Fish and Gout: What to Eat, What to Avoid

While nutrients in fish are beneficial for heart health, fish high in purines can trigger a gout attack.1 Purines are compounds important to the body that when broken down, form a substance called uric acid. High levels of uric acid can cause gout.2

If you have gout, attention needs to be paid to the types of fish you eat as some are safer than others. Studies have shown that eating large amounts of high-purine foods increases the risk of recurrent gout attacks by nearly five-fold.3

What may surprise you is that certain fish, such as bonito, have as many purines ounce per ounce as calve’s liver.3

This article offers a breakdown of the fish to eat or avoid if you have gout. It also describes which cooking methods are best when preparing fish for a gout-safe diet.

Fish That Are OK to Eat

When you have gout, look for fish that’s in the “low-purine” category. This means they have less than 100 milligrams (mg) of total purines per 100-gram (g) serving.3

Low-Purine Seafood
Salmon roe 4 mg
Crayfish 60 mg
Squid 60 mg
Smoked eel 78 mg
Oyster 90 mg
Caviar 95 mg
King crab 99 mg

Purine content per 100 g.

Fish to Eat in Moderation

Fish and seafood that are best consumed in moderation include those in the “moderate-purine” category. These are fish and seafood with a purine content of 100 to 200 milligrams per 100-gram serving.3 Most fish fit into this category.

Moderate-Purine Seafood
Rock lobster 102 mg
Main lobster 108 mg
Cod 109 mg
Pike 110 mg
Sole 130 mg
Scallops 136 mg
Snow crab 136 mg
Octopus 137 mg
Sea urchin 137 mg
Haddock 139 mg
Mackerel 145 mg
Clams 146 mg
Brown shrimp 147 mg
Crab 152 mg
Tuna 157 mg
Carp 160 mg
Salmon 170 mg
Halibut 178 mg

Purine content per 100 g.

Fish to Avoid

When you have gout, you should avoid fish in the “high-purine” category, or those with a purine content of 200 milligrams or more per 100 grams of fish.2

High-Purine Seafood
Herring 210 mg
Pickled herring 219 mg
Anchovy 239 mg
Bonito 211 mg
Ocean perch 241 mg
Tuna 257 mg
Tuna in oil 290 mg
Trout 297 mg
Sardines 345 mg
Pilchard 345 mg
Sardines in oil 490 mg

Purine Content per 100 g.

Cooking Tips

The way you cook fish can influence the amount of purines you consume. Studies have long shown that certain cooking methods can sharply reduce the purine content in foods. These include steaming, boiling, or poaching foods which transfer purines from the food into the cooking liquid.4

Boiling appears to be the most effective of the three methods, reducing purine levels in fish like sardines by anywhere from 23% to 41% after three minutes.4 Lower cooking temperatures are also seen to be more useful.5

By contrast, roasting fish appears to increase the risk of high uric acid, presumable by “locking in” purines rather than releasing them during the cooking process.6

Another factor often missed is that the highest content of purines in fish is generally the skin, particularly with marine fish.4 By simply skinning the fish before cooking, you may be able to dramatically decrease your risk of gout attacks.

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.7 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.8

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.


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 OK to eat, some should be eaten in moderation, and others are best avoided. While you learn, mastering alternative cooking methods may help. Boiling, poaching, or steaming fish in water can help lower purine content.

A Word From Verywell

Diet modification is crucial in the treatment of gout. For some people, cutting out high-purine foods, like shellfish, could prevent the need to take uric acid-lowering medications. For others requiring medication, these changes may reduce the dosage of medication necessary and reduce the risk of recurrent flares.

Important Notice: This article was also published at by Michelle Pugle where all credits are due. Medically reviewed by Anita C. Chandrasekaran, MD. Fact checked by Nick Blackmer.


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