High Protein Diet Recommendations for Individuals with Hyperuricemia
Individuals with elevated uric acid levels should avoid high-protein diets (≥1.3 g/kg/day) and instead limit protein intake to 0.8 g/kg/day, with a strong preference for plant-based over animal protein sources. 1
Why High Protein Diets Are Problematic with Hyperuricemia
High-protein foods—particularly meat, poultry, seafood, eggs, seeds, and nuts—are rich in purines, which are metabolized into uric acid. 1 This creates a direct pathway for worsening hyperuricemia and potentially triggering gout in susceptible individuals. 1
The type of protein matters significantly:
Animal protein (meat and seafood) shows a positive association with hyperuricemia and elevated serum uric acid levels. 2, 3 Seafood intake specifically increases hyperuricemia prevalence with an odds ratio of 1.56 in the highest consumption quintile. 2
Plant-based protein demonstrates an inverse association with hyperuricemia, meaning it may actually help lower uric acid levels. 2, 3
Total protein intake alone is not associated with serum uric acid levels when analyzed independently—it's the source that drives the effect. 3
Specific Dietary Recommendations
Protein Sources to Limit or Avoid
Limit purine-rich meats and seafood to reduce uric acid production. 1 The American College of Rheumatology specifically recommends limiting consumption of these foods for gout patients. 1
Avoid high-protein diets entirely if you have concurrent diabetes or chronic kidney disease, as these diets increase albuminuria and accelerate kidney function decline through glomerular hyperfiltration. 1, 4
Protein Sources to Encourage
Low-fat and non-fat dairy products have antihyperuricemic effects and should be encouraged. 1, 3 Consuming milk ≥1 time per day or yogurt every other day lowers serum uric acid by approximately 0.25-0.26 mg/dL. 3
Soy foods and plant proteins show an inverse association with hyperuricemia (OR 0.77 for highest intake quintile). 2
Purine-rich vegetables do not increase hyperuricemia risk, unlike animal-based purine sources. 2
Optimal Protein Intake Target
Aim for 0.8 g/kg body weight per day—this is the Recommended Dietary Allowance (RDA) level that balances nutritional needs without exacerbating uric acid levels. 1, 4 This recommendation is particularly important if you have:
- Diabetes with any stage of chronic kidney disease 1, 4
- Pre-existing kidney impairment 4
- History of gout or kidney stones 1
Additional Lifestyle Modifications
Beyond protein modification, the American College of Rheumatology recommends: 1
- Limit high-fructose corn syrup in soft drinks and energy drinks
- Reduce alcohol consumption, particularly beer, but also wine and spirits
- Encourage weight management if overweight, as obesity increases insulin resistance, which reduces uric acid excretion 5, 6
Critical Pitfalls to Avoid
Do not prescribe high-protein diets for weight loss in patients with hyperuricemia, diabetes, or any kidney impairment—the risks substantially outweigh potential benefits. 4 While high-protein diets may produce initial weight loss through ketosis and diuresis, they impose significant health risks including elevated LDL cholesterol, increased blood pressure, elevated uric acid, increased urinary calcium loss, and accelerated diabetic kidney disease progression. 1
Monitor for concurrent conditions: Hyperuricemia strongly associates with metabolic syndrome, insulin resistance, hypertension, and cardiovascular disease. 5, 6 Address these comprehensively rather than focusing solely on protein intake.
Evidence Quality Note
The Canadian Society of Nephrology (KDIGO guidelines) provides the most recent high-quality guidance (2015) recommending avoidance of high protein intake ≥1.3 g/kg/day in adults with CKD at risk of progression. 1 The American Heart Association's detailed analysis of high-protein diet risks (2001) and the American College of Rheumatology's gout management guidelines (2012) provide complementary evidence on the purine-uric acid connection. 1