What foods should be avoided when managing gout?

Foods to Avoid When You Have Gout

Patients with gout should limit consumption of purine-rich meats and seafood, alcohol (especially beer and spirits), sugar-sweetened beverages, and high-fructose foods to reduce the risk of gout attacks. 1

High-Purine Foods to Avoid or Limit

• Purine-rich meats and seafood should be limited as they raise serum uric acid levels and increase gout risk 1

  • Organ meats (liver, kidney, sweetbreads) 2, 3
  • Certain seafood, particularly anchovy, cutlassfish (hairtail), and fish milt (containing 300-560 mg/100g of purines) 2
  • Shellfish 3

• Foods containing very high purine content (>300 mg/100g) should be strictly limited, as even small portions (20-30g) can provide 20-40% of the recommended daily limit for gout patients 2

  • Dried Chinese soup stock 2
  • Dried yeast and yeast supplements 2, 4
  • Certain supplements (Euglena, Lactobacillus) 2

Beverages to Avoid

• Alcohol consumption should be reduced, with particular emphasis on limiting beer and spirits 1, 5

  • Complete alcohol abstinence is recommended during active gout flares 1
  • Beer has a stronger association with gout risk than other alcoholic beverages due to its high purine content 6

• Sugar-sweetened beverages and energy drinks containing high-fructose corn syrup should be limited 1, 5

  • These can raise uric acid levels through increased production and/or decreased excretion 1

Additional Dietary Recommendations

• Foods rich in fructose, including certain sweet fruits and fruit juices, should be moderated 1

• Weight reduction is recommended for overweight and obese patients with gout 1, 5

  • Controlled weight management can lower serum urate levels similarly to strict low-purine diets 6

Foods to Encourage

• Low-fat or non-fat dairy products are strongly encouraged as they are associated with lower risk of gout and may have antihyperuricemic effects 1, 5

• Cherries may help reduce serum urate levels and the frequency of gout attacks 1, 5, 6

• Vegetable protein and increased fruit intake may help reduce serum urate levels 6

Important Considerations

• Diet and lifestyle measures alone typically provide only a 10-18% decrease in serum urate levels, which may be insufficient for patients with significantly elevated uric acid levels 1, 5

• For most patients with gout, dietary modifications should be combined with appropriate pharmacological urate-lowering therapy for optimal management 1, 7

• The Japanese dietary guidelines recommend consuming less than 400 mg of dietary purines per day for patients with gout or hyperuricemia 2, 4

• Many nutritional recommendations for gout have limited high-quality evidence supporting their effectiveness, despite being commonly recommended 8

Common Pitfalls

• Overlooking the impact of alcohol, particularly beer, on triggering gout flares 1, 6

• Eliminating all purine-rich foods, including those that may have cardiovascular benefits (like fatty fish with omega-3 fatty acids) 8

• Focusing solely on diet without addressing weight management in overweight/obese patients 5

• Relying exclusively on dietary modifications without appropriate medication when indicated 7