Food and Gout: Updated Advice

“My joints started being painful when I ate….”

“I must have eaten a lot of … that’s why my knees are painful.”

“Is there anything I should avoid eating?”

“Is it true that eating pork, beans and rice cause joint pains?”

I almost always encounter similar statements and questions when evaluating patients coming in for joint pains. I don’t know if this is something cultural or a result of disinformation. But is there any truth to these associations? 

Except in relation to gout, there is NO direct scientific evidence linking intake of particular foods to arthritis. However, the result of overeating – that is, being overweight/ obese – is what has been implicated in the development and progression of some forms of arthritis. Some papers suggest that weight loss of as little as 5Kg in overweight individuals can reduce the incidence of osteoarthritis by 50% in women and reduce progression or worsening joint pains in osteoarthritis and other forms of arthritis.

I remember using an old table (from the 1994 Nutritionists Dieticians Association of the Philippines Diet Manual) when advising patients with gout while I was in training. It classified food in terms of its purine content as very high (>150mg/100g), high (75-150mg/100g) and moderate (<75mg/100g). I’d give patients a copy of the table and instruct them to “avoid those listed in the very high category, minimize those listed under high, take in moderation those under moderate, and everything else can be taken ad libitum.”

But guess what! I NO LONGER give such advise to my patients with gout. The same 12 year observational study that clarified the relation of alcohol to new onset gout, also cleared some misconceptions about food.

Purine-rich vegetables (legumes, dried beans) did not affect while dairy products appeared protective – decreasing the risks of new onset gout. More than 2-3 servings per week of beef, pork and lambincreased the chances of getting the disease. And eating >1 serving of seafood per week also increased the chances of new onset gout. The total protein and animal protein intake did not appear to increase the risk of gout.

So now I give the following advice to my patients:

  • Take vegetables (including legumes) in abundance.
  • If without contraindications, drink milk (doesn’t matter if low fat or high fat) daily or every other day.
  • At most 3 servings every week of beef, pork and lamb is allowed. Other animal meats can be taken in moderation
  • Ensure at most 1 serving of seafood every week. If omega-3 fatty acids (EPA/ DHA) are needed for lipid disorders, feel free to take supplements.

Footnote. 1 serving of beef, pork and lamb weighs 112-168g. 1 serving of seafood weights 84-140g. 1 serving of milk amounts to 240ml.

???????????????????????????????Dr. Sidney Erwin Manahan is a rheumatologist affiliated with the East Avenue Medical Center. He supervises internal medicine residents as their assistant training officer. He is presently the Secretary of the PRA Board of Trustees You can follow him at twitter at


Published by Phil Rheuma

The recognized leader in the field of rheumatology in the Philippines and a major contributor in the Asia Pacific Region. A Subspecialty Society of the Philippine College of Physicians. A Specialty Division of the Philippine Medical Association. A Non-stock, non-profit organization registered with the Security and Exchange Commission.

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