What foods should be avoided in a patient with gout?

Foods to Avoid for Patients with Gout

Patients with gout should limit consumption of purine-rich meat and seafood, high fructose corn syrup sweetened beverages, and alcohol (especially beer), while encouraging consumption of low-fat dairy products and cherries to reduce the risk of gout flares and lower serum urate levels. 1, 2

Foods to Limit or Avoid

High Priority Avoidance

• Purine-rich foods 1, 2:

  • Organ meats (liver, kidney, sweetbreads)
  • Shellfish and seafood (especially anchovy, cutlassfish)
  • Fish milt/roe (particularly cod, globefish) - contains extremely high purine levels (375-560 mg/100g) 3
  • Red meat (especially high quantities)

• Beverages 1, 2:

  • Alcohol, particularly:
    • Beer (strongest association with gout flares)
    • Spirits
  • Sugar-sweetened beverages containing high fructose corn syrup
  • Fruit juices (especially orange and apple juice)

Moderate Avoidance

• Foods with very high purine content (>300 mg/100g) 3, 4:
  • Dried Chinese soup stock
  • Dried yeast
  • Some supplements (Euglena, Lactobacillus)

Foods to Encourage

• Low-fat or non-fat dairy products 1, 2

  • Skimmed milk
  • Low-calorie yogurt

• Beneficial foods 2, 5:

  • Cherries (reduces frequency of gout attacks)
  • Coffee (associated with lower urate levels)
  • Vitamin C-rich foods (modest urate-lowering effect)

Dietary Patterns and Lifestyle Modifications

Recommended Approach

• Mediterranean diet pattern is beneficial for gout patients 5
• Weight loss if overweight/obese - can reduce serum uric acid by 10-18% 1, 2
• Regular moderate exercise (avoiding strenuous exercise during flares) 2
• Adequate hydration to prevent dehydration which can trigger gout 5

Quantity Considerations

• For very high purine foods (>300 mg/100g), limit portion sizes significantly 3
• Japanese guidelines recommend consuming less than 400 mg of dietary purines per day 3, 4

Important Clinical Considerations

1. Diet alone is insufficient for most patients:

   • Dietary measures typically only reduce serum urate by 10-18%, which is beneficial but often inadequate to achieve target urate levels in those with sustained hyperuricemia above 7 mg/dL 1
   • Pharmacologic urate-lowering therapy remains essential for most patients with gout

2. During acute flares:

   • Complete abstinence from alcohol is recommended during active arthritis 1
   • Continue prescribed medications even during dietary modifications

3. Individualized approach:

   • Address comorbidities such as obesity, hypertension, and hyperlipidemia 1
   • Consider medications that may affect uric acid levels (e.g., diuretics) 1

Practical Implementation

• Educate patients on cooking methods that can reduce purine content 6
• Encourage balanced nutrition while limiting high-risk foods
• Emphasize that dietary changes complement but do not replace pharmacologic therapy for most patients

By following these dietary recommendations alongside appropriate pharmacologic therapy, patients can effectively manage gout symptoms and reduce the frequency of flares while improving overall health outcomes.