High Uric Acid and Gout: Foods Rich in Purines to Avoid, Especially Fish

Gout is one of the most painful forms of arthritis, as most of my patients mentions the pain is unimaginable and scales to 11/10. Unfortunately for many patients food can make flare-ups worse. One of the biggest dietary triggers is purine-rich foods. Purines are natural substances found in the body and in many foods. When the body breaks them down, they form uric acid. If uric acid becomes too high, crystals can collect in the joints and trigger swelling, redness, and severe pain. But Doc Damian, what foods should we avoid to maintain our uric acid at a normal level?

Good question my friend! In today’s article, I will be listing foods that we should avoid because they are high in purine. Foods highest in purines are most commonly organ meats, red meat, certain seafood, and alcoholic drinks such as beer. Sugary drinks and foods high in fructose can also worsen uric acid problems and increase gout risk.

FOODS TO AVOID OR STRICTLY LIMIT

1. Organ meat

These are among the highest-purine foods and are best avoided by patients with gout or high uric acid. These includes:

a. Liver

b. Kidney

c. Heart

d. Intestine

But Doc Damian, these are plenty of food listed what can I eat that won’t raise my uric acid? Don’t worry, there are better food choices for people with high uric acid. Patient’s do better when they are told to focus is not only on “what to avoid” but also on “what to choose instead”.

This list includes foods that have a LOWER RISK IN DEVELOPING HIGH URIC ACID:

1. Low-fat milk and yogurt

2. Eggs

3. Vegetables

4. Fruits in reasonable amounts

5. Whole grains

6. Chicken – better part is the breast and limit the gravy

Is there no alternative fish that I can take Doc? There are fish that are lesser in purine than those listed above. However, be warned that these fish should be only taken in moderation and not daily:

1. Tilapia

2. Bangus

3. Lapu-Lapu

4. Galunggong

5. Pompano

These fish still contain purine but are not in high amounts as to the once listed above.

If you have gout or high uric acid, try to reduce the foods most likely to trigger attacks. Drink more water, control portion sizes, and do not rely on diet alone if your doctor has prescribed uric acid-lowering medications.

Diet helps, but many patients also need proper medical treatment because gout is often influenced by genetics, kidney handling of uric acid, body weight, and other health condition, not food alone. So if you are worrying about your uric acid, it is better seeking consult to your friendly Internal Medicine Doctor, and that is me! Doc Damian!

2. Red Meat

Red meat does not always need to be completely banned, but large portions and frequent intake can worsen uric acid levels. Example includes:

a. Beef

b. Pork

c. Lamb

d. Bacon

e. Processed meats

f. Meat gravies

3. Fish and seafood

A lot of my patients always comes to the clinic and surprised that they have high uric acid. Then they claim that they already limit eating red meat and organ meat however when further probed, they eat plenty of fish and seafood. Here in the Philippines, most of us eat fish daily since it is mostly cheaper and is healthier compared to eating meat every day. Take note that not all fish are equal when it comes to purines. Some seafood is more likely to raise uric acid than others. Commonly listed higher-purine seafood includes:

a. Anchovies / Dilis

b. Sardines

c. Herring / Tunsoy / Tamban

d. Mackarel / Hasa / Tulingan

e. Trout

f. Tuna / Tambakol

g. Mussels / Tahong

h. Scallops

i. Shellfish: Shrimp, Crabs, Oysters and Squid

Does this mean you must avoid all fish forever? Not necessarily. We must take note of this. Fish, though are high in purine, also has cardiovascular benefits. In many patients, the advice is to limit high-purine fish and avoid overeating them, rather than banning entirely all seafood permanently. Small amounts may fit into the diet, depending on the patient’s uric acid control, medications, kidney function and flare history. Remember – avoid frequent, large servings of high-purine fish, especially during gout attacks or when uric acid is poorly controlled.

4. Alcohol

Alcohol can worsen gout, especially BEER. It both increases uric acid production and makes it harder for the body to clear uric acid. During an active flare, avoidance is best.

5. Sugary drinks

Soft drinks, sweetened juices, and other sugary beverages are strongly linked with gout risks. Drinks high in fructose are especially problematic.