Arthritis Today

The Best Diet Advice for Gout: Eat Less Meat

Gout gout? Eating a lot of meat and other high-purine foods makes gout flares five times more likely.


If you are looking to dietary changes to lower uric acid levels and reduce your risk of gout attacks, findings of studies in recent years offer a number of suggestions: choose more low-fat dairy foods, eat cherries or increase your consumption of vitamin C. But the best dietary advice for gout perhaps is what doctors have been giving for years: eat less meat and other foods high in purines.

Purines are substances in animal and plant foods that the body converts to uric acid. When excess uric acid in the bloodstream builds too quickly or can’t be eliminated fast enough, it is deposited as needle-shaped crystals in the tissues of the body, including joints, causing intense pain.

In a 2004 study published in the New England Journal of Medicine, researchers evaluated the relationship between the intake of purine-rich foods, dairy foods and protein and the incidence of gout in a cohort of 47,150 men who had no history of gout at baseline. They found that increased meat and seafood intake was associated with approximately a 50 percent higher risk of gout development over the 12-year study period.

While the study was the first to show that consuming high-purine foods could increase the risk of gout development, researchers had long suspected that a diet rich in high-purine foods could increase the risk of gout attacks.  

A study published eight years later in Annals of the Rheumatic Diseases offered proof. The study, which involved more than 630 participants with a history of gout within the previous 12 months, showed a direct association between purine intake and gout attacks. In fact, eating a lot of purine-rich foods – like red meat, organ meat, certain fish and vegetables – over a short period of time increased the risk of a gout attack almost fivefold compared to the risk when eating fewer purine-rich foods.

The authors conclude that ingestion of purine-rich foods can actually trigger a gout attack within days – and that the risk rises as more purines are included in the diet.

“Our study showed that risk of recurrent gout attacks increased almost 40 percent if intake of purine went from less than 1 gram to 1.75 grams over two days,” says study co-author Yuqing Zhang, professor of medicine and public health at Boston University. The fivefold increase in gout-flare risk came at purine ingestion levels about twice that level – and the risk persisted even in those taking the uric acid-lowering agent allopurinol.

Registered dietitian Sandra Allonen, at Beth Israel Deaconness Medical Center in Boston who provides nutritional counseling to gout patients, says the average person needs a lot less protein than they probably are taking in. She uses a formula based on weight to determine daily protein needs. A 150-pound, generally healthy person, for example, needs about 54 grams of protein daily -- approximately the amount in 6 ounces of skinless grilled chicken breast -- even if they are prone to gout attacks. 

For people with gout, “I recommend the more alkaline proteins found in plant-based foods [first], then fish, then poultry and then red meat,” she says.

As for general dietary recommendations in those with gout, Allonen says it’s case-by-case. If they have regular gout attacks, “I would be more inclined to advise them to be careful with purine-rich foods. If their gout attacks are [few and far] between, I'd be a bit more liberal with their diet and work closely with the health-care provider who is overseeing their gout issues.”