Anti-gout Diet · Foods to Eat, Foods to Avoid, and More

Gout is a type of inflammatory arthritis in which monosodium urate (MSU) crystals deposit in a joint, causing erythema, warmth, tenderness, and swelling within hours. When this happens, it is typically called a “gout attack” and 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 develop through 3 main mechanisms. First, increased consumption of foods high in purines, like shellfish, anchovies, red meat, or organ meats (e.g., liver, kidneys). Next, from increased production of purines by consuming foods that increase purine synthesis; for example, high-fructose corn syrup, found in soda, packaged sweets, and fruit jams. Lastly, when there is decreased uric acid clearance from the body, which can result from dehydration or consuming alcoholic beverages, especially beer, uric acid may accumulate.   

Additionally, comorbidities, such as a genetic predisposition, obesity, metabolic syndrome, chronic kidney disease, or diabetes mellitus increase the risk of developing gout. Other risk factors include being assigned male at birth, hypertension, and dyslipidemia. Hyperuricemia may also develop in the setting of increased cell turnover, such as hematologic disorders (e.g., myeloproliferative disorders) or as a result of chemotherapy or radiation treatment. 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. 

Treatment of gout includes medications that are divided into acute flare management and chronic long-term urate-lowering therapy (ULT). During gout attacks, treatment usually includes colchicine; nonsteroidal anti-inflammatory medications (NSAIDS), such as ibuprofen; and glucocorticoids. For long-term control, medications include xanthine oxidase inhibitors (e.g., allopurinol) and uricosuric medications (e.g., probenecid), which improve the kidneys' ability to remove uric acid.  

As part of the management of gout, lifestyle modification which includes dietary considerations is strongly recommended. It is important to keep in mind that diet should complement and not replace pharmacologic therapy.  

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.  

An anti-gout diet focuses on foods that will not greatly affect serum urate levels. It is recommended to choose low-fat dairy products, consider a plant‑based high-fiber pattern emphasizing vegetables including those that are moderate-purine vegetables (e.g., asparagus, cauliflower, mushrooms, spinach, green peas, lentils, soybeans/edamame, kidney beans, and chickpeas), fruits (e.g., blueberries, grapes), whole grains, and nuts (e.g., almonds, walnuts).   

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), tofu and soy protein meat substitutes, and lentils.  

Hydration with water is a necessary component of the anti-gout diet. Interestingly, moderate amounts of coffee, both caffeinated and decaffeinated,  have also been shown to reduce the risk of gout.   

As part of the greater lifestyle modifications for gout management, physical activity and efforts to lose weight are recommended.   

An anti-gout diet typically limits or avoids three main categories of foods: high purine foods, foods and drinks containing high-fructose corn syrup, and alcohol.  

High purine foods, which break down into uric acid, include organ meats (e.g., liver, kidneys, calves’ sweetbreads), red meat (e.g., beef, lamb, pork, bacon), high-fat dairy products, and specific types of seafood (e.g., anchovies, mussels, sardines, shrimps, lobster, scallops, tuna).  

High-fructose corn syrup, found in soft drinks, sweetened fruit juices, packaged snacks, baked goods, candy, and some flavored yogurts and ice creams, can also increase uric acid levels.  

Alcohol, particularly beer, is another common trigger for gout attacks, so limiting or avoiding it is often advised.