purines

Gout is a complex and often debilitating form of arthritis, characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, most commonly the big toe. These painful episodes arise when uric acid levels in the blood become excessively high, leading to the formation of sharp, needle-like urate crystals within a joint or surrounding tissue. While medication plays a crucial role in managing gout, dietary adjustments are a cornerstone of preventing flare-ups and maintaining long-term joint health. Understanding which foods contribute to elevated uric acid and which can help lower it is paramount for individuals living with this condition.

A well-structured gout diet centers on minimizing the intake of purines, natural compounds found in many foods. When your body metabolizes purines, it produces uric acid. For individuals with gout, either their kidneys cannot efficiently excrete uric acid, or their bodies produce too much of it, leading to a buildup. By carefully selecting foods low in purines and incorporating those that support uric acid excretion, it's possible to significantly reduce the frequency and severity of gout attacks. This proactive dietary approach empowers individuals to take a more active role in managing their condition and improving their quality of life.

What Foods Are Safe to Eat?

Managing gout effectively involves selecting foods that naturally help lower uric acid levels and promote overall well-being. The goal is to keep your serum uric acid levels below 6 mg/dl to prevent crystal formation. Numerous studies have demonstrated that adhering to a specific dietary regimen can be highly effective, not only in reducing the frequency of gout attacks but also in alleviating the severity of associated symptoms, making daily life more comfortable for those affected. This comprehensive strategy targets the underlying metabolic pathways that contribute to gout development and progression.1

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Vegetables: For many years, there was a misconception that purine-rich vegetables like asparagus, spinach, and cauliflower should be avoided by people with gout. However, contemporary research has debunked this myth, showing that even consuming these supposedly problematic vegetables does not negatively impact uric acid levels or elevate the risk of a gout attack.2 In fact, including a wide array of vegetables in your diet is highly beneficial. They are packed with essential vitamins, minerals, and fiber, contributing to overall health and assisting in achieving or maintaining a healthy weight—a critical factor in reducing the likelihood of gout flare-ups.

Dairy Products: Incorporating low-fat dairy products into your daily diet can be a valuable strategy for gout management. Scientific studies have highlighted that certain proteins present in dairy, such as casein and lactalbumin, possess properties that can actively help reduce uric acid levels in the body.1 Opting for low-fat alternatives like skim milk, low-fat yogurt, or cottage cheese is particularly advantageous. These choices not only provide the beneficial proteins for uric acid reduction but also contribute to a healthy weight, which is a key component of a successful gout prevention plan and overall well-being.

Tofu, Whole Grains, Beans, and Lentils: While a gout diet often necessitates reducing intake of high-purine meats and seafood, it's essential to maintain adequate protein consumption, aligning with the U.S. Department of Agriculture (USDA) recommendations of 10% to 35% of daily calories. Plant-based protein sources like tofu, whole grains, beans, and lentils are excellent alternatives. Not only do they help meet your protein requirements, but emerging evidence suggests they may also offer a protective effect against gout attacks.1 These foods are also rich in fiber and complex carbohydrates, contributing to satiety and supporting a healthy digestive system.3

Citrus Fruit: Vitamin C is increasingly recognized for its potential role in gout management, although more dedicated research continues to unfold. This essential nutrient is believed to assist the kidneys in flushing out excess uric acid from the body, thereby potentially reducing the frequency of gout flare-ups.4 Citrus fruits such as grapefruit, oranges, and pineapple are excellent natural sources of vitamin C. When choosing fruits, prioritize those lower in fructose, a natural sugar that can, in higher amounts, potentially increase uric acid levels. This thoughtful selection maximizes the benefits while minimizing any potential drawbacks.

Cherries: The remarkable benefits of cherries, particularly tart cherries, for gout sufferers have garnered significant attention in medical research. Studies have consistently demonstrated that regular consumption of cherries or 100% tart cherry juice can effectively lower serum uric acid levels.5 This therapeutic effect is largely attributed to anthocyanins, powerful flavonoids found abundantly in cherries. Anthocyanins exhibit strong anti-inflammatory and antioxidant properties, which are crucial for combating the inflammation associated with acute gout attacks and providing natural relief from discomfort.6

Coffee: For coffee enthusiasts, there's good news regarding its role in a gout-friendly diet. Research indicates that consuming a moderate amount of coffee does not appear to elevate uric acid levels. In fact, some studies even suggest that regular coffee intake may actually reduce the risk of developing gout.7 While the exact mechanisms are still being explored, this finding offers reassurance and flexibility for individuals seeking to manage their gout effectively. It's important to note that moderation is key, and individual responses can vary.

Avocados: Avocados are a nutritional powerhouse and an excellent addition to a gout-friendly diet. They are naturally very low in purines, making them a safe food choice. Furthermore, avocados are rich in monounsaturated fats and vitamin E, both of which are known for their potent anti-inflammatory and antioxidant effects. These compounds can play a significant role in reducing the pain and inflammation often experienced during gout attacks. Diets that are high in these beneficial fats and antioxidants have also been linked to a decreased risk of joint damage, offering a protective effect for long-term joint health.8

Water: Consuming sufficient water is perhaps one of the simplest yet most effective strategies for gout management. Water is crucial for kidney function, enabling these vital organs to efficiently excrete uric acid from the body. Adequate hydration helps dilute uric acid in the bloodstream, preventing its concentration and subsequent crystal formation. Aiming for at least eight glasses of water daily can significantly reduce the risk of recurrent gout attacks, with some studies showing a reduction of up to 46%.9 Maintaining consistent hydration supports overall kidney health and uric acid clearance.

What Is Purine?

Purine is a chemical compound naturally found in certain foods and also produced by the body. When purines are metabolized, they break down to create uric acid. In individuals with gout, an excess of uric acid leads to the formation of needle-shaped crystals that deposit in and around the joints, triggering the excruciating pain and inflammation characteristic of gout attacks. Normally, the kidneys excrete uric acid from the body, but in gout, this process is impaired, allowing uric acid to accumulate and crystallize.10

Avoid These Foods

Certain foods and beverages are known contributors to elevated uric acid levels and, consequently, an increased risk of gout symptoms and painful flare-ups. A pivotal study revealed that individuals who consistently consumed a diet rich in purines experienced a five-fold increase in the likelihood of recurrent gout attacks. Conversely, consciously reducing the intake of these high-purine foods proved instrumental in significantly lowering the risk of subsequent episodes, underscoring the profound impact of dietary choices on gout management and prevention.11

The following categories of foods and beverages should be either strictly limited or, ideally, entirely avoided if you have a diagnosis of gout or are at a heightened risk of developing this condition:

Red Meat and Organ Meat: Red meats generally contain higher purine levels compared to white meats. Regular or excessive consumption of red meats, such as beef, venison, and bison, has been consistently linked to an increased risk of recurrent gout attacks. Organ meats, including liver, sweetbreads, tongue, and kidney, are particularly notorious for their extremely high purine content and should be entirely avoided. These foods directly contribute to the uric acid overload that precipitates painful gout flares, making their avoidance a critical step in dietary management.12

Coldwater Fish, Shellfish: While fish can be a healthy part of many diets, certain types are exceptionally high in purines and should be carefully limited or avoided by individuals managing gout. These include coldwater fish such as tuna, trout, herring, sardines, and anchovies. Similarly, many shellfish varieties, including shrimp, oysters, crab, and lobster, are known to have elevated purine levels.13 While some experts suggest occasional consumption of certain fish may be permissible, a general guideline is to reduce intake to prevent an unnecessary surge in uric acid that could trigger an attack.

Yeast Extract: Yeast extract is a concentrated food additive commonly used to enhance savory flavors in various products. Unfortunately, spreads such as Marmite, Vegemite, and Vitam-R are notable for their exceptionally high purine content due to the presence of yeast extract. Consuming these products can lead to a significant increase in uric acid levels in the body, directly raising the risk of gout attacks. Therefore, it is strongly advised to avoid all foods and spreads containing yeast extract to help maintain optimal uric acid levels and prevent painful flare-ups.14

Beer and Liquor: Alcohol consumption, particularly beer and liquor, is a significant trigger for gout attacks and should be largely avoided. These beverages not only contribute to uric acid production but, more critically, they also impede the kidneys' ability to excrete uric acid from the body. This dual effect rapidly elevates uric acid levels, increasing the risk of crystal formation.15 While beer and spirits are particularly problematic, some studies suggest that moderate consumption of wine does not appear to be associated with a higher incidence of gout, offering a slight distinction.16

Sugary Foods and Beverages: A critical component of a gout-friendly diet involves limiting or entirely avoiding foods and beverages high in fructose, especially those containing high-fructose corn syrup. Fructose metabolism in the body can directly lead to increased purine production and, consequently, higher uric acid levels.17 This includes popular items such as sodas, other sugary drinks, canned fruits in syrup, and many commercial fruit juices. Additionally, high-sugar processed foods like snack bars, doughnuts, pastries, candy, and certain breakfast cereals should be minimized to prevent spikes in uric acid.

White Bread and Honey: Carbohydrates that are rapidly digested and absorbed by the body can lead to quick spikes in blood sugar levels. This glycemic response, in turn, has been observed to contribute to an increase in uric acid levels.18 Therefore, it is advisable to avoid refined carbohydrates such as white bread, white rice, cookies, and cakes. Although honey is a natural sweetener, it is notably high in fructose. When the body breaks down fructose, it inadvertently releases purines, which can further exacerbate uric acid levels and should be limited.19

Recommended Foods

• Vegetables
• Dairy products
• Tofu
• Whole grains
• Beans and lentils
• Plant-based oils
• Citrus fruits
• Cherries or 100% cherry juice
• Coffee
• Avocados

Foods to Avoid

• Red meat
• Organ meats
• Coldwater fish
• Some shellfish
• Yeast extract
• Beer, liquor
• Sugary foods and beverages
• White bread
• Honey

Some people with gout take a vitamin C supplement. Speak with your healthcare provider to see if supplementation is needed and whether it fits into your diet and medication plan.

Sample Menu on the Gout Diet

Designing a daily menu that aligns with gout diet principles involves prioritizing low-purine foods while ensuring all nutritional needs are met. The key is to create well-balanced meals that reduce or eliminate foods known to elevate uric acid, simultaneously supporting the maintenance of a healthy weight. This approach not only helps manage gout symptoms but also promotes overall health. Here is an example of a day's worth of meals that effectively meet these crucial dietary goals:

For breakfast, a hearty bowl of oatmeal serves as an excellent foundation, providing complex carbohydrates and fiber for sustained energy. Complement this with a serving of tart cherries, known for their uric acid-lowering properties, and a side of low-fat cottage cheese for beneficial dairy proteins. Enjoying a moderate amount of coffee can also be included, as research suggests it may lower gout risk. This combination offers a satisfying and health-conscious start to the day.

Lunch could feature a crunchy lettuce wrap filled with nutrient-rich tofu, an array of mixed vegetables for essential vitamins and fiber, and a serving of brown rice for complex carbohydrates. This meal provides a balanced intake of plant-based protein and low-purine ingredients, offering a refreshing and light option. For dinner, consider whole wheat pasta tossed with mozzarella cheese and a generous portion of broccoli. Conclude the meal with a citrus fruit salad, incorporating lower-fructose fruits like oranges or grapefruit, to support vitamin C intake and aid in uric acid excretion.

The gout diet is remarkably flexible and can be adapted to suit various dietary preferences and needs. Individuals who adhere to vegetarian, vegan, or gluten-free eating plans can easily adjust their meals by focusing on the recommended plant-based proteins, whole grains, and diverse vegetables. While those following a pescatarian or Mediterranean diet might face more challenges due to the limitation on certain high-purine fish and shellfish, some experts, including the Arthritis Foundation, suggest that occasionally consuming specific types of fish may still offer benefits.13 Working closely with your healthcare provider or a nutritionist specializing in gout management is highly recommended to tailor a personalized plan. They can also advise keeping a food diary to pinpoint specific food triggers that might increase your individual risk of a flare-up.

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Other Ways You Can Manage Gout Flare-Ups

While dietary modifications are fundamental, a gout diet is typically part of a broader, comprehensive treatment plan designed to manage the condition effectively. Your healthcare provider may recommend several other synergistic strategies to help prevent and alleviate gout flare-ups, ensuring a more holistic approach to long-term management. These additional recommendations work in tandem with dietary changes to reduce uric acid levels, control inflammation, and minimize the frequency and severity of painful attacks.

Weight Loss: Maintaining a healthy weight is a powerful tool in the battle against gout. Numerous studies have unequivocally demonstrated that achieving and sustaining a healthy body weight can significantly reduce the frequency of gout flare-ups.1 It's crucial, however, to approach weight loss judiciously. Rapid or "crash" dieting can paradoxically trigger a gout attack due to quick changes in metabolic processes and a temporary increase in uric acid levels during rapid fat breakdown.20 Therefore, gradual and sustainable weight loss through healthy eating and regular exercise is the recommended and safest approach.

Exercise: Regular physical activity is essential for overall health and plays a supportive role in gout management. Consistent exercise helps improve joint function and mobility, which can be particularly beneficial for joints affected by gout. Furthermore, it contributes significantly to maintaining a target body weight, thereby reducing the risk of flare-ups. However, it's vital to choose appropriate exercises and avoid overly strenuous activities that could stress joints. Equally important is staying well-hydrated during exercise, as dehydration can increase the concentration of uric acid in the blood, potentially triggering a gout attack.21

Medication: For acute gout attacks and long-term management, medication often complements dietary and lifestyle changes. For immediate relief from the excruciating pain and inflammation of a flare-up, your healthcare provider may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. In some cases, corticosteroid injections directly into the affected joint may be recommended to quickly suppress inflammation and end a severe flare-up. Beyond acute management, long-term medications may be prescribed to lower uric acid levels and prevent future attacks.22

Key Takeaways

• Effective gout management and the reduction of painful flare-ups can be achieved through a low-purine diet focusing on plant-based foods, whole grains, and specific beneficial items.
• It is crucial to consciously avoid or severely limit foods with high purine levels, such as red and organ meats, certain alcoholic beverages, and highly sugary treats, to prevent uric acid accumulation.
• Incorporating a multi-faceted approach that includes maintaining a healthy weight through gradual loss, engaging in regular, appropriate exercise, and utilizing prescribed medications when necessary, significantly enhances the ability to manage gout and ease flare-ups.

A Word From Verywell

While following a low-purine diet is not a definitive cure for gout, it stands as a remarkably effective strategy for significantly reducing the risk of painful flares and often minimizing the reliance on prescription medications. Embracing this eating plan can profoundly improve your quality of life and give you more control over your condition. For optimal adherence and to ensure your dietary choices align with your specific health needs, collaborating with a qualified nutritionist experienced in gout management can be exceptionally beneficial. They can offer personalized guidance and support as you navigate this new eating plan.
— ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD

Read more:

• Health A-Z
• Arthritis
• Gout

22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective – A review. J Adv Res. 2017;8(5):495-511. doi:10.1016/j.jare.2017.04.008
2. Aihemaitijiang S, Zhang Y, Zhang L, et al. The association between purine-rich food intake and hyperuricemia: a cross-sectional study in chinese adult residents. Nutrients. 2020;12(12):3835. doi:10.3390/nu12123835
3. Wolfe RR, Cifelli AM, Kostas G, Kim IY. Optimizing protein intake in adults: Interpretation and application of the recommended dietary allowance compared with the acceptable macronutrient distribution range. Adv Nutr. 2017;8(2):266-275. doi:10.3945/an.116.013821
4. Brzezińska O, Styrzyński F, Makowska J, Walczak K. Role of vitamin C in prophylaxis and treatment of gout—a literature review. Nutrients. 2021;13(2):701. doi:10.3390/nu13020701
5. Martin KR, Coles KM. Consumption of 100% tart cherry juice reduces serum urate in overweight and obese adults. Current Developments in Nutrition. 2019;3(5):nzz011. doi:10.1093/cdn/nzz011
6. Lamb KL, Lynn A, Russell J, Barker ME. Effect of tart cherry juice on risk of gout attacks: Protocol for a randomised controlled trial. BMJ Open. 2020;10(3):e035108. doi:10.1136/bmjopen-2019-035108
7. Park KY, Kim HJ, Ahn HS, et al. Effects of coffee consumption on serum uric acid: Systematic review and meta-analysis. Semin Arthritis Rheum. 2016;45(5):580-586. doi:10.1016/j.semarthrit.2016.01.003
8. Arthritis Foundation. Best fruits for arthritis.
9. Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological management of gout and hyperuricemia: Hints for better lifestyle. Am J Lifestyle Med. 2017;11(4):321-329. doi:10.1177/1559827615601973
10. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout.
11. Danve A, Sehra ST, Neogi T. Role of diet in hyperuricemia and gout. Best Pract Res Clin Rheumat. 2021;35(4):101723. doi:10.1016/j.berh.2021.101723
12. Centers for Disease Control and Prevention. Gout.
13. Arthritis Foundation. Which foods are safe for gout?
14. Zhang Y, Chen S, Yuan M, Xu Y, Xu H. Gout and diet: A comprehensive review of mechanisms and management. Nutrients. 2022;14(17):3525. doi:10.3390/nu14173525
15. Rasheed H, Stamp LK, Dalbeth N, Merriman TR. Interaction of the GCKR and A1CF loci with alcohol consumption to influence the risk of gout. Arthritis Res Ther. 2017;19(1):161. doi:10.1186/s13075-017-1369-y
16. Helget LN, Mikuls TR. Environmental triggers of hyperuricemia and gout. Rheumatic Disease Clinics of North America. 2022;48(4):891-906. doi:10.1016/j.rdc.2022.06.009
17. Caliceti C, Calabria D, Roda A, Cicero A. Fructose intake, serum uric acid, and cardiometabolic disorders: A critical review. Nutrients. 2017;9(4):395. doi:10.3390/nu9040395
18. Juraschek SP, McAdams-Demarco M, Gelber AC, et al. Effects of lowering glycemic index of dietary carbohydrate on plasma uric acid levels: the OmniCarb randomized clinical trial. Arthritis Rheumatol. 2016;68(5):1281-1289. doi:10.1002/art.39527
19. Zhang C, Li L, Zhang Y, et al. Recent advances in fructose intake and risk of hyperuricemia. Biomed Pharmacother. 2020;131:110795. doi:10.1016/j.biopha.2020.110795
20. U.S. Department of Health and Human Services. Gripped by gout. NIH News in Health.
21. Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological management of gout and hyperuricemia: Hints for better lifestyle. Am J Lifestyle Med. 2017;11(4):321–329. doi:10.1177/1559827615601973
22. Harvard Health Publishing. Treatments for Gout.