Gout is among the oldest known types of arthritis, which is inflammation of the joints.
The condition causes sudden, severe attacks of pain, stiffness, and swollen joints, most often in the big toe or other areas of the foot.
While medications are commonly prescribed for treating gout, diet plays an important role in preventing and treating gout.
This article explains what to eat and avoid with gout to reduce flare-ups and provides a sample gout diet menu.
Causes and risk factors
Gout is a type of arthritis that is very painful.
The global prevalence of gout is around 1–4%. The prevalence is much higher in adults 80 years and older, affecting up to 10% of men and 6% of women (1).
Gout is an inflammatory form of arthritis like rheumatoid arthritis and psoriatic arthritis. It’s caused by a condition known as hyperuricemia, where there is too much uric acid in your bloodstream (2).
The levels of uric acid in your body depend on the balance between its production and excretion.
Hyperuricemia results from uric acid overproduction, underexcretion, or a combination of the two.
The majority of uric acid is naturally produced by your body while the rest comes from your diet in the form of purines. Purines are natural substances in foods that your body converts to uric acid.
There are several risk factors linked with hyperuricemia, including:
- Medications. Certain diuretics, or water pills, increase the reabsorption of uric acid in your bloodstream (3).
- Chronic disease. Diabetes, heart disease, and obesity can negatively affect your kidney’s ability to excrete uric acid (4).
- Genetics. Certain genes may increase the reabsorption of uric acid and decrease its release in urine (5).
In addition to these risk factors, diet and excess body weight are also linked with an increased risk of gout.
Gout attacks are triggered when uric acid crystals become deposited in and around your joints, causing severe swelling, pain, redness, and tenderness, symptoms similar to osteoarthritis.
These attacks often affect one joint — usually, the big toe — but can also occur in the foot and ankle joints, knees, elbows, wrists, and knuckles.
The attacks may be triggered by a variety of factors, such as stress or illness, and normally subside within 3 to 10 days. Subsequent attacks may not occur for months or even years.
Over time, gout can worsen and cause the joints to become disfigured, making it harder to move them.
The role of diet in gout
Several foods and dietary patterns are associated with a reduced risk of gout whereas others are associated with a higher risk.
One study showed that the DASH diet lowered uric acid levels within just 30 days with a sustained effect at 90 days (9).
The DASH diet emphasizes fruits, vegetables, lean proteins, low-fat dairy, nuts, and legumes, and limits sweets and foods high in saturated fats.
In contrast, the Western diet, or standard American diet, is low in fruits and vegetables and high in red and processed meats, pre-packaged foods, refined grains, and sugary beverages.
Alcohol consumption, especially beer, is also associated with an increased risk of gout because it increases your body’s production of uric acid and limits its excretion.
A review of 17 studies found that moderate drinking — defined as one drink per day for women and two for men — was associated with a 58% higher risk of gout (10).
The same review also demonstrated that heavy drinking — defined as three or more drinks per day — was associated with a 164% higher risk of gout.
In addition to diet, a higher body mass index (BMI) and waist circumference are associated with an increased risk of gout (13).
Therefore, if you are overweight and have gout, losing weight can help you reduce uric acid levels and better manage the condition (14).
Low-purine diet for gout
Several foods and beverages have been associated with an increased risk of gout, particularly those high in purines.
Purines are a natural component of many foods and are metabolized by your body to uric acid.
By limiting your intake of purines, you can lower the amount of uric acid your body produces, which may help reduce gout attacks as well as kidney stones, which are common in those with gout.
But not all foods high in purines increase the risk of gout. Purine-rich vegetables, for example, are not associated with an increased risk of gout because the purines are poorly absorbed (15).
Low-purine foods to eat
Foods that contain low to moderate amounts of purines include:
- Fruits: apples, apricots, avocado, bananas, blueberries, cherries, grapes, melons, oranges, etc.
- Vegetables: arrowroot, asparagus, beans, beets, broccoli, cabbage, cauliflower, kale, lettuce, mushrooms, peppers, etc.
- Grains and legumes: bread, pasta, rice, peas, lentils, and oats.
- Dairy: low- and fat-free milk, yogurt, and cheese.
- Beverages: water, tea, and coffee.
High-purine foods to limit:
Foods that contain high amounts of purines include:
- Vegetables: potatoes and tomatoes
- Seafood: anchovies, sardines, tuna, scallops, trout, shellfish
- Meat: beef, pork, lamb, bacon
- Poultry: chicken and turkey
- Beverages: beer, liquor, wine
It’s not productive or worthwhile to completely avoid foods high in purines, but you should consume less of them.
One-day sample gout diet plan
Here is a one-day sample gout diet plan that includes low-purine foods:
- Breakfast: Scrambled eggs, oatmeal topped with banana slices, and coffee.
- Snack: Greek yogurt and almonds.
- Lunch: Baked salmon with white rice and grilled asparagus.
- Snack: Apple slices and peanut butter.
- Dinner: Salad made with lettuce, garbanzo beans, shredded cheese, chopped avocado, and sunflower seeds, topped with vinaigrette dressing.
Supplements for gout
Several supplements have been shown to lower uric acid levels and may therefore help manage gout.
Vitamin C is a water-soluble vitamin that supports immune function and is needed to make collagen and chemical messengers, called neurotransmitters.
In addition to these functions, vitamin C supplementation has also been shown to reduce uric acid levels by decreasing your body’s production of uric acid and increasing its excretion.
A review of 13 studies involving 556 people showed that supplementing with an average dose of 500 mg per day of vitamin C was associated with significant reductions in uric acid (16).
While this study showed that vitamin C supplementation lowers uric acid, it’s unknown whether this decrease protects against gout attacks.
Shop for vitamin C supplements online.
Low vitamin D levels have been associated with several diseases and conditions, including an increased risk of gout and other forms of arthritis like psoriatic arthritis.
A review of seven studies found that people with normal vitamin D levels had a significantly lower level of uric acid compared with those with low vitamin D levels (17).
It’s unclear why this relationship exists, but researchers believe that low vitamin D levels inhibit the excretion of uric acid, causing high levels in the blood.
Still, more research is needed to determine if low vitamin D levels cause high uric acid levels and if vitamin D supplementation has a role in preventing or managing gout.
In either case, with 50% of the world’s population estimated to have low vitamin D levels, supplementing with 1,000–2,000 IU (25–50 mcg) of vitamin D daily is an effective and relatively inexpensive way to ensure adequate vitamin D levels (18).
Shop for vitamin D supplements here.
Quercetin is a plant compound found in high levels in onions, tea, apples, and cherries.
By inhibiting this enzyme, your body produces less uric acid.
Allopurinol — sold under the brand names Zyloprim and Loprim — lower uric acid in the same way and is the most commonly prescribed medication for treating gout.
A study in men found that daily supplementation of 500 mg of quercetin for four weeks led to significant reductions in high uric acid levels (21).
While promising, more research is needed to determine the effects of quercetin for managing gout.
The bottom line
Gout is an inflammatory and painful condition that often affects your joints.
The condition typically occurs when there is too much uric acid in your bloodstream.
You may relieve some gout symptoms by following a low-purine diet, which includes fruits, most vegetables, grains, legumes, and dairy.
In addition to diet, some research suggests that vitamin C, vitamin D, and quercetin supplements may be helpful for gout.