What to Eat, What to Avoid

While the nutrients in certain fish are beneficial for heart health, fish high in purines can raise uric acid levels and trigger a gout flare.

This article provides a breakdown of which high-purine fish a person with gout may want to avoid. It also covers some gout-friendly fish options that can provide omega-3 fatty acids, lean protein, and other important nutrients.

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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 of total purines per 100-gram serving.

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

Low-Purine Seafood
Japanese eel 92 mg
Monkfish (meat only) 70 mg
Sailfin sandfish 99 mg
Caviar 95 mg
Botan shrimp 53 mg
Japanese scallop 77 mg
Squid (organs) 60 mg
Red king crab 99 mg
Purine content per 100 g.

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

All fish should be eaten in moderation if you have gout, also known as gouty arthritis. You should also limit fish if you’re at risk of gout due to hyperuricemia, a condition defined by having too uric acid in the blood.

Excess uric acid (which your body cannot excrete) turns to uric acid crystals that build up in the joints and surrounding tissues and trigger the painful symptoms of gout.

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 200 milligrams per 100-gram serving.

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

Moderate-Purine Seafood
Halibut 133 mg
Japanese sea bass 120 mg
Yellow striped flounder 113 mg
Carp 103 mg
Tuna 157 mg
Rainbow trout 181 mg
Salmon 119 mg
Lobster 102 mg
Crab 152 mg
Oyster 185 mg
Purine content per 100 g.

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

Eating raw fish (such as sushi) is associated with increased blood uric acid levels.

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. 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.”

High-Purine Seafood
Anchovies (dried) 1,109 mg
Jack mackerel (half-dried) 246 mg
Bonito 211 mg
Sardines (half-dried) 306 mg
Purine Content per 100 g.

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

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 fish 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 (high uric acid level) and eating raw (sashimi and sushi) or roasted fish.

Steam On

Steaming is a fast cooking method, and it’s also healthy because there is no need for oil, butter, or other fats. As culinary scientist Jessica Gavin, MS, says, “…perhaps best of all, steaming keeps all those valuable nutrients inside the food, instead of in the cooking liquid.”

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. 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.

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.

Anita C. Chandrasekaran, MD, MPH
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Arthritis Foundation. Which foods are safe for 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. 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;26(9):778-785. doi:10.1016/j.numecd.2016.05.009.

  5. 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.

  6. American Heart Association. Fish and omega-3 fatty acids.


By Michelle Pugle

Michelle Pugle, MA, MHFA is a freelance health writer as seen in Healthline, Health, Everyday Health, Psych Central, and Verywell.




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