Gout and diet: Foods and drinks to avoid

Which foods should you avoid when you have gout?

Diet and lifestyle modifications are core aspects of the non-pharmacological management of gout. From a dietary perspective you should be aware that purines, that are compounds found in specific foods and drinks change to uric acid in the body. Most meat and seafood are high in these purine compounds and as a result can increase uric acid levels in the body. You should, therefore, limit these foods when experiencing symptoms either by avoiding them or reducing your portion size.

Foods high in purines include:

• Some varieties of fish such as anchovies, sardines, mackerel and herring as well as tuna,
• Offal foods such as liver, kidney and sweetbreads as well as dishes made from them like liver pate,
• Game meats including venison and rabbit as well as birds like partridge and pheasant,
• Rich poultry meats such as goose,
• Red meats including beef and lamb,
• Mussels, whitebait, shrimps, crab, roe and scallops,
• Meat-based gravies, stock cubes and meat and yeast extracts (including Oxo, Bovril and Marmite).

Care also needs to be taken with certain vegetables which may contain medium levels of purines, these include:

• Asparagus
• Beans
• Cauliflower
• Lentils
• Mushrooms
• Spinach
• Quorn

While these vegetables don’t need to be avoided completely, portion size is important – a moderate intake should not increase the risks of gout. All other vegetables may be eaten freely.

What is the recommended diet for gout sufferers?

There are no foods that can completely prevent the symptoms of gout, but a diet low in purines may help to reduce the frequency and severity of attacks. Following a nutritionally balanced, diet that is low in saturated and trans fats and rich in unprocessed, whole foods may be helpful.

Foods to help with gout include:

• Dairy (ideally low fat)
• Eggs
• Bread, pasta, potatoes and rice
• Nuts
• Vegetables (other than those listed above) and whole fruit (limit fruit juices)
• Tea and coffee.

Evidence suggests that including low-fat dairy products (about two 240ml glasses of skimmed milk per day), limiting sugary drinks and having a daily vitamin C supplement of 500mg may help to reduce the risk of gout. Speak to your GP before starting a supplement regime or altering your diet significantly.

Recent studies suggest fructose, the sugar found in fruit and often added to many processed foods and drinks (as glucose-fructose syrup or corn syrup), may increase uric acid and aggravate symptoms. That said whole fruit should be included in the diet, with juices limited, when they are drunk be sure to choose 100% unsweetened varieties and stick to guideline amounts. One exception to this may be cherries and the juice from them, often promoted as a natural remedy for gout sufferers the juice from two varieties (Montorency or Balaton) of sour cherry may reduce blood uric acid levels and act as a useful anti-inflammatory. More random controlled trials are needed but the evidence to date looks promising.

It is important to note that it is the quantity of purine-rich food consumed that is more important than the purine content in each food. However, if a patient is keen to measure quantities of food, a maximum total daily purine intake of around 200mg is recommended.

Drinking adequate amounts of hydrating fluid such as water as well as tea and coffee may aid the removal of uric acid via the kidneys. However, if you are on prescribed medication such as diuretics or have a kidney condition you should consult your GP to ensure a higher fluid intake is appropriate for you.

How does drinking alcohol affect gout?

Alcoholic drinks tend to be high in purines and consuming more than the recommended amount can increase the risk of a gout attack. It is therefore recommended to limit alcohol intake, avoid binge drinking and avoid all alcohol if you have painful gout or are having an attack. Beer confers a larger risk than spirits, but both should be restricted, along-with champagne and fortified wine, whilst moderate consumption of wine (no more than two small glasses per day) may not be associated with a significant increased risk it should still be consumed infrequently.

What other lifestyle factors may affect gout?

While there are no controlled studies or evidence on the effect of lifestyle changes on the incidence of gout, expert opinion suggests that positive changes in lifestyle can be beneficial to managing the condition. Being overweight is not recommended and the available evidence indicates that losing weight may be helpful. To this aim a slow and steady weight loss is the ideal (1-2lb per week) and support from a dietitian should be sought to help develop a sustainable weight loss plan. Rapid weight loss is not recommended as it may increase the amount of uric acid in the body and lead to an increased chance of a gout attack.

Regular exercise such as swimming or walking may help reduce the frequency of gout attacks. In addition, it may have a beneficial effect on associated conditions such as type 2 diabetes, hypertension and insulin resistance.

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This article was last reviewed on 17 October 2024 by Kerry Torrens.

Emer Delaney BSc (Hons), RD has an honours degree in Human Nutrition and Dietetics from the University of Ulster. She has worked as a dietitian in some of London's top teaching hospitals and is currently based in Chelsea.

Kerry Torrens is a qualified Nutritionist (MBANT) with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including Good Food.

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