What is Fish Milt?
Fish milt is the seminal fluid (sperm-containing reproductive organ) of male fish, and it should be avoided or strictly limited by patients with hyperuricemia or gout because it is an extremely high-purine food that will raise serum uric acid levels and increase the risk of gout flares. 1
Understanding Fish Milt
Fish milt, also called "soft roe" or "white roe," is the sperm sac of male fish. It is consumed as a delicacy in various cuisines, particularly in Japanese, Korean, and Russian cooking. From a nutritional standpoint, it is essentially a concentrated source of fish protein and nucleic acids.
Why Fish Milt is Problematic for Gout Patients
High Purine Content
- Fish milt is classified among the highest purine-containing seafood products, falling into the category of purine-rich foods that should be limited or avoided in gout management 1
- Purine-rich meats and seafood raise serum uric acid levels through increased purine metabolism, with shellfish and seafood showing a relative risk of 1.51 for gout attacks 1
- The American College of Rheumatology specifically recommends limiting consumption of purine-rich seafood as a key dietary modification to reduce flare risk and modestly lower serum uric acid levels 1
Mechanism of Harm
- Dietary purines are metabolized to uric acid in the body, and since humans lack the enzyme uricase (which would convert uric acid to the more soluble allantoin), consumed purines directly elevate serum uric acid 2
- Increased purine consumption from seafood is a well-established environmental trigger for both hyperuricemia development and acute gout flares 3
- Japanese dietary guidelines recommend consuming less than 400 mg of dietary purines per day for patients with gout or hyperuricemia to reduce the risk of gout attacks, and fish milt would consume a substantial portion of this allowance 1
Practical Recommendations for Patients
Foods to Avoid Instead
- Strongly encourage low-fat or non-fat dairy products as protein alternatives, since these are associated with lower gout risk and may have antihyperuricemic effects through uricosuric properties 1
- Choose lower-purine protein sources rather than organ meats, game meats, red meat, and high-purine seafood like fish milt 1
Important Context
- Dietary modifications alone typically provide only a 10-18% decrease in serum uric acid, which is therapeutically insufficient for most patients with sustained hyperuricemia substantially above 7 mg/dL 1
- Pharmacologic urate-lowering therapy is required for most patients to achieve target serum uric acid <6 mg/dL, with dietary modifications serving as important adjuncts 1
- Dietary factors serve more as flare triggers than primary causes of sustained hyperuricemia, though they remain clinically important to address 1
Critical Pitfall to Avoid
- Do not eliminate all seafood indiscriminately, as some fatty fish with omega-3 fatty acids have cardiovascular benefits that may outweigh gout concerns in certain patients, though fish milt specifically offers no such compensatory benefit 4, 1
- Avoid stigmatizing dietary discussions—gout has important genetic contributions, and patients frequently feel blamed for their condition when dietary factors are overemphasized 1