What foods are recommended for a person with gout?

Foods to Eat When You Have Gout

Strongly encourage low-fat or non-fat dairy products (skim milk, low-calorie yogurt, cheese) as your primary protein sources, since these are associated with lower gout risk and may actively lower uric acid through uricosuric effects. 1, 2

Foods to Encourage and Eat Liberally

Dairy Products (Highest Priority)

• Low-fat or non-fat dairy products should be consumed regularly—including skim milk, low-fat yogurt, and cheese—because they lower gout risk and may reduce serum uric acid through direct uricosuric properties. 1, 2
• Skim milk powder can be added to foods to boost protein content safely without raising uric acid. 1
• Eggs provide high biological value protein with minimal purine content and are explicitly recommended as safe animal protein sources. 1

Plant-Based Foods

• Vegetables should be consumed liberally, as higher fruit and vegetable intake increases urinary pH, enhancing uric acid solubility and reducing crystal formation risk. 1
• Nuts, legumes, and whole grains are healthy choices that help prevent gout by reducing insulin resistance and managing comorbidities. 3

Beverages

• Regular coffee consumption is inversely associated with gout incidence and may be considered a preventive measure. 1, 3
• Tea does not increase gout risk and may confer modest protective effects. 1

Specific Foods with Potential Benefits

• Cherries or cherry juice may modestly reduce serum urate levels and decrease gout attack frequency, though the certainty of evidence is low to very low. 1, 2
• Vitamin C supplementation (dose not specified in guidelines) may lower urate levels and could be considered as a preventive measure. 3

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Foods to Limit or Avoid Completely

Alcohol (Critical Priority)

• Limit all alcohol consumption, with particular emphasis on beer and spirits, because these raise uric acid through adenine nucleotide degradation and lactate production that impairs renal excretion. 1, 2
• Complete alcohol abstinence is mandatory during active gout flares, especially when medical control is inadequate. 1, 2
• Consuming more than 1–2 alcoholic drinks within 24 hours increases flare risk by approximately 40% in a dose-response manner. 2
• Heavy drinkers (≥30 units/week) continue experiencing flares despite urate-lowering therapy. 2
• Beer is particularly problematic compared to other alcoholic beverages. 1, 2

Purine-Rich Meats and Seafood

• Limit purine-rich meats—including organ meats (liver, kidney), red meat, and game meats—as these raise serum uric acid and increase flare risk through increased purine metabolism. 1, 2
• Restrict shellfish and seafood consumption, which increases gout risk with a relative risk of 1.51. 1, 2
• Japanese dietary guidelines recommend keeping total dietary purine intake below 400 mg per day. 1, 2
• Important caveat: Do not eliminate fatty fish containing omega-3 fatty acids entirely, as these provide cardiovascular benefits that outweigh modest purine content. 1

Sugar-Sweetened Beverages and Fructose

• Eliminate sugar-sweetened beverages and energy drinks containing high-fructose corn syrup, as these raise uric acid through increased production and reduced excretion. 1, 2
• Moderate foods high in fructose, including certain fruit juices (particularly orange and apple juice), because an acute dose of 1 g/kg body weight of fructose can raise serum uric acid by 1–2 mg/dL within two hours. 1, 2
• Avoid heavy meals in general. 1

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Weight Management (Essential Component)

• Achieve weight reduction through daily exercise and calorie restriction if you are overweight or obese, as a ≥5% reduction in BMI lowers the odds of recurrent flares by approximately 40%. 1, 2, 4
• An average weight loss of 5 kg is associated with a mean serum uric acid reduction of approximately 1.1 mg/dL, independent of purine restriction. 1, 2
• Regular physical activity decreases the excess mortality associated with chronic hyperuricemia. 4

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Critical Limitations You Must Understand

• Dietary modifications alone achieve 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, 2
• Pharmacologic urate-lowering therapy (allopurinol or febuxostat) is required for most patients to achieve target serum uric acid <6 mg/dL; dietary measures serve only as important adjuncts, not primary treatment. 1, 2, 4
• A single unit of beer raises uric acid by only approximately 0.16 mg/dL, illustrating the modest effect of individual dietary factors. 1, 2
• Dietary factors serve more as flare triggers than primary causes of sustained hyperuricemia. 1

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Common Pitfalls to Avoid

• Do not underestimate the flare-triggering effect of alcohol, particularly beer—this is often the most modifiable dietary risk factor. 2
• Do not neglect weight management in overweight/obese gout patients, as this has both uric acid-lowering and flare-reducing effects. 2
• Do not eliminate all purine-rich foods indiscriminately; some (like fatty fish with omega-3s) provide cardiovascular benefits that are important given gout's association with metabolic syndrome. 1
• Avoid framing dietary counseling as "patient-blaming"; gout has strong genetic contributors that account for the majority of hyperuricemia, and patients frequently feel stigmatized. 1
• Do not rely on diet alone—recognize that pharmacologic therapy is the mainstay of treatment, with diet playing a supportive role. 1, 2, 5