Weekly menu to lower uric acid: 7 days with a shopping list

Who is this menu for, and who is it not for?

It is designed for an adult with high uric acid on a blood test, or who has had an isolated episode of gout. It is suitable if you have no kidney complications and want to eat a varied diet comfortably at home. See “Diet for gout”.

It has not been calculated for pregnancy, breastfeeding or anyone under 18. It is also not for people with diabetes treated with insulin or medicines that can lower blood glucose too much. It is not intended for people with chronic kidney disease or who have or have had an eating disorder. If you have a condition with its own dietary plan (coeliac disease, a diagnosed allergy, heart failure or liver failure), follow that plan. If you have kidney disease, your nephrologist or dietitian will tell you how much protein, potassium, phosphorus and other ions and minerals are appropriate for you at your stage. If you have or have had an eating disorder, your care team should include psychological support.

The menu does not include a fixed calorie calculation. Adjust portions to your hunger and activity. If you need to feel fuller, add vegetables.

The 7-day weekly menu to lower uric acid

The week contains few animal purines, no alcohol or sugary drinks, and semi-skimmed dairy products every day. Pulses are the main protein source on four out of seven days. Eggs and white fish take the place of red meat, and every main meal includes wholegrain cereal and vegetables.

Fruit is eaten whole, for dessert or between meals, 2 to 3 pieces a day. Portions of white fish and white meat are around 100 g. For a mid-morning or afternoon snack, have plain yoghurt, a piece of fruit or a handful of unsalted raw nuts, around 20 or 25 g.

This week’s shopping list

It is calculated for one person for seven days. If you are cooking for more people, multiply the fresh ingredients. If you replace milk with a plant-based drink, choose one with no added sugar and at least 3% protein, and bear in mind that soya is an allergen.

Vegetables

• 1.5 kg of potatoes and 500 g of pumpkin
• 1 kg of courgettes and 500 g of green beans
• 1 bunch of fresh spinach and 1 bunch of chard
• 1 bunch of asparagus and 2 artichokes
• 250 g of mushrooms or mixed wild mushrooms
• 500 g of carrots and 1 bag of lamb’s lettuce or mixed lettuce
• 1.5 kg of ripe tomatoes and 2 cucumbers
• 4 onions, 3 leeks, 1 bunch of spring garlic and 2 bulbs of garlic
• 2 aubergines and 2 peppers (green and red)

Fruit

• 4 apples and 3 pears
• 2 bananas and 3 oranges or mandarins
• 2 kiwis and 1 slice of melon
• 1 punnet of strawberries and 1 punnet of blueberries or raspberries
• 1 medium avocado and 3 lemons

Pulses, grains and bread

• 1 medium jar of cooked lentils (or 200 g dried)
• 2 medium jars of cooked chickpeas (for the sauté and hummus)
• 1 medium jar of cooked white beans (or 200 g dried)
• 500 g of whole rolled oats and 1 packet of muesli with no added sugar
• 500 g of brown rice and 250 g of wholewheat pasta
• 1 packet of fine soup noodles
• 2 good-quality wholemeal loaves (to slice and freeze)

Fish, white meat and eggs

• 1 dozen free-range eggs
• 2 chicken breast fillets (about 200 g in total)
• 2 turkey breast fillets (about 200 g in total)
• 1 fillet of fresh or frozen hake (about 120 g)
• 1 medium, cleaned sea bream for baking (about 200 g)
• 1 medium, cleaned sea bass for baking (about 200 g)

Semi-skimmed dairy products

• 2 litres of semi-skimmed milk (or unsweetened soya drink with at least 3% protein)
• 12 plain, unsweetened, fat-free yoghurts
• 1 tub of semi-skimmed fresh cheese (about 250 g)
• 1 small portion of low-fat feta (about 100 g)
• 1 ball of low-fat fresh mozzarella (about 125 g)
• 1 small tub of low-fat cottage cheese (about 150 g)

Store cupboard and seasonings

• Good-quality extra virgin olive oil
• Apple cider or wine vinegar
• 100 g of raw, shelled, unsalted walnuts
• 50 g of linseeds or chia seeds
• Sweet paprika, black pepper, ground cinnamon, dried oregano and fresh parsley
• Coffee and assorted unsweetened herbal teas

How to organise the week when you have little time

• Tinned pulses. Rinse them in a colander under the tap and add them to your meal. This saves you hours of cooking.
• Freeze soups. Make double the amount of courgette or pumpkin soup and freeze portions. Add a poached egg on top for dinner in five minutes.
• When eating from the set menu. Choose salad or grilled vegetables for the starter. For the main course, choose white fish or grilled chicken, with fruit for dessert and water to drink.

What does this menu leave out, and why?

The weekly menu leaves out foods that gout guidelines advise avoiding or limiting [1], [2]. There is no safe amount of alcohol for health (WHO): the less, the better. Do not drink alcohol during pregnancy or breastfeeding, in childhood, if you are going to drive, or if your medication does not allow it. Avoid it during gout flares.

• Offal and pâté, the most concentrated source of animal purines.
• Red meat and processed meat, which the menu replaces with eggs, pulses, white fish and white meat.
• Shellfish and small oily fish, such as sardines, anchovies or whitebait, which contain many purines in a small portion.
• Beer, including alcohol-free beer, because of its purines.
• Wine and spirits, because alcohol slows the kidneys’ removal of uric acid.
• Sugary soft drinks and juices, because high fructose intake is associated with a higher risk of gout [3].
• Concentrated meat or shellfish stocks, because purines pass into the cooking water.

Why does this menu include pulses and vegetables if they used to be discouraged?

For years, dietary tables listed pulses, spinach, asparagus, cauliflower and mushrooms among foods considered risky. They were based on purine levels measured in the laboratory. This interpretation removed highly nutritious foods from the plate.

The 2004 study by Choi and colleagues found no increased risk of gout from eating purine-rich vegetables among the men studied. A 2021 review reports that purines from plant sources do not behave in the same way as those from animal sources [4].

Pulses and vegetables stay on the plate; animal purines, alcohol and sugary drinks are left out.

That is why you can eat chickpeas, lentils and leafy vegetables as part of a balanced dietary pattern. Tomatoes contain very few purines, and there is no reason to remove them from the outset. Limiting them only makes sense if you find that they coincide with attacks in your case.

What roles do water, semi-skimmed dairy products and coffee play?

Lowering uric acid also involves helping the body remove it in the urine.

Water comes first. As a general reference, EFSA, the European Food Safety Authority, sets an adequate total water intake at 2 litres a day for women and 2.5 litres for men [5]. This includes both what you drink and the water in food. Drinking enough keeps urine diluted and reduces the risk of urate forming crystals and kidney stones.

Semi-skimmed dairy products can be part of the menu every day. Have up to 3 servings a day, preferably plain and unsweetened (AESAN 2022). Gout recommendations advise including them [1]. A review reports a study in which uric acid fell by 10% in the three hours after drinking milk, because the kidneys removed more [4]. Semi-skimmed milk, plain unsweetened yoghurt and low-fat fresh cheese all fit into everyday meals.

Coffee, if you already drink it. In observational studies, people who drink coffee daily have slightly lower uric acid and less gout [4]. This is an observed association, so if you do not drink coffee, there is no need to start.

What if you also need to lose weight?

Excess weight, especially abdominal fat, is linked to insulin resistance. The body responds less effectively to this hormone, and the kidneys remove less uric acid. Losing weight can help. In a small group of people with obesity, losing about 5 kg reduced uric acid by an average of 1.1 mg/dl, according to the American gout guideline [2]. If you also have high cholesterol, you can find dietary guidance in the high cholesterol diet guide.

The approach matters. Prolonged fasting and strict ketogenic diets are not advisable. When carbohydrate intake is very low, the body uses its fat stores and produces ketone bodies. In the kidneys, these compete with uric acid for the same route out. Uric acid may rise suddenly and trigger an attack.

A gradual loss of about 0.5 kg per week is better. Cook food in the oven, steam it, bake it in parchment or grill it. Measure extra virgin olive oil, about 2 or 3 tablespoons a day, and save fried foods for occasional meals.

Is diet alone enough to lower uric acid, or is medication needed?

Diet reduces the frequency of attacks and supports kidney and heart health. But its effect has limits.

An analysis of five large population studies calculated that 63 foods, combined, explained 4.3% of the differences in uric acid levels between people. Common genetic variation explained almost 24% [6]. Genetics has a much greater influence than what is on your plate.

A low-purine diet lowers uric acid by around 1 mg/dl on average [4]. If you have gout, the American guideline sets a target below 6 mg/dl [2]. With levels of 8.5 or 9.5 mg/dl, diet alone is unlikely to be enough.

If a blood test has shown high uric acid but you have never had an attack, that guideline does not generally recommend starting medication [2]. Your doctor will assess this. If you already take a medicine to lower uric acid, such as allopurinol or febuxostat, do not change it or stop taking it on your own, even if your test results improve. The full clinical criteria are in the complete guide to uric acid.

What mistakes do we see in consultations?

Cutting out pulses, vegetables and tomatoes all at once. This is the old advice, and it leaves you with a plate of grilled chicken breast that no one can stick to for a month. Pulses and vegetables stay in your diet.

Switching from regular beer to alcohol-free beer. It still contains purines. Something similar happens when you replace a soft drink with juice, because the fructose is still there. We hear both of these choices almost every week in consultations.

Eating well during the week and letting go at celebrations. A very large meal, especially with alcohol, means a sudden load of purines and can trigger an attack. At these meals, choose a fish or vegetable dish and drink water.