High uric acid occurs when too much uric acid, formed as the body breaks down purines, is produced or when the kidneys cannot remove enough of it. In your diet, limiting offal, some seafood and red meat, cutting back on alcohol and sugary drinks, drinking enough water and reaching a healthy weight help keep uric acid under control; whether medication is needed is for your doctor to decide.
High uric acid sometimes causes no complaints for years and is noticed by chance on a routine blood test. In some people, however, crystals can build up in the joints and lead to a gout attack, or form stones in the kidneys. In this article I explain the causes and the place of diet in this picture.
- Uric acid is the breakdown product of compounds called purines; some purines come from food.
- Offal, some seafood, red meat, alcohol (especially beer) and fructose-sweetened drinks can raise uric acid.
- Low-fat dairy products, vegetables, wholegrains and plenty of water form the basis of the diet.
- Excess weight raises uric acid; however, crash diets and long periods without food can also trigger attacks.
- Diagnosis, treatment and medication decisions belong to your doctor; diet supports treatment but does not replace it.
What Is Uric Acid and Why Does It Rise?
Uric acid is a natural waste product formed when purines, found both in the body's own cells and in food, are broken down. It normally passes into the blood and most of it is removed in urine by the kidneys; if production rises or removal falls, its level in the blood goes up.
The main factors that contribute to high uric acid are:
- Diet: Frequent eating of purine-rich foods, alcohol and fructose-sweetened drinks.
- Excess weight and insulin resistance: These can reduce the removal of uric acid by the kidneys.
- Reduced kidney function: This makes it harder for uric acid to leave the body.
- Some medicines: For example, some diuretics can raise uric acid. Do not stop your medicines on your own; talk to your doctor.
- Genetic predisposition and sex: It is more common in men and in people with a family history of gout; in women the risk rises after the menopause.
- Fluid loss and long periods without food: Not drinking enough water, very low-calorie diets or prolonged fasting can cause temporary rises.
What Symptoms Does High Uric Acid Cause?
High uric acid often causes no symptoms; they usually appear when a gout attack develops from crystals building up in the joints, or when a kidney stone forms. A gout attack typically shows up as severe pain that starts suddenly in a joint, often the big toe, with redness, swelling and a feeling of warmth.
Attacks often begin at night and may ease within a few days; but if untreated they can recur and cause long-term damage to the joints. See a doctor without delay for sudden, severe joint pain, swelling with a high temperature, or signs of a kidney stone such as flank pain. What your test result means and which range it falls in is for your doctor to interpret, taking your laboratory values and overall health together.
Which Foods Raise Uric Acid?
The foods that affect uric acid most are offal high in purines, some small fish and shellfish, large portions of red meat, and alcohol and fructose-sweetened drinks. Banning these foods completely is often not necessary; frequency and portion size are what count.
| Food group | Recommended to limit | Better options |
|---|---|---|
| Meat and offal | Offal such as liver, kidney, brain and tripe; large portions of red meat; meat broth and concentrated meat sauces | Chicken and turkey in small portions; a limited number of portions of lean red meat a week |
| Seafood | Frequent, large amounts of small oily fish such as anchovies, sardines and mackerel; mussels, prawns | White fish in moderate portions; plan fish intake with your doctor |
| Drinks | Beer and other alcoholic drinks, sugary fizzy drinks, ready-made fruit juices | Water, mineral water, unsweetened herbal teas, ayran (Turkish salted yoghurt drink) |
| Dairy products | Frequent eating of full-fat and sugary milk desserts | Low-fat milk, yoghurt, kefir, cheese |
| Grains and sugar | Sugary desserts, refined flour products, products containing glucose-fructose syrup | Wholegrain bread, bulgur, oats |
| Vegetables and pulses | A marked restriction is usually not needed | All vegetables; pulses in moderate portions |
Although some vegetables such as spinach, asparagus and mushrooms contain purines, research suggests that purines from vegetables do not raise the risk of gout as much as those from meat and seafood. So, rather than restricting vegetables, I recommend giving half of your plate to vegetables.
The cooking method also makes a small but meaningful difference. Because some of the purines pass into the cooking liquid, soups made with bone and meat broth, stock cubes and concentrated sauces should be limited. If you have boiled meat, pouring away the liquid rather than using it in soup or pilaf, choosing grilling or baking, and keeping the meat portion about the size of your palm are practical measures.
Why Do Fructose and Alcohol Matter So Much?
Fructose and alcohol are two important factors that can increase uric acid production in the body and reduce its removal. That is why, with high uric acid, focusing only on purine-rich foods and ignoring sugary drinks and alcohol is a common mistake.
Sugary fizzy drinks, ready-made fruit juices and products containing glucose-fructose syrup should be limited. Whole fruit, on the other hand, contains fibre and is different from fruit juice; 2–3 portions of fruit a day can be part of a balanced diet. Some studies have looked at the link between sour cherries and cherries and gout attacks; but these do not replace treatment. As for alcohol, the safest choice is to stay away from it as far as possible on your doctor's advice; beer and spirits in particular can clearly affect uric acid.
How Do You Plan a Sample Day With High Uric Acid?
The basis of the plan is plenty of vegetables, low-fat dairy products, wholegrains, moderate protein and water spread through the day. The sample below is a framework; if you have kidney disease or another health problem, the plan varies from person to person.
- Breakfast: Egg, low-fat white cheese, tomato, cucumber, greens and wholegrain bread; water or light tea alongside.
- Snack: A bowl of yoghurt and a handful of cherries or an apple.
- Lunch: A vegetable dish cooked in olive oil, bulgur pilaf and ayran.
- Snack: A glass of kefir or milk.
- Dinner: A small portion of grilled chicken, plenty of salad and a small amount of wholegrain pasta or a pulse dish.
Increasing the water you drink through the day helps the kidneys remove uric acid. If you have a condition that needs fluid restriction, such as heart or kidney failure, ask your doctor how much water you should drink.
Does Losing Weight Lower Uric Acid?
In people with excess weight, slow and balanced weight loss can help bring uric acid down and reduce gout attacks. However, losing weight very quickly, going hungry and very low-carbohydrate crash diets can temporarily raise uric acid and trigger an attack.
So in people with high uric acid, a weight-loss plan needs to be set up more cautiously: without skipping meals, drinking enough water and keeping weekly loss reasonable. The article on excess protein intake and health risks can give you an idea of the risks of high-protein diets in this picture.
How Should You Eat During a Gout Attack?
During an attack, the priority is to follow the treatment your doctor recommends and to rest the joint; in your diet, giving up alcohol completely, drinking plenty of water and staying away from offal, red meat and seafood may help you feel better.
You may lose your appetite during an attack; even then, avoid long gaps without food and choose light meals such as yoghurt, soup and vegetable dishes. I covered what to watch for at times when meat consumption rises, such as religious holidays, in the article on eating meat at Eid al-Adha (Kurban Bayramı).
If you have high uric acid or a diagnosis of gout, we can work together on a nutrition plan that is compatible with your medication and suits your lifestyle within nutrition counselling for gout.
Sources
- NHS – Gout
- NIAMS (NIH) – Gout
- NHS – Water, drinks and your health
- Turkish Ministry of Health – Turkey Nutrition Guide (TÜBER) 2022
This article is for general information only; please consult your doctor and dietitian about your own situation.
Frequently Asked Questions
Does high uric acid go down on its own?
In some people, uric acid can come down with changes to diet, weight loss, giving up alcohol and enough fluid intake. However, because the rise may be due to kidney function, genetic predisposition or the medicines being taken, the assessment should be made by your doctor.
Can someone with high uric acid eat eggs?
Eggs are a low-purine protein source and can be eaten by most people with high uric acid. If you have no other restriction for fat and cholesterol, they can be part of a balanced diet.
Are dried pulses off limits with high uric acid?
They are generally not off limits. Pulses such as lentils, chickpeas and dried beans can be eaten in moderate portions; research suggests that plant sources of purines do not pose as much risk as meat and seafood.
Does coffee affect uric acid?
In some observational studies, regular coffee drinking has been linked with lower uric acid levels; but this is not a treatment recommendation. Drink coffee without sugar and in moderation, and ask your doctor if you have a heart rhythm or stomach problem.
How much water should I drink for uric acid?
There is no single amount that applies to everyone; for most adults, plenty of water spread through the day is recommended. If you have a fluid restriction because of heart or kidney disease, always set the amount with your doctor.
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The information in this article is general; what you need depends on your age, health and goals. Message us and we will build the plan that suits you together.
This content is for information only. For a personalised nutrition programme, please consult a dietitian.
