Is salmon a low‑purine food, particularly for patients with gout, hyperuricemia, or a history of uric‑acid kidney stones?

Is Salmon Low Purine?

No, salmon is not a low-purine food—it falls into the moderate-to-high purine category (typically 100–200 mg/100g), and patients with gout or hyperuricemia should consume it in limited quantities rather than freely. 1, 2

Purine Content Classification

• Low-purine foods contain <50 mg/100g and include dairy products (0.0–1.4 mg/100g), most vegetables (0.9–47.1 mg/100g), and grains 1
• Moderate-purine foods contain 50–150 mg/100g 2
• High-purine foods contain 150–200 mg/100g 2
• Very high-purine foods contain >200 mg/100g and should be strictly limited 1, 2

Fish and seafood as a category range from 19.0–385.4 mg/100g, with most common fish (including salmon) falling in the moderate-to-high range 1. Shellfish specifically carries a 1.51-fold increased gout risk 3.

Practical Dietary Guidance for Gout Patients

Foods to Prioritize Instead of Fish

• Low-fat or non-fat dairy products (milk, yogurt, cheese) contain minimal purines (0.0–1.4 mg/100g) and are associated with lower gout risk through potential uricosuric effects 3, 1
• Eggs provide high biological value protein with minimal purine content and are explicitly recommended as safe animal protein sources 3
• These protein sources should constitute at least 50% of dietary protein intake 3

Purine Intake Targets

• Japanese guidelines recommend <400 mg total dietary purines per day for patients with gout or hyperuricemia 4, 1, 5
• Well-balanced diets (Japanese, Mediterranean, DASH, American MyPlate) naturally provide 308–494 mg/day of purines, staying within this recommended range 5
• A single serving of moderate-purine fish can consume 20–40% of the daily purine allowance 1

Higher Priority Dietary Modifications

The American College of Rheumatology emphasizes that dietary modifications yield only modest serum uric acid reductions (10–18%), making the following interventions more impactful than fish restriction alone: 4, 3

• Alcohol limitation (especially beer and spirits) reduces flare risk by 40% when avoiding >1–2 drinks per 24 hours; heavy drinkers (≥30 units/week) continue having flares despite urate-lowering therapy 4, 3
• Weight loss >5% BMI is associated with 40% lower odds of recurrent flares and reduces serum uric acid by approximately 1.1 mg/dL per 5 kg lost 4, 3
• Avoiding high-fructose corn syrup and sugar-sweetened beverages, as 1 gm fructose/kg body weight raises serum uric acid by 1–2 mg/dL within 2 hours 4, 3

Critical Clinical Pitfalls

• Overemphasizing fish restriction while ignoring alcohol: Beer raises uric acid and triggers flares more consistently than moderate fish intake 4, 3
• Eliminating all purine-rich foods including beneficial ones: The American College of Rheumatology specifically warns against eliminating fatty fish with omega-3 fatty acids that provide cardiovascular benefits 3
• Relying on diet alone: Pharmacologic urate-lowering therapy (allopurinol, febuxostat) is required for most patients to achieve target serum uric acid <6 mg/dL; dietary measures serve only as adjuncts 4, 3
• Patient-blaming: Gout has strong genetic contributions (accounting for most hyperuricemia), so dietary counseling should be supportive rather than stigmatizing 4, 3

Evidence Quality Note

A small randomized trial (n=29) using low-purine diet education did not demonstrate significant serum uric acid reduction despite improved dietary knowledge, highlighting the limited therapeutic impact of purine restriction alone 4. The dose-response relationship exists (higher purine intake increases flare risk), but individual dietary factors have small effects—a unit of beer raises uric acid by only 0.16 mg/dL 4.