What did I eat to cause this ridiculous amount of pain? What food do I need to avoid? These are the typical questions people ask when they experience their first full blown gout attack. The simple answer from research is eat less purine-rich foods to lower your risk of chronic gout.
Adapting to a new diet is never easy. If it was, then everyone would be able to resist junk foods, eat healthier whole foods and maintain their optimum weights. Just like knowing calorie content for weight gain, it is important to know, or at least be aware, of the foods that contain a high amount of purines that trigger gout . Unfortunately, purine information is not readily available or conveniently listed on product labels.
If you are like me, someone who needs specifics before making a decision, then this post will serve you well. If you are new to the game, this information will save you from a grueling trial and error phase that most chronic gout sufferers, like me, had to endure. The purpose here is not to be a hardcore research study. More so, to form a consensus and clarify recommendations by medical and health authorities on the worst foods for gout.
Purines the Root Cause of Hyperuricemia
A purine is an organic compound usually found in the same foods that contain protein. To break down purines the liver must produce uric acid. When there is a large presence of purines, the liver tends to produce more uric acid than the kidneys can filter out of the body. Hyperuricemia is the condition when uric acid levels are above normal levels. Excess uric acid crystals build up at a joint, which causes symptoms of gouty arthritis; inflammation and pain.
[For more details on how purines are linked to hyperuricemia and gout read my article: What Is Gout? Arthritis, Uric Acid, Purines And Pain!]
High Risk Does Not Always Mean High in Purines
High content, moderate content, high risk, and low risk are some of the ambiguous terms experts use to describe gout-causing foods and their purine content. It causes confusion because classifications based on content amounts can vary from each source. It is not uncommon to see the same type of food, like lobster, listed as high in purine by one source, but then listed as a moderate-risk by another.
Not to mention, different purine studies or tables have different data and results. (If there is an all encompassing book for purine content in foods, I have not found it yet. Please advise if you know of one.) A more simplified approach will be taken here instead of sounding like a technical report on determining purine content.
Several major health authorities consistently state the following food groups as high risk or high in purine content.
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Organs Meats
This food group was the most noted to avoid and considered to have extremely high purine content by all sources referenced. These meats are basically the internal organs from animals like cow, pig, chicken, lamb, deer and goat. Common organ meats are the liver, kidney, heart, intestine, stomach/tripe and gizzard.
Internal organs, also called offal, are delicacies in the Western diet, but eaten regularly in several European and Asian countries. Common food products that contain organ meats are liverwurst, sweetbreads/thymus, pâté and haggis.
Keep in mind any sausage or meatloaf can be made of organ meats.
Insight: At rare occasions albeit during my undisciplined diet years, just a couple of mouthfuls of chopped liver, liverwurst, or tripe, triggered a gout flare. If this food group was never part of your diet, then avoiding it now should be easy for you.
Fish – Two Worse Kinds
The two killer fish that stood out from the rest are sardines and anchovies. All sources listed these two as high in purine concentration and high risk for chronic gout patients.
The other fish most frequently mentioned to avoid or limit are mackerel, herring, trout, tuna, halibut, haddock and codfish.
If you are poissonnier or a fish connoisseur, keep in mind the majority oily fish contain more purines than white fish. Also, be aware all fish when dried or cured have higher amounts of purines
For some perspective, one reference for purine content listed salmon at 170 mg/100g, sardines at 480 mg/100g, and beef liver at 554 mg/100g. 100 grams is about a 3.53 oz portion. Inconsistent advice or limited information was found for many popular fish like salmon, bass, grouper, snapper, and mahi-mahi.
Roe, or fish eggs, contain a high amount of purines. Caviar is roe cured and salted. Roe can also be cured, increasing its purine content. Roe is popular in Japanese cuisine and added to many types of sushi rolls. Caviar, considered a delicacy to some, may look like a spread.
According to one recent study, boiling fish before eating or cooking reduced the purine content. Note, the purines transfer to the boiling water.
Insight: I used to eat a lot of different types of sushi, and get gout sooner or later. Now, I always avoid eating sardines, anchovies, roe, mackerel and any dried fish because I know these hit me the fastest. Common salmon, yellowtail and tuna rarely bother me unless I overeat. On that note, I had less massive gout attacks when I stopped going to all-you-can-eat sushi buffets. However, now I can have an occasional sushi dinner and not have any issues because of a well managed low-purine diet.
Alcohol – Because of the Yeast
Alcohol was on the avoid or high-risk list by every major health source referenced. Abstaining from drinking could be a tough ask for many. The point here is there is plenty of scientific evidence confirming drinking alcohol directly increases uric acid levels that induces gout.
Yeast, in general, contains a high amount of purines. The most common gout triggers made with yeast are; beer, liquor, wine, cider, marmite, vegemite, processed meats, cured meats, and extracts.
Brewer’s yeast is used to make drinking alcohol. It is the main ingredient that contains purines. Beer gets the bulk of its purine content from brewer’s yeast, which has about three times the purines as baker’s yeast.
Some sources stated that wine is less of a risk than beer and liquor. However, a 2015 study published by the American Journal of Medicine stated otherwise.
Episodic alcohol consumption, regardless of type of alcoholic beverage, was associated with an increased risk of recurrent gout attacks, including potentially with moderate amounts. Individuals with gout should limit alcohol intake of all types to reduce the risk of recurrent gout attacks.
-Am J Med. Author manuscript; available in PMC 2015 Apr 1.
Another point was that drinking alcohol hinders the kidneys’ ability to remove waste products such as uric acid. Drinking alcohol can also cause dehydration, which leads to unnecessary uric acid production.
Marmite and vegemite are spreads made with high amounts of brewer’s yeast. These products are quite popular in England and Australia. Eating a vegemite sandwich and drinking beer would be a purine overload and probably cause gout symptoms immediately.
Wild Game Meats
Another group consistently found on the high purine content lists is wild game meats. Common animals in this group include; rabbit, turkey, goose, pheasant, quail, boar, venison (deer) and elk. Also noted was the skin and internal organs of these animals not only contain more fat and protein, but also more purines.
Wild turkey meat contains more protein than farm raised turkey, which indicates more purine content. This is usually the case for animal meats with high protein content.
Insight: I’m not much of a hunter, nor have I eaten much of any wild game. Do keep in mind any red meats high in protein will likely contain high amounts of purines.
Shellfish – Crustacea and Mollusks
There are two groups of shellfish, crustacea and mollusks. Crustacea includes crabs, shrimp, crayfish and lobsters. Mollusks are oysters, clams, oysters, mussels, squid, scallops and snails.
Which shellfish group is higher gout risk? There is no big difference. A purine table from a 2014 Japanese study included a comprehensive list of different shellfish and seafood. It listed oysters, shrimp and certain squid with similar purine content.
The research also determined different species can have different purine concentrations. For example, a snow crab had more purines than a king crab.
Most of the medical experts recommend to limit the portions to an unfulfilling 4-6 ounces. An amount which most of us can easily eat more of if not aware.
Insight: Even after realizing different shellfish have different purine amounts, shellfish is still the most unpredictable food group to gauge gout for me. On some occasions, I would eat a small amount of crabs, and end up with a terrible flare up in my ankle. Then another time, I would eat about twice as calamari and not feel any symptoms. My uric acid level at the time may have been a factor, but he unpredictability made me reduce my shellfish intake. However, I learned to prepare myself when I want to satisfy a craving.
Red Meats- The Ones We Love
Per nutritional value, this food group is the most controversial or debated. More research has shown that the typical Western pattern diet which consists of a high intake of animal meats increases chronic illnesses and disorders. Inconsistencies also apply to purine content. Beef, pork, veal, and lamb are mentioned the most to avoid or limit to maintain a low-purine diet.
However, these meats have less of purines than organ meats. So why do some experts claim it to be high-risk? Experts elude since it is undeniably the food of choice by millions in America, people’s tendency to overeat red meat makes it a high risk.
The general theme from experts suggest to limit portions to 4-6 oz daily rather than to completely avoid. A six ounce cut of beef or burger is about the size two decks of playing cards. Also, one Wendy’s beef patty is said to be 4 oz.
Processed meats and cured meats may contain very high levels of purine because of added ingredients like yeast extract and MSG (monosodium glutamate). Bacon, beef jerky, prosciutto and luncheon meats are examples of such products.
Insight: It is a challenge to avoid eating red meat. It took a long time for me to go from eating it every day, including processed meats, to once a week. Even now, it is not a huge portion. Last month, I did have a 12 oz steak and felt no gout symptoms, but it was not with any seafood or other gout triggers. I savor it and appreciate it more than ever. Many gout sufferers I know have beef or pork twice a week and do not experience gout. They do keep portions small, but take gout medication regularly.
Sneaky Gout Triggers: Yeast Extract, MSG, Fructose, Sauces
Yeast extract and MSG – Yeast extract plus other additives is basically MSG (monosodium glutamate). MSG powder contains purines that immediately metabolizes to uric acid. Although there is proof linking yeast to purine content via alcoholic beverages, only a few sources warn yeast extract as a high-risk gout trigger.
MSG and yeast extract are flavor-enhancers in several products such as; processed meat, canned food, bouillon, sauces, soup mixes, gravies, and salad dressings. Since the ingredient percentages are not typically listed or shared, it is very risky for people with chronic gout .
Manufactures will camouflage MSG by listing these these sub-ingredients instead; of yeast extract, protein isolate, hydrolyzed vegetable protein, hydrolyzed yeast, and soy extracts.
MSG is not only associated with gout. It is also linked to other health problems and allergies. Known side effects from MSG overconsumption are heart palpitations, headaches, numbness and drowsiness.
Fructose – Even though there is plenty of evidence that fructose causes the body to produce purines, most major sources did not account for it as a major gout trigger. Research from 2016 linked fructose consumption to increased uric acid levels which leads to gout flares.
Fructose is a type of sugar naturally in vegetables, fruits and honey. High Fructose Corn Syrup (HFCS) is derived from glucose and fructose. Popular products that contain HFCS and fructose are such as candy, soda/juice, frozen food snacks, yogurt, salad dressing, canned fruit, processed cookies, energy drinks and jelly.
The point here is not to stop eating fresh fruits because it contains fructose. Fruits contain very low amounts of purines and provide many health benefits. The concern here is consuming too much high fructose products on a regular basis can unnoticeably elevate uric acid level as well as affect kidney health.
Sauces – Popular sauces that may cause or contain purines are fish sauce, worcestershire sauce (anchovies), oyster sauce, barbecue sauce (extracts), and Maggi seasoning (MSG).
Insight: Cutting out soda not only helps to keep the uric acid levels down, but also helps reduce empty calories that cause weight gain. I have felt gout symptoms from just eating one can of Campbell’s soup with MSG or yeast extract in it. Chronic gout sufferers would benefit so much if MSG amounts are listed on food labels. Furthermore, I had meals where I thought I lightly added oyster or worcestershire sauce, and still felt symptoms the next day. Make sure you take a minute and read labels!
Don’t Be Scared of Beans, Legumes, Vegetables
The most inconsistent recommendations are for beans, legumes and certain vegetables. No source indicated to avoid these food groups. However, many state they are high risk like some seafood.
From this particular purine table, beans, lentils and peanuts have far less purines than the other food groups mentioned previously. Therefore, they are not as high-risk for gout. Keep in mind, cured or dried food, such as beans, will have a higher purine concentration per weight because of shrinkage.
Some sources caution eating asparagus, cauliflower, peas, chickpeas, spinach and broccoli because it contains more purines than most vegetables. However, the purine amounts for asparagus, spinach and broccoli are less than half of pork or beef. Lastly, a recent study concluded purine-rich vegetables are less of a risk than animal based purines.
Final Thoughts
Based on a consensus of several legitimate medical or health authorities, this compilation should serve as a solid guide to help you recognize the most common gout triggers. Also, you can determine which foods you are overloading and need to cut down on.
The biggest part of a low purine diet is reducing your intake of high-purine foods and drinks. When you can do this regularly, you can become more GOUTPROOF!
Lastly, sushi and beer were the hardest to cut down for me. What gout-causing food is the hardest to resist for you?
References
- Purine-rich foods intake and recurrent gout attacks https.ncbi.nlm.nih.gov/pubmed/22648933/
- https://www.healthline.com/nutrition/best-diet-for-gout#section3
- https://www.medicinenet.com/foods_that_cause_gout_to_flare_up/ask.htm
- https://www.arthritis.org/search/?q=GOUT+FOODS&g=go
- https://www.winchesterhospital.org/health-library/article?id=213316
- What is a low-purine diet? https://www.drugs.com/cg/low-purine-diet.html
- https://nutritionfacts.org/2018/09/06/plant-vs-animal-food-purines-for-preventing-gout/
- https://www.hopkinsarthritis.org/?s=GOUT+DIE
- https://www.everydayhealth.com/gout/tracking-triggers-of-a-gout-attack.aspx https://familydoctor.org/low-purine-diet/
- https://www.livestrong.com/article/470070-gout-diet-with-fish/
- https://www.nems.org/Files/Health%20Ed/AM%20Low%20Purine%20Diet%20-%20English.pdf
- https://www.arthritis-health.com/types/gout/what-are-purinesTotal Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia
- https://www.jstage.jst.go.jp/article/bpb/37/5/37_b13-00967/_html/-char/enGrahame, R. (2003). Gout: Answers At Your Fingertips. London: Class Publishing.
- https://www.brendadavisrd.com/plant-based-diets-and-gout/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922789/
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