High Uric Acid Foods to Avoid or Limit
Patients with gout or hyperuricemia should strictly limit purine-rich meats and seafood, avoid beer and spirits, eliminate sugar-sweetened beverages, and encourage low-fat dairy products as part of comprehensive dietary management. 1, 2
Foods to Avoid or Strictly Limit
Highest Priority Restrictions
Alcohol (especially beer and spirits): Beer increases gout flare risk by 49% per serving per day, and spirits by 15% per serving 3. Alcohol metabolism consumes ATP, leading to increased uric acid production through purine nucleotide degradation, and lactate production inhibits renal uric acid excretion 4. Complete abstinence is recommended during active gout arthritis 2, 3.
Purine-rich meats and seafood: These foods contain >200-300 mg purines per 100g and should be consumed in very limited quantities 2, 5. Extremely high-purine foods (>300 mg/100g) include anchovy, cutlassfish, dried Chinese soup stock, and dried yeast 5.
Fish milt and organ meats: Fish milt contains 375-560 mg purines per 100g, with a typical 20-30g serving providing 75-168 mg total purines—representing 20-40% of the recommended daily limit of 400 mg 5.
Sugar-sweetened beverages and high-fructose foods: These raise uric acid levels through increased production and/or decreased excretion 1, 2. This includes energy drinks, certain sweet fruits, and fruit juices (particularly orange and apple juice) 1.
Specific Purine Content Guidelines
The Japanese dietary guidelines recommend consuming less than 400 mg of dietary purines per day 2, 5. Foods are categorized as:
- Very high purine (>300 mg/100g): Avoid or severely restrict 5
- High purine (200-300 mg/100g): Eat in very limited quantities 5
- Moderate purine (50-200 mg/100g): Consume in moderation 6
Foods to Encourage
Beneficial Dietary Components
Low-fat or non-fat dairy products: Strongly encouraged as they have antihyperuricemic effects and are associated with lower gout risk 1, 2, 3. Dairy products contain only 0.0-1.4 mg purines per 100g 5. Specifically, skimmed milk and low-calorie yogurt show inverse associations with urate levels 1.
Cherries: May reduce serum urate levels and decrease the frequency of gout attacks 1, 2.
Coffee: Negatively associated with gout risk 1.
Vegetable protein and plant-based foods: Most vegetables contain low to moderate purines (0.9-47.1 mg/100g for Japanese vegetables) and can be safely consumed 5, 7. Even plant foods with higher purine content may be safely tolerated in normouricemic individuals as part of a balanced plant-based diet 7.
Weight Management and Lifestyle
Weight reduction: Recommended for overweight and obese patients through daily exercise and limiting excess calorie intake 1, 2, 3. Weight loss can reduce serum uric acid by approximately 100 μmol/L (1.7 mg/dL) 1.
Regular physical activity: Should be advised as it may decrease excess mortality associated with chronic hyperuricemia 1.
Critical Caveats and Pitfalls
Important Limitations
Dietary modifications alone are insufficient for most patients: Diet and lifestyle measures typically provide only a 10-18% decrease in serum urate levels 2, 3. For most patients with gout, dietary modifications must be combined with appropriate pharmacological urate-lowering therapy to achieve the target serum uric acid level of <6 mg/dL (360 μmol/L) 1, 2.
Don't eliminate all purine-rich foods indiscriminately: Eliminating all purine-rich foods, including those with cardiovascular benefits such as fatty fish with omega-3 fatty acids, is not recommended 2.
Wine is different from beer and spirits: Wine consumption does not increase serum uric acid levels to the same degree as beer and spirits 1.
Comorbidity Management
Address metabolic syndrome components: Hyperlipidemia, hypertension, hyperglycemia, obesity, and smoking should be addressed as integral parts of gout management 1, 2. Consider losartan or calcium channel blockers for hypertension, and statins or fenofibrate for hyperlipidemia 1.
Diuretic substitution: When gout occurs in patients receiving loop or thiazide diuretics, substitute the diuretic if possible 1.