Based on PubMed | Does eating fish increase the risk of gout flare-ups?

Eating certain fish and seafood can increase the risk of gout flare‑ups, but not all fish affect gout the same way. Evidence suggests that seafood high in purines such as anchovies, sardines, mussels, scallops, trout, tuna, and some shellfish can raise uric acid and trigger attacks, whereas small portions of lower‑purine fish may be reasonable for some people. ^{[1] [2]} Diets rich in red meat and shellfish and drinks high in fructose also raise uric acid and gout risk, and alcohol especially beer adds to that risk. ^{[3] [4]}

Why fish can trigger flares

• Purines in food break down into uric acid; when uric acid builds up, needle‑like crystals can form in joints and cause gout attacks. ^{[2] [4]}
• Several public health and clinical resources list specific high‑purine seafood anchovies, sardines, mussels, scallops, trout, and tuna that may increase gout risk when eaten in larger amounts or frequently. ^{[1] [4]}
• Clinical research in people with established gout shows that short‑term increases in total dietary purines especially from animal sources are linked to a higher chance of a recurrent gout attack within the next two days. ^[5] This study found a stepwise increase in flare risk with higher purine intake, with animal‑derived purines having a stronger effect than plant‑based purines. ^[5]

What the research shows

• In people with gout, higher recent purine intake was associated with up to an almost five‑fold increase in flare risk; animal purines (from meat and seafood) had a stronger association than plant purines. ^[5]
• Population data have linked seafood intake with higher odds of hyperuricemia (high uric acid), a key driver of gout, although the strength of association varies across studies and populations. ^[6]
• Public health guidance consistently identifies certain seafood as purine‑rich and advises limiting them if you are prone to gout. ^{[1] [4]}

Not all fish are equal

• Guidance recognizes that fish provides heart‑healthy nutrients; therefore, even people with gout may include small amounts of fish while avoiding frequent intake of the highest‑purine choices. ^[7] Because of this, portion control and species selection matter. ^[7]
• High‑purine seafood to limit: anchovies, sardines, mussels, scallops, trout, tuna, codfish, and some shellfish. ^{[7] [4]}
• Lower‑purine, more moderate options (general guidance): Some white fish and salmon are often considered more moderate choices, and small servings can fit into a balanced plan for many individuals, though personal tolerance varies. ^[7]

Practical eating tips

• Limit high‑purine seafood to occasional, small portions (for example, one 3–4 oz serving) and avoid multiple high‑purine servings in the same day. ^{[7] [4]}
• Choose alternative proteins more often: low‑fat dairy, plant‑based proteins, and legumes (which do not appear to raise gout risk in most studies). ^[4]
• Reduce other dietary triggers that compound risk, such as beer and hard liquor, and sugar‑sweetened beverages. ^{[3] [4]}
• Maintain a healthy body weight and stay well hydrated to help keep uric acid lower. ^{[3] [4]}

Putting it together

• Fish and seafood can increase the risk of gout flares primarily when they are high in purines and eaten in larger amounts or frequently. ^{[1] [4]}
• For many people with gout, a prudent approach is to limit the highest‑purine seafood, choose lower‑purine fish in modest portions, and balance the diet with low‑fat dairy, vegetables, whole grains, and water, while limiting alcohol and fructose‑sweetened drinks. ^{[7] [4]}

Quick reference: seafood and gout

Category	Examples	Suggested approach
Higher‑purine seafood (limit)	Anchovies, sardines, mussels, scallops, trout, tuna, codfish, shellfish	Keep portions small and infrequent to lower flare risk. [1] [7] [4]
Moderate‑purine fish (use caution)	Some white fish and salmon	Consider small portions if tolerated; avoid multiple animal‑purine servings in a day. [7]
Lower‑purine proteins (prefer)	Low‑fat dairy	Use as primary protein source when possible to reduce gout risk. [4]

If you experience frequent flares, it may help to track your personal triggers, limit high‑purine seafood, and review your overall plan (diet, alcohol, hydration, and medications) with your clinician, as individualized tolerance and uric acid targets can differ. ^[4]