Anyone that has ever had a gout attack has undoubtedly searched feverishly for ideas to relieve the acute pain of the gout attack as quickly as possible.
Within these sources, you will always find a recommendation to “watch what you eat” and avoid foods high in purines such as organ meats, shellfish, and beer.
When you look at the recommendations from multiple sources on foods to avoid with gout, you may find the recommended dietary restrictions confusing and sometimes contradictory.
The simple reason for this is that there are only a handful of food groups that have been studied sufficiently to make an informed recommendation and then there are other types of food where the anecdotal evidence points to potential issues or benefits, but there isn’t sufficient research to support a firm recommendation.
In this article, we will try to cut through the noise and confusion to provide you with information to create a clear plan of action on what to eat and avoid during an acute gout attack. Lastly, please note that while it may be true that dietary changes will not have the same impact for everyone with gout as the reasons for elevated uric acid levels vary depending on your particular circumstances, making these dietary changes can have a significant impact for many people and can still offer good, wholesome nutritional support for others. Unless you have specific medical conditions that impact your dietary requirements, you can only help yourself by changing your diet during a gout attack.
Goals During an Acute Gout Attack
A thorough discussion on the causes of gout are outside the scope of this article.
However, to understand your dietary goals during an acute gout attack, it is important to understand what has caused the gout attack and how you can provide nutritional support to your body to assist it in healing.
Briefly, an acute gout attack is the result of your body accumulating heightened levels of uric acid resulting in a condition known as hyperuricemia.
When uric acid levels rise, the uric acid can form crystals which settle into one or more joints and cause a substantial inflammatory response.
That inflammatory response causes the intense pain of an acute gout attack. If uric levels continue to rise or stay the same during an acute gout attack, the gout attack may last longer as additional uric acid crystals accumulate and cause additional inflammation. It may also feel like the gout is moving around to different parts of your foot or other joints.
With this said, your goal during an acute gout attack must be to lower uric acid levels or at least avoid increasing them.
There are two ways to accomplish this:
- You can help your body eliminate uric acid faster and
- You can help your body avoid overproducing uric acid.
This is where diet can play a key role. Providing your body with proper nutrition and hydration can strengthen its ability to excrete uric acid more efficiently and, by avoiding certain foods, you may be able to prevent further accumulation of uric acid that will need to be eliminated by your body.
There are many reasons why you may have hyperuricemia. Factors range from diet, body weight, kidney (renal) issues, dehydration, genetic factors, and many more. However, for many, diet is key to ending a gout attack sooner and also to preventing future acute gout attacks. This is particularly true because medications used to treat an acute gout attack do not serve any role in reducing or controlling uric acid levels. These acute gout treatments are solely focused on inflammation reduction.
Your Enemy May Be Delicious, but It Is Still Your Enemy
As stated above, your body is either an over-producer or under-excreter of uric acid…or both. One of the most certain ways to overproduce uric acid is by eating certain foods and drinking certain beverages that have a higher concentration of purines, which is a natural substance found in foods. Purines are compounds found in many foods and beverages such as red meat, shellfish, beer, and spinach. When your body metabolizes purines, the end product is uric acid. If you accumulate uric acid faster than your body can eliminate it, you risk an acute gout attack.
Unfortunately, the story doesn’t end with purines. Research has shown that the consumption of high-fructose may also contribute to the overproduction of uric acid. Additionally, although more research is still needed, there is also some research and anecdotal evidence suggesting that foods high in oxalates may trigger a gout attack. Oxalates are found in leafy greens, legumes, and root vegetables such as beets and parsnips. This is where quite a bit of the advice circulating can be contradictory. Some will say to avoid vegetables high in purines and oxalates, while others will say that there is no evidence that they can trigger a gout attack.
Foods to avoid with gout DURING an attack vs a gout friendly diet at other times
Before we dive into an examination of foods to avoid with gout, it is vital to distinguish between creating a dietary plan during an acute gout attack and a dietary plan for all other times. We suggest they should not be the same. An acute gout attack requires a more intensive approach to ensure you maximize the chances of lowering uric acid levels in an impactful way. However, a more nutritionally balanced approach is called for at other times. Additionally, if you have not yet determined your triggers, your diet at other times is an opportunity to selectively include and exclude certain foods to determine which may be a trigger for you. With all this said, your sole goal during an acute gout attack should be to end the acute gout attack and this can only be done by reducing inflammation by using your medication of choice and by lowering uric acid levels through your dietary choices.
Okay, I Can Do Anything For a Week or Two…what foods should I avoid with gout?
That’s the spirit! With smart choices and a little bit of time, the pain of your acute gout attack will be in the rearview mirror shortly. It cannot be said often enough…this plan should only be used DURING an acute attack and perhaps for a short time after. It should not be your full time, gout friendly nutrition plan.
Unfortunately, the restrictions during this time will likely include many of your favorite foods that are a big part of your regular diet. However, a strict diet during a gout attack is likely to pay off in ending the attack sooner and preventing a rebound attack. The primary purpose of avoiding certain groups of foods is to limit the overproduction of uric acid. This gives your body a chance to eliminate the existing uric acid more quickly and efficiently. The wholesale elimination of many of these foods will impact your overall nutrition for a short period of time, so it is essential that you balance the nutrition from the allowed food groups to ensure that you are consuming a sufficient amount of protein, carbohydrates, and fats. Do not go on a crash diet during a gout attack or attempt long periods of fasting. Both of these approaches can RAISE uric acid levels by impacting your bodies ability to efficiently excrete uric acid. You must eat and eat regularly. Lastly, if you have any health issues or other concerns about changing your diet, please check with your doctor before you substantially modify your diet. You may not be a good candidate for even short-term dietary changes depending on other factors that may apply to you and your specific situation.
Eliminate or limit these foods as much as possible during a gout attack
The main grouping of foods in this category will be those that contain higher levels of purines. These are compounds that produce uric acid when broken down and metabolized by the body. However, purines are not the only compounds that have been shown to raise uric acid levels. For instance, alcohol contains higher levels of purines, but also increases the body’s metabolism of something called nucleotides that serve as an additional source of uric acid producing purines. Also, high-fructose corn syrup and other added sugars have been shown to raise uric acid levels and serve as a trigger for gout. Lastly, there is evidence that foods containing oxalates and tomatoes may produce higher uric acid levels in some people. The research on this last area isn’t yet clear or fully established. However, remember that the goal during a gout attack is to stop the gout attack as soon as possible and avoid a rebound attack. Therefore, you might consider eliminating or curtailing the foods below to stop the gout attack even before the research is in. You can experiment with foods to determine which foods to avoid as you create your gout management plan after the gout attack has subsided. We have said it before, but it bears repeating…this diet is only to be used during an acute gout attack, and should not be your full-time diet. A strict acute gout attack diet is different from a gout-friendly diet and lifestyle. Check out our other articles to help you create a complete gout management plan. But for now, during an acute gout attack, avoid or limit these foods:
Eliminate or Limit Meat Protein
Meat proteins contain some of the highest levels of purines. This is particularly true of organ meats such as liver, shellfish such as mussels, and fatty fish such as sardines and herring. However, even beef and pork contain higher levels of purines and should be avoided during an acute gout attack. Lastly, even though it may be helpful to avoid all meats during a gout attack, if you choose to eat meat during the attack, choose chicken and white fish such as cod and only consume about 4oz or less per day. These meat protein options contain fewer purines than red meats and shellfish. Here is a list of the meat proteins to avoid:
- Organ meats such as livers, hearts, and intestines
- Mollusks and bivalves such as clams, mussels, oysters, scallops, octopus, squid, and snail
- Crustaceans such as shrimp, prawns, crab, and lobster
- Beef, Pork, Lamb, Rabbit, Venison, Elk, Buffalo, and the dark meat of poultry such as thighs and drumsticks
- White meat poultry and white fish (if necessary, eat in moderation during a gout attack)
Eliminate or Limit Certain Vegetables
This is a tough category since vegetables are generally an excellent source of nutrition during a gout attack. However, certain vegetables, particularly the green leafy vegetables and other green vegetables contain higher levels of purines and oxalates. There is evidence that these vegetables may raise uric acid levels in some people and may trigger a gout attack. Although you should experiment if any of the vegetables are triggers for you, it may be advisable to simply avoid the high purine vegetables during an acute gout attack in order to end the attack sooner. Here are some of the vegetables that you may want to avoid or limit during an acute gout attack:
- Leafy greens such as spinach and kale
- Asparagus, broccoli, mushrooms, and cauliflower
- Foods high in oxalates such as beets, beet greens, sweet potatoes, swiss chard, endive, and rhubarb
Eliminate or Limit Fructose and Other Added Sugars
Although fructose and other sugars do not contain purines, when your body breaks down fructose, purines may be released, There have been a number of research studies and other scholarship that suggest fructose from both high-fructose corn syrup and other sources of concentrated fructose, such as fruit juices, may very quickly raise uric acid levels…sometimes within minutes of consumption. However, one of the main culprits in the daily diet of many are sugar sweetened soft drinks. There is a study indicating that two or more sodas a day can increase risk of a gout attack by a whopping 85% over someone who drinks less than one a month. During a gout attack, avoid the following:
- All foods and beverages with high fructose corn syrup such as candy and soda
- Highly limit or eliminate pure fruit juices such as orange juice (opt for an orange instead, see below)
- Sweeteners such as honey and agave
- Try to eliminate desserts that have higher sugar content such as milk chocolate and ice cream