth.com/arthritis/gout/your-anti-gout-food-plan/

Healthline. Best diet for gout: What to eat, what to avoid. Retrieved 16/10/2022 from https://www.healthline.com/nutrition/best-diet-for-gout#TOC_TITLE_HDR_1

Mayo Clinic. Gout diet: What’s allowed, what’s not. Retrieved 16/10/2022 from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524