Key points
- Losing weight helps many people with gout. Studies link weight loss to lower uric acid and fewer attacks, although most of them are small and the evidence is of low to moderate quality.
- Slow and steady is safer than fast. Starvation diets and long fasts can raise uric acid for a while and set off a flare, so regular meals and a calm pace work best.
- Drinks matter a lot. Sugary soft drinks, beer and spirits are linked to more gout, and swapping them for water cuts many calories too.
- Portions matter more than bans. Large helpings of meat, organ meats and some seafood raise the risk; a moderate portion, plenty of vegetables and some dairy fit both goals.
- Rest during a flare, walk between flares. Cool and raise the painful joint during an attack, then build up gentle walking again once it has settled.
- Talk to your doctor first. Gout treatment is a medical decision, and you should never stop or change a prescribed medicine because your weight has gone down.
Does losing weight help gout? What the studies show
Yes, for many people with gout who carry extra weight, losing some of it lowers uric acid and makes attacks less frequent. The research is not perfect, but it points the same way, and rheumatology guidelines include weight loss in their advice.
The clearest overview is a systematic review in the Annals of the Rheumatic Diseases. Its authors found ten studies of people with gout and overweight, including one randomised trial. Average weight losses ranged from 3 kg to 34 kg.
In six of the eight studies that counted attacks, people had fewer of them after losing weight. Uric acid usually went down too, by up to about 2.8 mg/dL (168 µmol/L) in the studies with the largest weight loss. A few studies showed no change.
The reviewers rated the quality of this evidence as low to moderate, mostly because the studies were small and few had a comparison group. That is an honest limit. It does not mean weight loss fails; it means the exact size of the benefit is still uncertain.
What gout guidelines advise
The American College of Rheumatology (ACR) guideline advises people with gout who have overweight or obesity to follow a structured plan to lose weight. It does not back any one plan, and it calls the recommendation conditional because the evidence is limited.
The same guideline describes a long-term study of men who developed gout during a large heart study. A drop in BMI of more than 5% went with about 40% lower odds of repeat flares, and a rise of more than 5% with about 60% higher odds. The numbers were small, but the trend ran in both directions.
| Study | Who took part | Weight change | What happened to gout |
|---|---|---|---|
| Pilot diet study (Dessein, small, no control group) | 13 men with frequent attacks, average BMI about 30 | About 7.7 kg lost in 16 weeks on a moderate 1,600 kcal plan | Attacks fell from about 2 to under 1 a month; uric acid came down and reached normal in 7 of 12 men |
| Small cohort, described in the ACR guideline | 11 people with gout and obesity | About 5 kg lost | Uric acid about 1.1 mg/dL (65 µmol/L) lower |
| Cohort within a large heart study, described in the ACR guideline | Men who developed gout, followed over time | BMI more than 5% lower | About 40% lower odds of repeat flares |
| Health Professionals Follow-up Study (Choi) | 47,150 men without gout, followed for 12 years | 4.5 kg (10 lb) or more lost | About 39% lower risk of developing gout |
| Weight-loss surgery, described in the ACR guideline (small) | 12 people with gout | About 34 kg lost in 12 months | Uric acid about 2 mg/dL lower after a year, but flares briefly more likely in the first month |
The table shows typical findings, not a promise for one person. Genes, kidneys, medicines and drinks all play a part, which is why your own blood tests and your doctor’s advice count more than any average.
How much weight do you need to lose for gout?
There is no fixed target. In the review, losing more than about 3.5 kg was enough to see fewer attacks in several studies, and bigger losses tended to bring bigger drops in uric acid.
Many people find 5 to 10% of their starting weight a realistic first goal. Our weight loss percentage calculator shows what that means in kilos for you.
Why extra weight raises uric acid and gout risk
Extra weight makes your body produce more uric acid, and your kidneys may not clear all of it. When uric acid stays high for a long time, it forms tiny sharp crystals in and around a joint, and those crystals cause the sudden, severe pain of a gout attack.
Arthritis UK explains that the more overweight you are, the more urate (the salt form of uric acid) your body makes. That is why gout is much more common in people living with overweight or obesity.
The numbers from the Health Professionals Follow-up Study show how strong the link is. Compared with men at a BMI of 21 to 22.9, the risk of gout was about twice as high at a BMI of 25 to 29.9 and about three times as high at a BMI of 35 or more.
Weight gain over the years mattered too. Men who had gained 30 lb (about 14 kg) or more since early adulthood had about twice the risk of those whose weight had stayed stable, while losing weight lowered it.
Insulin, blood pressure and the kidneys
Researchers also point to insulin resistance. Insulin affects how much uric acid the kidneys let go, so a body that needs more insulin may hold on to more of it.
High blood pressure and water tablets (diuretics) are separate risk factors. In the same large study, high blood pressure raised the risk of gout by more than twice and diuretic use by almost 1.8 times. If you take a water tablet, keep taking it and ask your doctor whether it fits your gout.
Gout often goes together with heart and kidney problems. European diagnosis guidance asks doctors to check every person with gout for heart risk factors, so losing weight can help on several fronts at once.
Who gets gout, and why it is not a personal failing
Gout is about four times more common in men than in women, according to Arthritis UK. Women rarely develop it before the menopause, because oestrogen helps the kidneys remove urate; after the menopause their risk rises.
Genes play a large part as well. Arthritis UK states that lifestyle choices are not the main reason most people get gout, and the ACR guideline asks doctors to talk about food without blaming patients. Food, drinks and weight are simply the parts you can work on.
Lose weight slowly: crash diets, fasting and gout flares
Fast weight loss and fasting can trigger a gout flare, so the safest way to lose weight with gout is slowly, with regular meals. This is the most important difference between losing weight with gout and losing weight without it.
The authors of the weight-loss review point out that gout attacks are more likely after surgery, in the first months of uric-acid-lowering treatment and during starvation. Fasting and dehydration both raise uric acid, and one theory is that sudden swings in uric acid, rather than the level itself, set off an attack.
Arthritis UK gives the same practical advice: extreme weight loss and starvation diets are not recommended because they can raise urate levels. Its list of common triggers also includes dehydration, drinking too much alcohol and an unusually large meal, especially a fatty one.
What a steady pace looks like
For most people, a steady pace means roughly 0.5 to 1 kg a week, as our guide to safe weight loss explains. Eat three regular meals, keep a water bottle within reach and avoid skipping meals to “catch up”.
Very-low-calorie plans, juice cleanses and multi-day fasts are the ones to avoid unless your doctor supervises them. Meat-heavy, very low-carbohydrate diets are also not recommended by Arthritis UK, because they bring a lot of purines, the natural substances your body turns into uric acid.
Intermittent fasting and religious fasts
Arthritis UK notes that daytime fasting, for example during Ramadan, should usually be fine. Even so, drink plenty of water in the hours you can, avoid very large meals when you break the fast, and speak to your doctor beforehand.
If you are thinking of trying a fasting schedule to lose weight, read who should not fast or ask a doctor first. With gout, a regular eating pattern is usually the calmer choice.
After weight-loss surgery, uric acid can rise for a short time and flares become more likely in the first month. If you have gout and surgery is planned, make sure your surgical team knows.
An eating plan for weight loss with gout
The best gout diet for weight loss is a normal, filling eating pattern with fewer calories: lots of vegetables, wholegrains, beans, low-fat dairy, fruit, eggs and moderate portions of meat or fish. Weight loss usually does more for uric acid than any single food.
The ACR guideline is frank that diet changes on their own usually move uric acid only a little. They still matter, because some foods and drinks can trigger flares, and because the same changes help you eat less without going hungry.
Talk to your doctor first before you change the way you eat, especially if you also have diabetes, kidney problems or take several medicines.
A DASH-style pattern lowered uric acid in a trial
The DASH diet is rich in vegetables, fruit and low-fat dairy and low in saturated fat. In a feeding trial with more than 300 adults, it lowered uric acid compared with a typical American diet within eight weeks, even though weight was kept the same on purpose.
The average drop was small, about 0.25 mg/dL, but it was larger in people who started with higher levels: about 0.7 mg/dL in those at 8 mg/dL or more. Add the effect of weight loss, and the two work together.
Dairy, vegetables and fruit: good news for gout
In the large men’s study on purine-rich foods, those who ate the most dairy had about 44% lower risk of gout than those who ate the least. Low-fat milk and yogurt also bring protein that keeps you full, as our page on dairy for weight loss shows.
The same study found that a moderate intake of purine-rich vegetables did not raise the risk, and nor did a moderate protein intake. There is no need to drop them; our guide to vegetables and legumes for weight loss shows how to fill your plate with them.
Fruit looks helpful too. In a study of nearly 29,000 male runners, those who ate more than two pieces of fruit a day had about half the risk of gout of those who ate less than half a piece.
| How often | Foods | Why for gout | Why for weight loss |
|---|---|---|---|
| Often | Vegetables, salad, whole fruit, wholegrains, beans, lentils | Not linked to more gout; a DASH-style pattern lowered uric acid | Lots of food for few calories, with fibre that fills you up |
| Often | Low-fat milk, yogurt and cottage cheese; eggs | More dairy went with less gout | Protein keeps you full between meals |
| Often | Water, unsweetened tea or coffee, zero-sugar drinks | Diet soft drinks were not linked to gout; water helps prevent dehydration | Few or no calories |
| Moderate portions | Chicken, turkey, white fish, lean red meat | Risk rises with large amounts of meat and seafood | Lean protein, but portions add up quickly |
| Rarely, small amounts | Organ meats such as liver and kidney, shellfish, small oily fish, yeast extract spreads | Among the foods richest in purines | Often served in rich or fried dishes |
| Rarely | Sugary soft drinks, fruit juice, beer and spirits | Linked to more gout and more flares | Calories that do not fill you up |
Our free eating plan already follows this pattern. Use portion control tips, such as the plate method, to keep meat and fish to a modest share of the plate.
Meat, fish and seafood: how much is OK with gout?
Moderate portions of meat and fish are usually fine; the problem is large amounts, especially of organ meats and some seafood. You do not need to cut out animal protein to lose weight with gout, but it helps to make it a smaller part of the meal.
In the large men’s study on purine-rich foods, those who ate the most meat had about 41% higher risk of gout, and those who ate the most seafood about 51% higher. A moderate protein intake as such was not the problem.
For people who already have gout, timing matters. In an online study of 633 people, those who ate the most purines over two days had almost five times the odds of an attack compared with those who ate the least. Purines from animal foods carried a much higher risk than purines from plant foods.
Practical portions
Arthritis UK advises against eating large quantities of red meat, game and organ meats, and of seafood such as shellfish and small oily fish like anchovies, herring and sardines. It also says you should not have to remove any food from your diet completely.
- Keep meat or fish to about a palm-sized portion at a meal, and fill the rest of the plate with vegetables and a wholegrain or potatoes.
- Swap a meat portion now and then for eggs, beans, lentils, tofu or dairy, as Arthritis UK suggests.
- Keep organ meats and shellfish rare, and avoid big platters or all-you-can-eat buffets, which combine a large meal with a lot of purines.
- Choose grilled, baked or steamed over breaded and fried; the calories drop sharply.
How much meat and fish to eat in general, how often to eat fish and which cuts are leanest are all covered on our page about meat and fish for weight loss.
Gout-friendly swaps that help you lose weight
The table shows everyday swaps with approximate calories from the USDA food composition database. Each one lowers your purine or sugar load and saves energy at the same time.
| Instead of | Try | Why for gout | Approximate calories saved |
|---|---|---|---|
| 500 ml regular cola: about 210 kcal | Water, sparkling water or a zero-sugar drink: 0 to 10 kcal | Sugary soft drinks are linked to gout; diet versions were not | About 200 kcal |
| 250 ml orange juice: about 110 kcal | 1 medium orange (130 g): about 60 kcal | Less fructose at once, with fibre | About 50 kcal |
| 2 bottles of regular beer (2 × 330 ml): about 285 kcal | Sparkling water with lime: 0 kcal | Beer has the strongest link with gout of all drinks | About 285 kcal |
| 250 g grilled sirloin steak: about 610 kcal | 120 g roast chicken breast: about 200 kcal, with extra vegetables | A smaller meat portion means fewer purines | About 410 kcal before vegetables |
| 120 g cooked beef liver: about 230 kcal | 2 hard-boiled eggs (100 g): about 155 kcal | Organ meats are very rich in purines; eggs are not | About 75 kcal |
| 200 g breaded fried shrimp: about 485 kcal | 150 g baked white fish such as cod: about 160 kcal | Less shellfish and a smaller seafood portion | About 325 kcal |
Values are rounded and differ by brand, cut and cooking method. Choose one or two swaps that suit you and keep them for a few weeks before adding more.
Sugary drinks, juice and alcohol with gout
What you drink may matter even more for gout than what you eat. Sugary soft drinks, fruit juice, beer and spirits are all linked to higher uric acid or more attacks, while water and zero-sugar drinks are not.
Sugary drinks and fructose
Fructose is a sugar found in table sugar, syrups, fruit juice and many soft drinks, and it raises uric acid quickly. The ACR guideline notes that a large dose of fructose can raise uric acid by 1 to 2 mg/dL within two hours.
In a study of more than 46,000 men followed for 12 years, those who had two or more sugary soft drinks a day had about 85% higher risk of gout than those who had less than one a month. Diet soft drinks were not linked to gout, and the authors noted that fruit juice may raise the risk as well.
Whole fruit is a different story: it brings fibre, comes in a natural portion and fills you up. Arthritis UK stresses that the benefits of eating fruit far outweigh any concerns about its sugar. Our page on fruits for weight loss has portion ideas, and our no sugar diet guide helps you spot added sugar.
Alcohol and gout
Beer has the strongest link with gout. In the large men’s study on alcohol, each daily bottle of beer (355 ml) raised the risk by about half, each daily shot of spirits by about 15%, while moderate wine drinking was not linked to more gout.
For people who already have gout, the ACR guideline describes a study in which more than one or two drinks in the previous 24 hours went with about 40% higher risk of a flare. It recommends limiting alcohol, and your doctor may advise a lower limit than the general one.
Alcohol also adds calories and makes snacks harder to resist. Our page on alcohol and weight loss has a practical plan to drink less, and our guide to drinks for weight loss lists low-calorie alternatives.
Water: your main drink
Dehydration is a known gout trigger, and water is free of calories. Arthritis UK advises people with gout and a history of kidney stones to drink at least two litres of water a day.
If you have heart or kidney problems, ask your doctor how much you should drink each day. Spreading your drinks through the day is easier than drinking a lot at once.
Gout myths: cherries, vinegar and cutting out all purines
No single food, drink or supplement cures gout. Some popular ideas have a small grain of truth, others none, and the basics of steady weight loss, fewer sugary drinks and less alcohol still do the most.
Are cherries good for gout?
Cherries may help a little. In the same online study of 633 people with gout, those who had eaten cherries in the previous two days had about 35% lower odds of an attack. A tiny study of ten healthy women without gout also saw uric acid dip five hours after a large bowl of cherries (280 g).
Neither study was a randomised trial, and the ACR guideline rates the evidence on cherries as too weak for a recommendation. So enjoy cherries as one of your fruit portions: 280 g of fresh sweet cherries has about 175 kcal. Cherry extracts, concentrates and supplements are not needed, and we do not recommend them.
Vitamin C, apple cider vinegar and baking soda
The ACR guideline recommends against adding vitamin C supplements for gout, because two small trials found the effect on uric acid too small to matter. Fruit and vegetables bring vitamin C anyway.
Apple cider vinegar, lemon water and baking soda are often shared as gout remedies, but none of the guidelines on this page recommends them. Read our myth-check on apple cider vinegar and its safety before you try it.
Do you have to cut out all purines?
No. A very strict low-purine diet is hard to follow, and in one small trial, teaching people with gout to eat fewer purines did not lower their uric acid compared with their usual diet. Avoiding big purine-rich meals and keeping portions moderate is enough for most people.
Walking and exercise with gout: during and between flares
During a gout flare, rest the joint; between flares, regular walking and other gentle exercise help you lose weight and may lower your risk of new attacks. The trick is to know which phase you are in and to build up slowly.
During a flare
Arthritis UK advises avoiding exercise during a flare, because it can make the pain worse. Rest the joint, raise it on a cushion and cool it with an ice pack or a bag of frozen peas wrapped in a tea towel. The ACR guideline also supports ice as an extra treatment during a flare.
A typical gout attack lasts about five to seven days, sometimes up to two weeks. Start moving the joint again once the pain and swelling have gone down, not before.
Between flares
Staying active lowers your chance of an attack, according to Arthritis UK, and even a little exercise is better than none. In a study of nearly 29,000 male runners, those who were fitter and ran further had a lower risk of gout, partly because they weighed less.
You do not need to run. Walking is the easiest way to start: begin with a few minutes on flat ground and add a little each week, as our walking for weight loss plan shows. Short bursts spread through the day count too, as our page on exercise snacks explains.
If your feet or knees are often sore, joint-friendly options help. Swimming and cycling take weight off the joints, and our guide to exercise with bad knees offers more gentle choices.
- Wear roomy, cushioned shoes with space for your toes, because the big toe and other foot joints are typical places for gout.
- Drink water before and after you walk, especially in warm weather, so you do not become dehydrated.
- Stop if a joint becomes hot, red or swollen, and rest until it settles.
- Add gentle strength work twice a week once walking feels easy, with our free workout videos in the Start, Build and Strong levels.
| During a flare | Between flares | |
|---|---|---|
| Movement | Rest the painful joint, raise it, cool it with a wrapped ice pack | Daily walking, built up slowly; swimming or cycling if feet are sore |
| Food | Regular, light meals; no big or rich meals; no dieting extremes | A steady calorie deficit with vegetables, dairy and moderate protein |
| Drinks | Plenty of water; no alcohol | Water as the main drink; little or no beer, spirits or sugary drinks |
| Medicines | Use the flare plan your doctor gave you | Keep taking prescribed treatment as agreed with your doctor |
| When to call the doctor | First attack, fever, feeling unwell, or no improvement after a few days | Attacks keep coming back, or lumps appear under the skin |
When to see a doctor about gout
See a doctor if you think you have gout for the first time, if attacks keep coming back, or straight away if a joint is hot and swollen and you also have a fever or feel unwell. Gout needs a proper diagnosis, and its treatment is a medical decision.
A blood test for uric acid is not enough on its own to diagnose gout. European guidance recommends looking for urate crystals in fluid from the joint where possible, and checking for heart risk factors in everyone with gout.
Get help the same day
A suddenly painful, hot, swollen joint can also be caused by an infection in the joint. Septic arthritis is a medical emergency, so do not wait if you have a fever, chills or feel very unwell, or if this is the first time a joint has swollen like this.
Also tell your doctor if you have had kidney stones, which are linked to high uric acid, or if you notice firm lumps under the skin near joints, called tophi.
Gout treatment and your weight-loss plan
Many people with gout need a medicine that lowers uric acid over the long term. Whether you need one, which one and at what dose is decided by your doctor, based on how often you have attacks, your kidneys and your other health conditions.
Keep taking any prescribed gout treatment while you lose weight, and do not stop it because your weight or uric acid has improved. Both starting and stopping treatment can bring on flares, so your doctor will plan any change with you, often with extra cover in the first months.
The same applies to blood pressure medicines and water tablets. Some can raise uric acid, and your doctor may review them, but never change them yourself. Our doctor visit checklist helps you prepare questions about your gout and your weight.
Whether medication is right for you is something to discuss with your doctor. Obesity Foundation does not recommend or promote weight-loss medication; our focus is good food, appropriate exercise and walking. The same goes for gout medicines: we neither recommend nor discourage them, as that is your doctor’s decision with you.
Free help to lose weight with good food and walking
We help people lose weight and get healthier with good food, suitable exercise and walking, at a steady pace that suits gout. Everything is free and works alongside the care you get from your own doctor.
- A free eating plan: regular, filling meals with vegetables, beans, low-fat dairy and moderate portions of lean protein, so you eat less without going hungry. Ask for your free eating plan.
- Free workout videos: 150 videos in three levels, from gentle chair-based Start to Build and Strong, for the weeks between flares. Get the free workout videos.
- A free video meeting (in English): talk through your first steps and the questions to take to your doctor with one of our team. Book a free video meeting.
- The free Obesity Foundation Club: your own account to log your walks and workouts and see your progress add up. Join the Club.
We are not doctors. Questions about your diagnosis, blood tests or gout medicines belong with your own doctor, and we will always point you back to them.
Gout can make you afraid to move or to eat. A calm pace, water as your main drink, sensible portions and a daily walk between flares let you lose weight and give your joints a better chance at the same time.
Frequently asked questions
Will losing weight lower my uric acid?
For many people with gout and extra weight, it helps. In a pilot study, men who lost about 8 kg on a moderate 1,600 kcal plan saw their uric acid fall and their monthly attacks drop by more than two thirds. Results differ from person to person, so ask your doctor to recheck your level after a few months.
Can a diet or fasting trigger a gout attack?
Yes, it can. Starvation diets and long fasts can raise uric acid for a while, and sudden swings in uric acid are thought to set off attacks. A steady pace of weight loss with regular meals and enough water is the safer route; check with your doctor before any kind of fasting.
Is chicken or fish OK for weight loss with gout?
Usually yes, in moderate portions. The risk in studies came from large amounts of meat and seafood, and from organ meats and some shellfish and oily fish. A palm-sized portion of chicken or white fish, with vegetables, wholegrains and some beans or dairy, fits both a gout-friendly and a weight-loss plate.
Are cherries good for gout?
They may help a little, but they are not a cure. In one online study, people with gout who had eaten cherries in the previous two days had fewer attacks, and a tiny study in ten healthy women saw uric acid dip a few hours after eating them. Enjoy cherries as one of your fruit portions; extracts and concentrates are not needed.
Can I walk during a gout flare?
It is better not to. Rest the painful joint, keep it raised and cool it with a wrapped ice pack until the pain and swelling settle. Once the flare has passed, start again with short, easy walks and build up slowly.
Do I still need my gout medicine if I lose weight?
Do not stop it on your own. Weight loss can lower uric acid, but often not enough on its own, and stopping or starting treatment suddenly can trigger a flare. Your doctor can review your treatment with you once your weight and blood tests have changed.
Sources
- Nielsen SM, Bartels EM, Henriksen M et al. – Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Annals of the Rheumatic Diseases (2017)
- FitzGerald JD, Dalbeth N, Mikuls T et al. – 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care & Research (2020)
- Richette P, Doherty M, Pascual E et al. – 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Annals of the Rheumatic Diseases (2020)
- Choi HK, Atkinson K, Karlson EW, Curhan G – Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the Health Professionals Follow-up Study. Archives of Internal Medicine (2005)
- Dessein PH, Shipton EA, Stanwix AE et al. – Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction on serum urate and lipoprotein levels in gout: a pilot study. Annals of the Rheumatic Diseases (2000)
- Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G – Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine (2004)
- Zhang Y, Chen C, Choi H et al. – Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases (2012)
- Juraschek SP, Yokose C, McCormick N et al. – Effects of dietary patterns on serum urate: results from a randomized trial of the effects of diet on hypertension. Arthritis & Rheumatology (2021)
- Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G – Alcohol intake and risk of incident gout in men: a prospective study. The Lancet (2004)
- Choi HK, Curhan G – Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ (2008)
- Zhang Y, Neogi T, Chen C et al. – Cherry consumption and decreased risk of recurrent gout attacks. Arthritis & Rheumatism (2012)
- Jacob RA, Spinozzi GM, Simon VA et al. – Consumption of cherries lowers plasma urate in healthy women. Journal of Nutrition (2003)
- Williams PT – Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. American Journal of Clinical Nutrition (2008)
- Mathews CJ, Weston VC, Jones A, Field M, Coakley G – Bacterial septic arthritis in adults. The Lancet (2010)
- Arthritis UK (Versus Arthritis) – Gout: symptoms, causes and treatment
- USDA Agricultural Research Service – FoodData Central, SR Legacy (approximate values per portion)