Fish and gout – prizes and pitfalls





This page, discussing fish and gout, was last reviewed or updated on 6 June 2014. 

Fish and gout is a subject that interests all gout sufferers. So this is quite a long discussion about gout and fish because it is an important gout diet topic, as we hope you will see.

The question is.... how much fish should be in a gout diet, and which fish are best? Many accounts of the value of omega -3 say "get it from cold water fish" and leave it at that. However many cold water fish are not very high in omega -3 fats, which are good for gout.

Popular examples of low omega-3 fish are: plaice, cod, sole, red snapper, flounder, haddock and halibut. These are not worth eating if you're looking for natural omega -3. But if you are lucky enough to be able to buy halibut caught in Alaskan waters...that does contain useful amounts of the Omega-3 EPA and DHA, and it is only moderately high in purines.

So to learn more about whether fish are a good food to eat for gout, we first need to know how much of the omega -3 fatty acids are in different kinds of fish. Remember there are three omega -3 fatty acids – EPA, DHA, and alpha linolenic acid (ALA), but EPA and DHA, the ones found in fish, are much better than ALA. 

Click this link to view a very useful list of the amounts of omega -3 fatty acids in various fish at the Paleo diet. This can help you plan the right fish to eat. 

When the page at the Paleo diet's website arrives on screen, just scroll down to the list. Because of where you live, most readers will not know some of these fish, but many should be familiar. 

Fish oil supplements should be in a gout diet, as described on the fish oil for gout page.

Their omega -3 are also called essential fatty acids. The word essential is used because, well, they are. Your body does not make them. You can get them from fish oil supplements and the other foods we explain on that page. Omega-6 fats are explained on the omega -6 page.

But let's now consider purines.in this discussion about fish and gout. When we do so, it becomes more difficult to reach a definite conclusion about which fish, and how much of it, to eat, but we shall reach a general conclusion about how much to include in a gout diet.

PURINES TABLE 

Consider the purines table here. It shows the amount of uric acid produced by 100 grams of a food.

On this table there are four columns of numbers. Use the first three (left to right) columns and mainly the first left column. First left is the average amount of uric acid produced per 100 grams of a food.  Purines themselves – there are two main ones plus  three related pyrimidines – produce different amounts of uric acid. Moreover, the amount of each of the  purines in different foods is not the same. So the total amount of purines in foods differs.

Second left (when numbered) is the minimum uric acid amount found in the testing, third is the maximum uric acid amount (when numbered) found in the testing. The difference between the minimum and maximum is sometimes quite significant which tells you to use this as an approximate guide only. Ignore the last column.

WHICH FISH ARE HIGH IN OMEGA-3 AND LOW PURINE? 

Unfortunately most fish are high or medium (moderate) in purines.

Some can be considered almost low purine. The purines table numbers here for moderate in uric acid are quoted in quite a wide range, of between 100 – 400 mg uric acid produced per 100 grams of a food.

Because of this wide range, it is probably better to assume that those fish which will be safer are those that produce up to 170 mg of uric acid per 100 grams of fish. Viewed this way, fish which are useful for omega -3, and are under 170 mg of uric acid produced, are mackerel, salmon, certain kinds of mussels and certain kinds of shrimps.

Mackerel, many types of which are high in omega -3, are shown to produce less than 170 grams of uric acid/100 grams, which appears to make them excellent. However, other purines' tables describe mackerel as high in purines. 

Two other seafoods  worth mentioning are oysters and real caviar. Oysters are fairly high in omega -3 and low medium in purines. They are in the top ten for the desirable EPA/DHA. These days oysters are expensive in many countries, but their omega-3:purine ratio is quite good. 

Real caviar (black and red) is also worth a mention. It is not shown in the linked table above to the omega -3 in fish, but it is very high in omega 3 and medium purine. It is also expensive of course, but it is a good food to eat for gout, when you feel like paying for it !

There aren't any other high omega fish that are not also medium or high purine. 

Other purine tables - we have links to other purines tables on this page.

Don't expect these tables, nor the omega -3 tables linked to above, to be absolutely precise. There are simply too many different variables at different testings. Among these, are that amounts of purines are usually shown from raw food, and purine amounts can change when food is cooked. In other words this is fairly scientific, but not exactly.

Remember too that purines in foods, like cholesterol in foods, only partially affects the amount of uric acid you produce. Most is produced in the liver.

How often should you eat fish for gout, and ideally with what? 

Since the benefits of high omega -3 fish make them a food to eat for gout, it's reasonable to say that eating fish that are not the highest in purines (for example between 100 – 400 mg uric acid produced per 100 grams of fish, and safer if the number is under 170 grams) twice a week is a good idea, especially if the rest of the meal is low purine which it will be if it's vegetables or a salad. The purines in vegetables and salad foods do not have much effect on uric acid levels.

Despite their huge omega -3 benefit, you may have to be careful of salmon and mackerel 

Its possible your uric acid levels are not falling because of fish in your diet. If so you'll know what to do. You know what you like, and some fish should be eaten. Study the tables we have linked to. If you understand ounces better than grams, note that 100 grams is about 3 ½ ounces, a small serving size.

Avoid high purine fish Consider fish in the table linked to above which produce 100 mg of uric acid and above per 100 grams of fish i.e. those which are medium-high and highest in purines: herring roe, herrings, (so that means kippers (smoked herrings) and pickled herrings – usually sold in glass jars), anchovies, tuna, trout, pilchards, smoked sprats  and sardines. All these should be completely avoided. 

Other seafood reported to be medium/high purine, which are not listed in the purine table on the link to the purines' table are: scallops, unsmoked eels, other fish roes, clams, and tiny fish such as sprats and whitebait. 

A SEAFOOD AND GOUT STUDY - INCREASED RISK

One study that found a risk of gout from eating fish was done a few years ago among men who were thought to have developed gout. It analysed the diets of 730 men. The researchers weren't completely sure that all 730 did have gout, but we can assume most did – and this is a large number.

In this study, those who ate the least fish certainly had the least risk. (The statistical number was less than 0.15 servings per day). But there was not much risk difference in groups who ate more than those in the least group. (The statistical number range was servings per day of 0.15 up to 0.56). Nevertheless, in this statistical range, the risk was definitely greater than those in the least group. And the risk was highest in those who ate the most fish.

However, in the gout sufferers diet (the Zone diet) study, that was quite successful against gout, the participants were recommended to eat fish at least four times a week for their polyunsaturated oils (omega -3 oils are polyunsaturated). Four times a week could be considered quite a high consumption of fish. 

We don't know what fish they ate, but we do know that the diet ignored purines. And it's important to say that insulin resistance was almost certainly their cause of gout, not excessive purine consumption over a number of years, so perhaps eating high omega -3 fish in their case didn't matter.

The diet was quite successful in reducing gout attacks and in improving markers of heart health and insulin resistance.  Perhaps the anti inflammatory, heart benefit and anti insulin resistance action of the omega-3 fish, was more effective than the potential rise in uric acid from the purines, but that's a guess.

Here's another reinforcing point about not including too much fish in your diet if you have gout. One nationality prone to gout are Filipinos. They eat a lot of fish and use a fish sauce made from tiny fish they call dilis, which in English are high purine anchovies. They eat so much fish that their government felt the need to make an internet post, of a list of purine amounts in those fish caught in local tropical waters which are high, medium and moderate in purines. (Unfortunately I can't link to it because I think it has now been taken down).

Remember the fish oil dietary supplements don't contain purines.

The bottom line about fish and gout

If you live in a country where people eat a lot of fish, or you do, you will probably need to reduce your fish consumption to a couple of times a week and use fish oil supplements for more omega -3. If your uric acid levels are not falling, cut back your fish consumption more.

If your uric acid level is say 5.0 mg/dL, and thus a couple of points under the level which is at the beginning of high uric (7.0 mg/dL), you might consider an extra serving a week, but this is a personal matter.

Another factor affecting your choice of fish, is that the amounts of omega -3 and purines in the types of fish eaten many countries are difficult to discover, probably because the research has never been done. Try to research this further if you live in one of these countries. Local rheumatologists may know and have anecdotal reports from other gout patients. And you may find that certain fish affect you and cause a rise in your uric acid levels, and even gout attacks.....so be alert!

Omega -3 fish are one of the good foods for gout, but you have to be careful about fish and uric acid.

RELATED PAGES

Visit our seafood and gout page to read why fish lowers gout attacks.

The best fish for gout are those that have the most omega -3 (or EPA) oils per purine, or amount of uric acid created. Here's our ranking tables.

Best beef for gout. Purines throughout the cow's body are not the same in every prime cut. So which are the best beef cuts for gout ?

Here is the study of the 730 men who developed gout. To learn more about fish and gout you can download it free of charge, courtesy of the New England Journal of Medicine. 






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