6 Risky Foods To Avoid With Gout (No. 5 Was Unexpected)

[Last Updated, 6th December 2017]

A gout attack is not pleasant.

The pain is so bad that sufferers are often hospitalised for days, if not weeks.

More importantly, gout is typically indicative of other more serious health issues behind the scenes… Like a window into the state of an individual’s metabolic health.

Unfortunately the occurrence, or recurrence of gout is only getting worse.

Rates are on the rise from China to the UK, and it is now the most common inflammatory arthritis in the US (1, 2).

Information online about gout treatment can be particularly confusing, and even contradictory at times.

This is because we don’t yet completely understand the mechanism behind gout… But we do have a lot of big clues.

The following is a list of the top 6 foods to avoid with gout, explaining what we know and how it applies to you.

What is Gout and What Causes It?

Before we can look at foods to avoid with gout, it is necessary to briefly understand what it is.

Gout is a form of joint inflammation, caused by excessive uric acid in circulation (known medically as Hyperuricaemia).

When the body’s natural uric acid threshold is exceeded, painful crystals (urate) can form in and around the joints. These crystals trigger the characteristic symptoms and pain.

what is gout in the toe

Not everybody with high uric acid levels will get gout, but those who do always have high uric acid levels. This indicates there are other factors at play, but from a dietary perspective uric acid is the focus.

Excessive uric acid in the blood stream is typically driven by two factors: genetic predisposition (family history) and the ingestion of high-purine foods. Obviously, the dietary factor we can control.

When purines we eat are broken down and metabolised by the body, uric acid is formed as a by-product of this process. It’s normal and healthy for uric acid to be formed, but excessive amounts are problematic.

Therefore, consuming less purine-rich foods should lower uric acid levels in your blood, lowering gout risk.

At least, in theory.

It’s actually not that clear-cut because other nutrients appear to aggravate gout symptoms too…

Here’s a list of foods to avoid if you have gout, based on real scientific evidence.

Summary: Gout is a type of joint inflammation that occurs when excessive uric acid levels build up in the blood. The breakdown of purines from our food is thought to drive excess uric acid levels, although there is much more to it.

1. Alcohol is the biggest risk factor for gout

alcohol and goutIt is well-established that frequent alcohol intake dramatically increases risk of gout (3).

The Framingham Heart Study of over 4,500 participants provides some perspective.

Researchers found that regular alcohol use was associated with three times greater risk of gout in women compared to those who have less than 2 standard drinks per week. For men, regular drinkers had double the risk of non-drinkers (4).

Beer seems to be the worst, followed by hard liquors such as spirits. Interestingly, moderate wine consumption is not linked with any risk (5).

The reason why alcohol increases uric acid levels is still not well-understood. Some forms, particularly beer, can be high in purines… but they are certainly not the richest source of purines in our diet.

Additional theories propose that excessive alcohol may also reduce the body’s ability to excrete uric acid. Others state that alcohol – especially beer – increases the chemical breakdown of purine-containing ATP nucleotides, which is a precursor of uric acid production (6, 7).

Summary: Regular alcohol intake severely raises uric acid levels in the blood. It doubles, if not triples your risk of gout.

2. Chicken, beef and other meats appear to be foods to avoid with gout

The conversion of purines to uric acid, in theory, causes gout.

Therefore high-purine foods are often suspected to trigger symptoms.

Meat, and to a lesser extent seafood, are prime suspects. This includes all the most common meats like beef, chicken, pork and lamb.

The data available somewhat confirms suspicions.

chicken, meat and gout

Each additional daily serving of meat or seafood is associated with a 21% or 7% increased risk of gout, respectively (8). This implies meat could be three times worse than seafood.

There was another similar study that found even greater risks associated with meat intake, but none for seafood. Overall this suggests seafood is far less of a concern than meat (9).

For those who already have gout, the impact of meat intake (and maybe seafood) on symptoms is even worse. This is likely due to sharper increases in blood uric acid, as well as poorer clearance by the body (10).

Therefore if you have a history of gout, it is best to dramatically reduce your meat intake, and seafood as well to a lesser extent. Anecdotal evidence suggests avoiding dark part of salmon, and de-veining prawns/shrimp before eating.

You should also buy your meat direct from the butcher where possible, or at least the better quality choices in the supermarket. Sausages and low-quality ground beef may contain traces of organ meat that can cause big problems (see the next point).

In saying that, it would be beneficial to include high-quality (purine-free) Omega-3 fish oil supplements in your diet. They have powerful anti-inflammatory properties that may help with gout symptoms.

Summary: Frequent consumption of meat is strongly linked with gout risk. The impact of seafood appears far less severe, but there is a link.

3. Organ meats are extremely high in purines and should also be avoided

offal organ meats and goutOrgan meats, known as Offal, contain by far the most purines of any food in the human diet.

The most common forms of offal in the Western diet include liver (such as Foie Gras), brain, heart, kidneys, and a mixture called Pâté.

Below is the purine content of a handful of foods. Note this is just an example I’ve selected, and you can find much more extensive lists on Goutpal or here.

Purine Content of Food (per 100 grams):

purines in food list

Consider that values listed are per 100 grams, so portion sizes must be taken into account… Meat portions we eat tend to be heaviest.

Previous studies have not differentiated between intake of conventional meat and offal, so recommendations have to be the same. Given the strong link between meat intake and gout – which is based on purine content alone – offal should definitely be avoided too.

Somewhat contradictory to the purine-gout theory, consumption of purine-rich vegetables is not associated with an increased risk of gout (3).

Researchers speculate this could be due to a lower bioavailability of purines in vegetabes, as well as other nutrients which may offset the harmful effects of their purines.

Summary: Organ meats are some of the highest purine foods and should be completely avoided if you suffer gout attacks.

4. A good diet for gout should not include soft drinks or fruit juice

fructose soft drinks and goutAdded sugar is a big problem in the modern diet.

Generally speaking, the sugar that is added to our food and drink products are 50% glucose and 50% fructose.

While glucose molecules are metabolised in the cell, fructose is metabolised in the liver. Further explanation is out of the scope of this article,  but they behave very differently in the body.

Fructose intake, and not glucose intake, is strongly linked with gout.

Soft drinks and fruit juices tend to have the greatest amount of added sugar, and therefore the greatest amount of added fructose.

In fact, gout occurrence in the US has risen in line with fructose consumption (listed as high fructose corn syrup) since 1970 (11).

fructose intake and gout

In a large study of over 46,000 men, researches found that two or more sugar-sweetened soft drinks a day was associated with an 85% increased risk of gout (12).

The largest consumers of sugar-sweetened soft drinks (and foods) actually had a risk of gout comparable to the risk seen with three to five servings of alcohol.

Unfortunately the researchers did not account for family history of gout, which may or may not have changed their findings somewhat.

The strange thing out of all this, however, is that soft drinks don’t typically contain purines.

Fructose is thought to be the “culprit” linking added sugars with gout. It appears to share the same mechanism as alcohol: fructose accelerates the breakdown of purine-containing nucleotides like ATP. This in turn drives up uric acid levels (13, 14, 15).

Glucose and other simple sugars, on the other hand, have no effect on uric acid.

It still remains unclear whether the increase in gout incidence is caused directly by fructose, or indirectly through some other mechanism, such as obesity (16).

Either way, added sugars appear to play a part and should be avoided to minimise gout risk. They offer no nutritional value anyway.

If you must have something sweet, diet soft drinks (artificially sweetened) were not associated with gout and appear to be safe (17). Just know that several artificial sweeteners are thought to upset gut bacteria, and are not necessarily a healthier choice.

Summary: Drinks high in added sugar are associated with an 85% increased risk of gout in men. Fructose is thought to be the nutrient responsible as it stimulates uric acid production in the same way as alcohol.

5. Frequent consumption of certain fruits may trigger recurrent gout attacks

fructose in fruit and goutHigh sugar drinks may not be the only stimulant of gout flare ups.

Certain fruits – which are a natural source of fructose – have also been linked with gout.

This is a highly contentious area, because several studies have linked higher fruit intake with less incidence of gout. This is probably due to their high fibre content (9, 18).

And unlike fruit juice and other sugar-sweetened drinks, whole fruits are nutritious and generally good for health. There is no disputing this.

However, if you continually have gout attacks – despite cutting out alcohol and sugar-sweetened drinks – then I’m not convinced a large amount of fruits are safe for you. Especially if you are overweight and eat a Western diet.

So cutting back on certain very high-fructose fruits is like a Plan D, if you will.

The link comes back to fructose, which stimulates uric acid production in a similar manner to alcohol. Fructose is naturally found in fruit and honey.

One study found that the consumption of apples or oranges – the most popular fruits in this study – was linked with an increased risk of gout compared to those who consume less than one serving of fruit per month. No link was found with other fruits however (12).

While most fruits are very low in fructose, a few are very high. Frequent consumption of these could theoretically causes problems for gout sufferers.

Foods Highest in Fructose per 200 Calories (19):

fructose in food list

Note this list is ranked on a per calorie basis, not per serving.

200 calories of soft drink equals just over one standard 375 ml (16 oz) can, hence why gout sufferers should avoid soft drinks.

But looking at fruits, 200 calories also equals 3 medium apples, 3 medjool dates, or 2.5 wedges of watermelon. It is easily possible to consume these amounts in the course of a few hours, or less.

If the fructose content in soft drinks and juices may contribute directly to gout, then the same can be said for an equivalent amount in fruit.

Summary: In theory, large intakes of certain fruits may also aggravate gout in those who suffer frequent attacks.

6. Aspirin and diuretics significantly increase gout risk

aspirin and goutNot exactly foods to avoid with gout, but the ingestion of some common medications sharply raise the risk of a gout attack.

Specifically, low doses of aspirin, which one in three middle-aged Americans takes regularly to help prevent heart disease (20).

The emphasis is on low doses because aspirin has a dual effect on uric acid levels. Very high doses above 3,000 mg promotes excretion of uric acid (good in this case), whereas low doses prevent excretion (21).

In a study of 49 elderly patients, just 75 mg of aspirin per day increased blood uric acid levels by 6% within one week. A daily dose of 150 mg kept levels high during the second week, before coming down with 300 mg doses in the third week (22).

uric acid and aspirin use

Considering the typical dose for heart disease prevention is 81-325 mg per day, it is no real surprise this dosage is associated with a doubling in gout risk.  In fact, even the use of a low-dose aspirin for two consecutive days (as a painkiller for example) increases risk of recurrent gout attacks (23).

Another type of medication known to trigger gout is diuretics. They are typically used to treat high blood pressure and oedema, and if feasible should be discontinued in gout sufferers.

I’m by no means recommending you cease your medications if you have gout, but it’s important to understand the pharmaceutical triggers. First speak with your doctor and closely monitor uric acid levels before making any changes.

And if you need a temporary painkiller, choose paracetamol or ibuprofen. No aspirin.

Summary: Low dose aspirin is a widely used drug that is proven to trigger gout, even if taken for a short period of time. Diuretics are also known to increase risk.

The cause of gout is more than just diet

While diet is critical, don’t overlook other important factors that affect gout. These include family history, sleep apnoea, and lack of physical exercise to name a few.

Further discussion of best treatment for gout is outside the scope of this article. But there are foods thought to be protective; namely dairy, cherries, and coffee, in decreasing order of evidence.

And as much as I prefer focusing on what you should eat to prevent health scares, there are just so many clear trigger foods for gout.

It’s important to deal with these factors first and foremost.

By understanding what to avoid, and why, gives you the best chance to overcome it.

6 risky foods to avoid with gout

Comments

  1. Good post, Joe. I’ve forwarded this to a friend who suffers from gout. Cheers!

  2. Mark Wadel says:

    Joe, this is a very helpful post. I have had gout for many years and always attempted to avoid certain types of meat or breads but would still have gout flare ups – the sugar was something that I wasn’t paying attention to. After I became more mindful of syrup, sugar, fruit juices – that reduced my gout attacks even more. One thing that I have found that works for me for eating meat occasionally, is to buy fresh meat or ask the butcher directly for trimmed meat. I like to cook and if you want to make your own sausage for breakfast or ground beef for a dinner dish you can with a well trimmed piece of meat and grind it yourself and add spices. The big problem with sausage or ground beef that you buy at the grocery store is because the producers throw in organ meat or whatever they have left over into sausage or ground beef which is a sure fire way to get a gout attach. Also, seafood is great but remove the dark / fatty part of the salmon or fish. With shrimp – make sure the shrimp is de-veined – this has got me many times – one missed shrimp and I will be in pain in a few hours.

  3. naz@akabane says:

    thanks for your tips JOE..yes i have avoided some of that already..and took me a while also to realised that juice fruits also can trigger gout but i keep to myself as a list to avoid until i read your post,so that should be comfirm but sometimes maybe it depend on immune system to certain people of this patient.. ..and some of vegetables also can give some effect…and for me like cabbage also one of foods i need to avoid it immediately can trigger…for fruit,like watermelon,apple,pear..you can take by small piece to taste only should be no problem,…and of course squid!!…sausage in big quantity,but sometimes if eat 1 or 2 also can trigger already..and i notice a lot frozen food sometime can make it happen like burger meat or chicken..unless not meat like fries should be no problems for frozen..and egg as well,if you want to eat egg can without the middle one “yolk” (just egg white no problem,unless you eat in big quantity)…lamb also need to avoid..beef for me no problem and also depend on quantity do not eat frequently and big quantity portion…coffee need to avoid and you can change to tea..anchovies need to avoid…and of course mushrooms!!!no no for soup or anythings made by it..hope this can help you to add information 🙂

  4. great article

  5. Have been recently diagnosed with GOUT
    Extremely painful
    Consulted my podiatrist
    Prescribed some steroids
    Didn’t help
    Hurt my stomach real bad
    She suggested cherry juice
    Worked wonders
    I drink a four to six ounces an hour before going to bed
    Don’t know how and why but helps get a good nites sleep
    Only problem – you pee a lot
    I guess the juice flushes oute the Uris acid

  6. Thank you for the article, JOE. I’m in pain this minute, prob lay because of having chicken liver for dinner last night. I wasn’t aware of I have gout, but my mum has it. … I’m careless for food, but eat healthy. I will have to take on board your information. Thank you very much for sharing your knowledge here. Really appreciate,

  7. I have read with interest about people’s love affairs with gout and suggested remedies. I first experienced gout six years ago after having climbed Mt Sinia in Egypt at age 60, a not too difficult climb if you are willing to put some effort into your fitness level before hand. The decent from the summit of Mt Sinai interestingly I found more challenging as my toes were pushed to the front of my trainers. When I returned to Sydney a few days later it was then I had my first attack to my right toe. My doctor provided medication and after a week or so the gout subsided. Two years ago I experienced another attack took medication and the gout subsided.

    Now the fun part. On 24 May 2017 I had a complete knee replacement to my right leg. I was disciplined and did all the recommended exercises before the operation and I was advised the operation went well and I have since maintained the recommended exercise routine with absolute discipline and on the 27 May, my registrar along with my physiotherapists allowed me to go home. On Wednesday 31 May I had another gout attack to my right ankle the same leg as my knee replacement. After such a major operation a gout attach was not what I had in mind and I am now on appropriate medication to assist in reducing the gout.

    So what brought on the attack is hard to define and it may have, so I was advised the type of anaesthetic used. The anaesthetic was injected into my spine to assist with improved pain management during recovery. My own unqualified opinion is that apart from my knee exercises I did not do any other exercises for a week and therefore rightly or wrongly had a big weighting for my gaut attack. Yesterday I stopped taking pain killers for my knee and recovery is going well.

    What I do question however, and bear in mind my opinions are unqualified is the foods and liquids you cannot or can consume if you suffer from gout. Every schoolboy and schoolgirl knows that rubbish foods such as coke, fanta, hamburgers etc high in sugar and salt are bad for you although I’m guilty of drinking a couple of long neck beers a week and sharing a few glasses of good quality wines.

    If I was to follow the suggested diets I have been reading about I would be almost dead by know. I have eaten sensible all my life for example why purchase orange juice in a carton when you can purchase an orange. My apologies for having been so long winded but I am keen to know what others have to say about my thoughts and latest experience with gout.

  8. I applied tons of research to mitigate the gout pain I’m experiencing to know avail I’ve tried cherry juice cherries apple cider vinegar. Apple cider vinegar with baking soda, molasses and apple cider vinegar .also have not consumed any kind of meat approximately three weeks.still in pain still have gout., pain meds stop pain just a little while and that’s relief. Does any one out there have a remedy with out side effects?

    • Turmeric can naturally lower uric acid if that is a source of your gout problem. Its an anti inflammatory. Take it with food, never on an empty stomach. I just buy the vita cost brand. It works fine. It takes about three days. You may wish to take a probiotic at bedtime (not with the turmeric) as it can be a little harsh on the GI tract.

      I hope that you feel better soon.

  9. faisal mir says:

    sir normal level of uric acid is upto 7.5 and i have 7.6……can i take suppliment and egg whites because i do Gym please reply me as soon as possible

  10. Roberto says:

    Roberto – i had gout attack 3 weeks ago that took me out of work for a whole week – i normally get it once a year in my big toe joint but this time was in my right knee – i was immobile for 7 days which was longest period of time – i recall 3 days before gout attack i went out for a few drinks and had 3 beers – then 3 days later bang !! gout struck

    i have been a non meat eater for 1 year now and dont drink red wine – i drink 1 cup coffee a day and on allopurinol but it dosent seem to stop the production for too long before i have an attack- massively frustrated . I also cut out yeast i.e bread as i was told yeast was major no no for gout including . yeast spreads – i was also advised chick peas and mushrooms were not to be consumed as they raise the uric acid levels as they are high in purines – it seems which ever direction i take i still get it so im now thinking it may be genetic – i drink 1 litre of water a day and am 186 cm tall and 90 kg so not over weight – one day ill figure out how to stop this crippling disease – lol
    Roberto

    • Beer contains yeast. That is what caused your problem. I’m sorry that you are suffering.

      My doctor has me drinking 3 liters of water a day.

  11. Remarkable! Its really awesome article, I have got much clear idea
    regarding from this paragraph.

  12. Thanks for theextra information, I was unaware of Turkery and Salmon being high in purined as well as watermellon.

  13. David Siegfried says:

    I have had gout for years and it doesn’t seem to be any one item that causes a out break…………..except excessive drinking , eating really rich foods and no exercise.
    When I stop exercising regularly goat attacks become more frequent.
    My question to the group ( “perhaps there is a nutritionist in the house”)

    So what would be a low purine breakfast/ Lunch / Dinner that we can try to stay the course on to “rule out” foods with High Purines?

  14. I have had gout for 11 years now. Had a big attack 5 years ago after drinking 3 beers one night. Gout was in both feet and would travel around the foot, ankle, knee. Drank soft drinks and got gout in my hand that inflammed the whole back hand. 4 weeks ago I ate two icecream drumsticks and two days later gout was in my wrist. This past week I ate 6 shrimp and the next day my elbow started hurting. For me the following causes gout. 1. alcohol (beer and liquior) 2. high fructose corn syrup (sodas and fruit drinks) 2. corn syrup (icecream) 3. shrimp (six to eight) 4. sardines. 5. orange juice. I’m tired of being in pain. I eat a strick diet and when I change one thing, I know what causes the gout. I basically eat raw fruit and raw vegs and chicken Mon-Fri now. I drink alot of coffee black, and it does not cause me gout.

    • G’day Andy – Be aware that the fructose from fruits is notorious for purines and concerting to uric acid. Plus, the fructose is converted by your liver to triglycerides in your blood and contributed to depositing fat around the midsection. Just thought you should know. Season ripe fruits usually ripen just before Autumn when the last of fat depositing is needed before the hard to find food time of Winter. Hence, a good reason NOT to eat fruit year round. Since food is not hard to find these days and season ripen fruits are available year round, best to avoid them most of the time.

      Cheers!
      ~J.D.
      gout sufferer since 2003
      microbiologist and epidemiologist working in research

  15. Lots of good info. Was told this morning by dr. Gout in left toe. Can use all of this ind Thank you all.

  16. longvaljga@gmail.com says:

    Good post Joe, I am a long time gout sufferer and overtime I tried all kind of remedies. I think that anyone having gout attacks should have PH sticks alongside their cherry or apple cider vinegar remedies. I am a walking battery and when I see my acidic level rise from alkaline state, I start treating myself before the gout kick in. For me it is a good tool to gage my health.

  17. Arun Debnath says:

    As a sufferer of Grout, Yes, Joe, I found this to be incredibly helpful indeed. Thank you for your post. Now I know, what’s a good diet for me and what should I avoid.

    Not sure how, but I think it should be publicised widely amongst the gout sufferers and in different languages etc.

    Thank you again for your helpful post.

  18. Great article. Just coming out of a flare-up. Been building up for about a week. Didn’t really click till it was too late. . I find alcohol to be my Nemesis when it comes to Gout. I rarely drink more than 2 small bottles of beer, or 2 glasses of wine a week, however had a works do last weekend and had about 4 pints of lager. Monday morning started to get flare up. Tuesday- worsened, Wednesday- off work. Saw Doctor Wednesday, prescribed Colcocine. Taken that plus lemon juice, back to work Thursday. Any how, I find that freshly sqeezed lemons in a glass of water works petty well, as does half teaspoon of bicarbonate of soda in half pint of water. Also ORGANIC apple cider. And Concentrated black cherry juice.

  19. Bromelian 500 to 1000g per day and Quercetin (chevk label gor dose). A quote from the web “During a gout attack, take 500mg of bromelain capsules every three hours until the attack subsides. For gout attack prevention, take 500mg twice a day between meals, on an empty stomach and add 500mg of quercentin twice daily. Quercentin is a flavonoid that reduces high uric acid levels that causes the inflammation and pain during a gout attack. Bromelain assists in increasing your body’s absorption and utilization of quercetin, working very well together. ”
    Celery juice (the entire bunch) as well.

  20. Jane Simmons says:

    I’ve been battling for years & didn’t realize it…i ate shrimp it prawns @ last once a week as i love in the Pacific NW & is a big part of our menus here. Lived with toe pain & swollen ankle… thinking it was from my job as i stand all day… quit pedicures for awhile cuz of my toe. I don’t drink so i just didn’t get it…
    Loooong story short found out thats what ive been suffering from & cut out the shrimp. Marked improvements but have had to learn the other triggers through much pain. NO to Turkey on thanksgiving!!!! Was in pain for 3 weeks. Also learning little bits of meat only. I don’t eat any steak or shellfish…a few steamers or a little salmon seems ok..Chicken seems to be my best bet… tiny hamburger ok, no mushrooms or spinach..Occasionally… but don’t add up other foods that trigger the next day you’ll be sorry..i stick to salads & yogurt, crackers, bran cereal & cheese. It’s not much choices but it’s better than the alternative..o ya definitely no lasagne, big mistake for me , no rich sauces either.. olive oil or some butter are better….drink organic tart cherry or black cherry daily seems to help greatly! I’ve heard turmeric helps I’m going to try it. I try to everything natural but have used Aleve when the pain was debilitating… which does help with inflammation… of course Lots of water. Hope thats helpful to someone out there.

  21. Realy chicken , bread and egg are prohibited for a person with gout. Shit what should i eat

  22. Good information for us gout sufferers! I find that there’s so much contradiction in what to eat and what not to eat depending on which article you read, it’s confusing at times. I’ve also read that trauma can also cause a gout attack.

  23. Jesse Drew says:

    I read that some well known person back in the eighteen hundreds and a big time.gout sufferer found that eating cherries was a big help.

  24. Jesse Drew says:

    I read that some well known person back in the eighteen hundreds and a big time.gout sufferer found that eating cherries was a big help.Also will a spoonful of raw apple cider vinegar daily be any help with gout.

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