Diet for high uric acid: what to eat and what to avoid

What is uric acid, and when is it considered high?

Uric acid is what remains when the body breaks down purines, substances found in our own cells and in food. It travels through the blood and is eliminated mainly in the urine.

Hyperuricaemia is when the blood level rises above about 6.8 mg/dl, the point at which urate stops dissolving, according to European rheumatology recommendations [1]. Above this level, it can form microscopic needle-shaped crystals.

High levels do not always cause symptoms. If crystals settle in a joint, they cause the sudden inflammation of gout. If they form in the urinary tract, they can cause kidney stones and renal colic. See “Diet for gout”.

For gout, the usual target is to lower it below 6.0 mg/dl so that the crystals gradually dissolve [2]. If you have tophi (crystal deposits under the skin), frequent attacks or chronic arthritis, the target is below 5.0 mg/dl [1].

Which foods raise uric acid?

The main contributors are foods high in purines from animal sources and those that slow their removal by the kidneys.

Red meat and, especially, offal (liver, kidneys, pâtés) contain a lot of purines, and guidelines recommend limiting them [2]. The same applies to shellfish and small oily fish eaten whole or tinned, such as sardines and anchovies.

Alcohol deserves special attention. Beer, both alcoholic and alcohol-free, provides guanosine, a purine that is absorbed quickly and is ultimately converted into uric acid. Alcohol also produces lactate, which competes with urate in the kidneys and slows its removal. That is why European recommendations advise avoiding beer and spirits in particular [1].

Soft drinks and products with glucose-fructose syrup also matter. An analysis of several cohort studies associated higher fructose consumption with a higher risk of gout [3]. When the liver processes it, it uses cellular energy and leaves waste products that are eventually converted into uric acid.

What can you eat if you have high uric acid?

Most everyday foods. The foundation is the same as for any healthy diet, with a few adjustments.

Semi-skimmed dairy products are among the most useful foods available to you, and European recommendations encourage including them [1]. Milk proteins, such as casein and lactalbumin, help uric acid leave the body in the urine [4]. Milk, plain yoghurt and fresh cheese can all be eaten daily.

Eggs and lean white meats (chicken, turkey, rabbit) provide protein with fewer purines than red meat or processed meats. White fish such as hake, cod or sole can be included in rotation.

You can have two or three pieces of fresh whole fruit a day. It provides water, fibre and vitamin C, and the fibre means its fructose reaches the liver gradually, unlike the fructose in juices and soft drinks.

Cereals (rice, oats, pasta, bread) and tubers (potatoes, sweet potatoes) contain very few purines and make a good base for your meals.

Can you eat pulses, spinach and tomatoes if you have high uric acid?

Yes, in most cases. For decades, lentils, chickpeas, beans, spinach, asparagus, cauliflower and mushrooms were removed from diets because food composition tables list them as containing purines.

Choi’s 2004 study found that purine-rich vegetables and pulses did not increase the risk of gout [4]. European recommendations focus on limiting purines from animal sources [1]. You can eat pulses and leafy green vegetables several times a week.

Tomatoes are not among the foods these guidelines ask people to limit [1], [2]. Some people associate them with their attacks. If that applies to you, mention it at your appointment, but there is no reason to remove them from the outset.

What to drink throughout the day

Water is the main drink. EFSA recommends 2 L of total water a day for women and 2.5 L for men, including the water provided by food. Needs can vary for older people, in hot weather, during exercise, pregnancy or breastfeeding. A good volume of urine dilutes urate, making it less likely to crystallise and helping prevent kidney stones.

Unsweetened herbal teas and mild vegetable stocks also count. It is best to discard the water used to boil meat or fish, because purines pass into the stock.

You do not need to change anything about coffee if you already drink it in moderation. In observational studies, drinking it daily is associated with slightly lower uric acid levels [4]. Even so, this is not a reason to start drinking it.

If you also want to lose weight

Excess weight and abdominal fat are associated with insulin resistance and reduced removal of uric acid by the kidneys. That is why improving body composition can help lower the level. You can find guidance in the weight loss diet guide. If you also have high cholesterol, see the high cholesterol diet guide.

Prolonged fasting and strict ketogenic diets are not advisable. When the body receives very few carbohydrates, it uses its fat stores and produces ketone bodies. These compete with uric acid in the kidneys and slow its removal.

This can raise uric acid and trigger a gout attack. Weight loss works better when it is gradual, with regular meals and complex carbohydrates, and without very low-calorie diets.

What mistakes do we see in consultations?

Replacing a soft drink with juice. Juice may seem like the healthy option, but its fructose reaches the body all at once, just like the fructose in a soft drink. Fruit is better eaten whole and chewed.

Switching to unlimited white meat. Chicken and turkey have fewer purines than beef, but they are still meat. If the whole plate is meat, the portion matters. Leave room for pulses, eggs and dairy products.

Stopping medication when your blood test looks good. If your level has fallen with treatment, the treatment is doing its job. Your doctor decides on any change to your plan.

Is diet enough, or is medication needed?

Your diet can help make attacks less frequent and support kidney and heart health. If you also have high blood pressure, the diet for high blood pressure is compatible with this approach. But diet alone is rarely enough to control gout.

A large population-based cohort analysis found that diet explained at most 0.3% of the differences in uric acid levels between people [5]. Common genetic variants explained 23.9% [5]. A later review concludes that diet has a small effect on uric acid and that medication remains the mainstay of treatment [4].

If your level is well above the target of 6.0 mg/dl [2], diet alone will not bring it down to that level. The medication prescribed by your doctor, such as allopurinol (Zyloric) or febuxostat (Adenuric), does that work, with diet supporting it.