If you’re one of the millions who suffer from gout, you know the pain. A form of arthritis, gout is characterized by sudden bouts of pain, swelling, redness, and tenderness in the joints. Often, gout affects the joint at the base of the big toe, but it can affect any joint in the body. Symptoms can be intermittent, but flare-ups of the condition can come on suddenly and unexpectedly, and pain can last for hours or even weeks post-flare-up.
Gout can affect anyone, although it is more common with age and among men (sorry, guys!), postmenopausal women, and people with type 2 diabetes, obesity, high cholesterol, high blood pressure, and atherosclerosis—meaning that dietary and lifestyle habits are at least partially to blame. In fact, it's well-known that some very common foods containing high levels of compounds called purines contribute directly to gout flare-ups.
The good-ish news: While you can't control all of your risk factors, you can control your diet. If you have gout, avoiding purines is definitely in your best interest, along with loading up on foods that help reduce pain and inflammation.
Here, learn everything you need to know about managing gout with a nutritional approach, including what high-purine foods to remove from your diet.
What is the role of purines in gout?
Gout occurs when uric acid builds up in the blood. Typically, uric acid dissolves in your blood and is excreted via urine. But when your body is producing too much uric acid, or your kidneys aren't sending enough of it out in your urine, it builds up and leads to the formation of urate crystals. These tiny needle-shaped crystals of uric acid get deposited in your joints and can trigger sudden swelling.
If treated right away, gout is nothing to be too worried about. Untreated, however, it can lead to advanced gout and tophi, which are deposits of sodium urate monohydrate crystals around a joint that causes a swollen growth under the skin. Over time, this can lead to permanent joint damage. Untreated gout can also cause kidney stones.
But where does this uric acid that causes all this trouble come from? It's a by-product of the breakdown of purines, "substances naturally present in the body as well as in many foods," says Jessica Cording, M.S., R.D., CDN, registered dietitian and health coach.
If you already suffer from gout, eating a diet high in purines can make your symptoms much worse by increasing the level of purines in your system when your body is already struggling to break them down. "This is why sticking to a low-purine diet can be extremely important for managing gout flare-ups," says Cording.
So, what foods contain purines? Loads of them, from meat to alcohol to legumes to nuts to veggies like asparagus and mushrooms. Interestingly, though, not all food sources of purines are equally damaging for people with gout, which we want to make clear from the get-go.
Plant-based purines are most likely safe.
While some outdated recommendations still advise limiting their consumption, "it's important to note that plant-based sources of purines have not been associated with an increased risk of gout," says celebrity nutrition and fitness expert JJ Virgin.
In fact, in a 2015 study, researchers stated that "the myths about restricting plant-based foods that are high in purines, such as beans, lentils, soy, and certain vegetables, [have been] perpetuated by non-evidence-based patient education materials. Counteracting these popular myths, our data provides evidence that plant sources of protein...are not associated with an increased risk of gout."
Plant-based purines may even help reduce gout symptoms. Given the protective effect of these foods against other dangerous conditions like heart disease (a risk factor for gout), they may actually help people manage gout as opposed to worsening it, according to researchers. Plus, some purine-containing legumes also pack a decent amount of protein, so they may further reduce gout symptoms if they're consumed in place of high-purine animal protein sources.
Other research supports the consumption of plant-based sources of purines and reduction of animal-based sources. In a 2012 study, researchers concluded that patients with existing gout could help reduce their recurrent gout attacks by avoiding or reducing purine-rich foods, "especially of animal origin" while purines from plants were substantially less likely to cause harm.
Another study, from 2004, found that long-term, habitual consumption of purine-rich vegetables was not associated with an increased risk of gout, but rather, people with the highest vegetable protein consumption had a 27 percent lower risk of gout than those who consumed the least.
All of which is to say, don't skimp on your veggies—especially protein-rich ones—even if they contain purines.
25 medium- and high-purine foods to limit or avoid.
While not all purine-containing foods should be avoided (i.e., veggies and legumes), people with gout should take care to reduce their intake of the following medium- and high-purine foods and beverages that have been associated with increased symptoms of gout.
The following medium-purine foods should be limited to 4 to 6 ounces per day:
The following high-purine foods should be drastically reduced or avoided altogether:
- all alcohol (beer, wine, hard cider, malted beverages, mead, spirits, etc.)
- liver and other organ meats
- meat-based gravies and sauces
- yeast extract supplements
So, what should you eat if you have gout?
High-purine foods are bad for gout symptoms, but other foods and dietary approaches can significantly help manage the pain. Case in point: a Mediterranean diet. In one study of almost 4,500 people, a Mediterranean diet was found to lower participants' risk of developing high uric acid levels in their body. Researchers believe that this is because Mediterranean diets—with loads of vegetables, fruits, whole grains, and healthy fats like olive oil; and moderate amounts of fish and poultry—are low in red meat and high in antioxidants, which have anti-inflammatory properties.
Taking a whole-foods, Mediterranean approach to eating can help you lose weight and manage the other conditions—such as obesity, diabetes, and high blood pressure—that likely contributed to a gout diagnosis in the first place. If you're overweight, for example, your body produces more uric acid, and your kidneys have a more difficult time eliminating uric acid.
Drink up, too. People with gout should be hydrating more than the average, healthy person. Experts recommend drinking eight to 16 cups of liquid per day (at least half of which should be water), which can help your body flush out extra uric acid.
Knowing if you're at a higher than average risk of gout is the first step to knowing if a low-purine diet is right for you. Remember that purines are not dangerous unless you have gout, and most people are able to process them and pass them just fine. If you have questions about gout, your risk of developing it, or the benefits you might personally enjoy from a low-purine diet, talk to your doctor or a registered dietitian who specializes in dietary approaches to managing pain.
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Kayleigh Roberts is a freelance writer and editor living in Los Angeles, California. She earned a B.S. from the Medill School of Journalism at Northwestern University. She covers culture, entertainment, and health and has written for several notable publications including Elle, Marie Claire, and The Atlantic.