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.
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 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 www.verywellhealth.com by Michelle Pugle where all credits are due. Medically reviewed by Anita C. Chandrasekaran, MD. Fact checked by Nick Blackmer.
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