Fish and Gout: What to Eat, What to Avoid

By now, you’ve probably received “the memo”: Certain types of fish are great sources of heart-healthy omega-3 fatty acids, lean protein, and essential vitamins and minerals, including antioxidants in vitamins B2, B12, and vitamin D.

However, eating seafood, including fish, is also a well-recognized risk factor for increased uric acid levels in the blood, which can lead to a gout attack. And this is the last thing you want if you already live with gout.

This article explains the connection between the uric acid found in fish and gout. It also provides a breakdown of fish that contain low, medium, and high levels of a chemical substance known as purines (or purine compounds).

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Learn About Purines

Your body produces purines naturally, and you also get them from food. Trouble begins when your body produces too many purines, or you eat too many foods high in purines.

First, your uric acid levels will increase. Then excess uric acid (which your body cannot excrete) turns to uric acid crystals. These crystals build up in the joints and surrounding tissues and trigger the painful symptoms of gout.1

Also known as gouty arthritis, gout is a common type of arthritis that can flare up out of nowhere, causing sharp pain, swelling, and tenderness in at least one joint.

Fish contains low, moderate, and high levels of purines. So, if you consume too much of certain types of fish, the purines can build up and trigger a painful gout attack.

Purines

You need a healthy supply of purines in your diet. But if you have gout, purines can accumulate into excess uric acid in the blood because you can’t efficiently expel them. Uric acid then builds up in joints and causes the pain, redness, and swelling associated with gout.

Fish That Are OK to Eat

All fish should be eaten in moderation if you have gout or are at risk of gout due to hyperuricemia, which is a condition defined by having too uric acid in the blood.2

Fish and seafood that are OK to eat when you have gout are those in the “low-purine category,” meaning they have less than 100 milligrams of total purines per 100-gram serving.

The best options include Japanese eel, monkfish meat, and sablefish. The purine content of catfish, flounder, red snapper, salmon, sole, and tilapia skew slightly higher but are good options, too.

Purine Content per 100g.

These fish varieties can be eaten fried, grilled, boiled, roasted, or barbecued.

Fish to Eat in Moderation

Fish and seafood that are best consumed in moderation include those in the “moderate-purine category,” or those with a purine content from 100 to 400 milligram per 100-gram serving).3

Most types of fish fit into this range. They include carp, cod, flounder, haddock, halibut, pike, sea bass, and sole.

Purine Content per 100g.

These fish are typically served boiled, fried, steamed, or baked.

Fish to Avoid

When you have gout, you should avoid fish in the “high-purine category,” or those with a purine content of 400 milligrams or more per 100 grams of fish. Studies have shown that fresh anchovies have the total highest purine content at about 410 milligrams per 100-gram serving.4

Some of the most popular types of fish are, unfortunately, high in purines. They include crab, lobster, trout, and tuna. Other fish with high purine levels include herring, ocean perch, mackerel, sardines, scallops, and trout.

They all can trigger what the Centers for Disease Control and Prevention calls a “gout flare.”2

Purine Content per 100g.

The purine content above is approximate and can range between species and with cooking methods.3

Cooking Tips

Avoiding certain types of fish may be the ideal, but it may not always be practical. (Think of a wedding or anniversary dinner where grilled trout headlines the menu.)

In this case, it might be good to know that cooking methods affect the purine content of fish so that you can order accordingly. Boiling, poaching, or steaming in water can reduce the overall purine content of a fish dish.

Cooking doesn’t always lead to the best outcome, however: Researchers have found a significant positive relationship between the risk of hyperuricemia and eating raw (sashimi and sushi) or roasted fish.5

Omega-3 Fatty Acids

The good news for gout patients (and fish lovers) kept rolling in when a (small) study found a relationship between consuming omega-3 acids and the risk of gout flare-ups.6 Specifically, consuming omega-3 fatty acids was found to decrease the number of gout flare-ups.

Omega-3 fatty acids were already highly regarded for their presumed ability to improve heart health and reduce the risk of heart attack or stroke. This is why the American Heart Association recommends eating two servings of fish per week.7

Fish like anchovies, herring, mackerel, black cod, salmon, sardines, bluefin tuna, striped bass, and whitefish are high in omega-3 fatty acids.

It would appear that a green light could not be flashing brighter if you have gout and you’re concerned about heart health. But it always pays to be certain, especially when you realize that the study was a small one (and could breed false hope). Plus, gout differs from one patient to another.

No doubt you’ll find the best guidance from your healthcare provider or nutritionist, who can guide you to the right foods and even create a diet that suits your particular circumstances.

Until you do, perhaps the best advice comes from the Arthritis Foundation, which advocates on behalf of all arthritis patients:

  • “The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. You can learn by trial and error what your personal limit is and which foods cause you problems.”

Summary

If you have gout, you probably know that you have to be careful about the types of fish you eat. You want to keep your purine levels low so that you do not trigger a gout attack. Some types of fish are perfectly OK to eat, some should be eaten in moderation, and others are best avoided altogether. Do your best to master alternative cooking methods, too. “Moist” preparation methods can help lower purine content.

Mercury in Fish

Keep an eye on the amount of mercury in your fish choices. Eat fish that is low in mercury, such as canned light tuna, catfish, pollock, salmon, and shrimp.8

A Word From Verywell

People with gout should be watchful about the purine content of fish. Dietary changes are the easiest way to avoid a gout flare-up and a buildup of uric acids. Choose a fish with low purine levels. Then prepare it using a moist method like boiling, poaching, or steaming.

Sources:

  1. Arthritis Foundation. Which foods are safe for gout?
  2. Centers for Disease Control and Prevention. Gout.
  3. Kaneko K, Aoyagi Y, Fukuuchi T, Inazawa K, Yamaoka N. Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull. 2014;37(5):709-21. doi:10.1248/bpb.b13-00967
  4. Ellington, Anna. Reduction of purine content in commonly consumed meat products through rinsing and cooking. GETD.
  5. Ren Z, Huang C, Momma H, et al. The consumption of fish cooked by different methods was related to the risk of hyperuricemia in Japanese adults: A 3-year follow-up study. Nutr Metab Cardiovasc Dis. 2016 Sep;26(9):778-85. doi:10.1016/j.numecd.2016.05.009
  6. Zhang M, Zhang Y, Terkeltaub R, Chen C, Neogi T. Effect of dietary and supplemental omega-3 polyunsaturated fatty acids on risk of recurrent gout flares. Arthritis Rheumatol. 2019;71(9):1580-1586. doi:10.1002/art.40896.x.
  7. American Heart Association. Fish and omega-3 fatty acids.
  8. Harvard Medical School. What to do about mercury in fish.
  9. Ragab G, Elshahaly M, Bardin T. Gout: an old disease in new perspective – a review. J Adv Res. 2017;8(5):495-511. doi:10.1016/j.jare.2017.04.008
  10. Arthritis Foundation. Gout diet dos and don’ts.

Important Notice: This article was originally published at www.verywellhealth.com by Michelle Pugle where all credits are due. Medically reviewed by Anita C. Chandrasekaran, MD, MPH.

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