Paleo Diet and Gout: Purines, Risks and a Safer Plan

By Paleo Life Coach Editorial Team · Last updated October 8, 2026 · Checked against the American College of Rheumatology guideline, NIAMS, NHS and the original studies

Gout has a reputation as the disease of people who eat a lot of meat, and paleo asks you to eat a lot of meat. So if you’ve had a flare, or a high uric acid result on a blood test, it’s fair to ask whether paleo is a bad idea. The paleo diet and gout question doesn’t have a one-word answer: paleo cuts some of the strongest dietary gout triggers and adds others. This guide lays out purine numbers for the foods paleo eaters actually buy, what the studies found for each food group, and how a typical paleo day changes when you adjust it for gout.

The quick version: Paleo can raise gout risk if it means large daily portions of meat and seafood, which cohort studies link to more gout. It also removes sugary drinks and beer, which raise risk. With moderate meat portions, eggs, low-purine vegetables and no beer, a paleo day can stay under 400 mg of purines. Medication, not diet, is the main gout treatment.

What causes gout, and where does diet fit in?

Gout happens when urate (uric acid) builds up in the blood and forms needle-shaped crystals in a joint, causing sudden pain and swelling. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains that urate comes from purines, which are found in your body’s tissues and in many foods, and that flares can be triggered by certain foods, alcohol, some medications, injury or illness (NIAMS).

Diet matters, but less than most people think. A 2018 analysis of 16,760 US adults found that diet patterns each explained 0.3% or less of the variation in serum urate, while common genetic variants explained 23.9% (Major et al., BMJ 2018). That’s why the 2020 American College of Rheumatology (ACR) guideline treats urate-lowering medication as the core of treatment for people with frequent flares, and diet changes as conditional, supporting steps (FitzGerald et al., 2020).

Diet still counts for flares, though. In people who already have gout, the amount of purine eaten over the previous two days is linked to the chance of an attack, as the next sections show.

Does the paleo diet cause gout?

There is no direct evidence either way. A PubMed search we ran on October 3, 2026 for paleolithic diets combined with gout, urate or uric acid returned no trials. So the honest answer comes from looking at what paleo changes, food group by food group:

Does the paleo diet cause gout?
What paleo changes	Effect on gout risk in studies	Source
More meat	Men in the highest fifth of meat intake had 1.41 times the risk of gout of the lowest fifth	Choi et al., NEJM 2004
More seafood	Highest fifth of seafood intake: 1.51 times the risk	Choi et al., NEJM 2004
No dairy	Highest dairy intake was linked to lower risk (0.56); paleo gives up that association	Choi et al., NEJM 2004
No sugary soft drinks	Two or more a day: 1.85 times the risk; diet sodas showed no link	Choi & Curhan, BMJ 2008
No beer (grain-based)	Each daily 12-oz beer: 1.49 times the risk; spirits 1.15; wine showed no significant link	Choi et al., Lancet 2004
Purine-rich vegetables allowed freely	Not linked to higher gout risk	Choi et al., NEJM 2004
Total protein	Not linked to higher gout risk; the source of the protein mattered	Choi et al., NEJM 2004

The NEJM and Lancet studies followed 47,150 US male health professionals for 12 years; the BMJ study followed 46,393. They are observational, so they show associations, not proof of cause, and they included only men.

Read together, the studies suggest that the size of your meat and seafood portions decides most of paleo’s gout effect. A paleo eater who has a palm-sized piece of chicken at dinner and eggs at breakfast is in a different position from one who eats steak twice a day and sardines for lunch. Dropping soda and beer, both common in the standard American diet, works in paleo’s favor. Losing dairy works against it.

Which paleo foods are high in purines?

Purines are concentrated in animal flesh, organs and some fish. Eggs contain almost none. The table below uses laboratory measurements of 270 foods published by researchers at Teikyo University in Japan, who grouped foods on a five-level scale (Kaneko et al., 2014).

Which paleo foods are high in purines?
Purine level (mg per 100 g)	Paleo foods in this group, with total purines
Very low (under 50)	Chicken egg 0 · Carrot 2.2 · Onion 2.3 · Cabbage 3.2 · Zucchini 13.1 · Sweet potato 17.0 · Avocado 18.4 · Almond 31.4
Low (50-100)	Spinach leaf 51.4 · Cauliflower 57.2 · Bacon 61.8 · Broccoli 70.0 · Beef rib loin 74.2 · Scallop 76.5 · Beef brisket 79.2 · Pork shoulder 81.4 · Beef tenderloin 98.4
Moderate (100-200)	Salmon 119.3 · Pork tenderloin 119.7 · Mackerel (chub) 122.1 · Chicken leg 122.9 · Chicken breast 141.2 · Clam 145.5 · Tuna 157.4 · Oyster 184.5 · Shrimp (kuruma) 195.3
High (200-300)	Sardine 210.4 · Bonito 211.4 · Beef liver 219.8 · Pork liver 284.8
Very high (over 300)	Chicken liver 312.2 · Dried anchovy 1,108.6

Source: Kaneko et al., Biological and Pharmaceutical Bulletin, 2014, Tables 1-9 (PubMed abstract). Values are for Japanese foods, mostly raw, per 100 g; exact levels in US products will differ somewhat.

Some things here surprise people:

Chicken breast is higher than beef. At 141 mg per 100 g, chicken breast measured above most beef cuts in the study, including tenderloin (98 mg) and rib loin (74 mg). “White meat is safer” isn’t supported by these numbers.
Eggs are effectively purine-free, which makes them the most useful paleo protein for anyone watching gout. Our are eggs paleo guide covers their other nutrients.
Purine-rich vegetables don’t behave like meat. Spinach and cauliflower contain purines, but the NEJM cohort found no link between purine-rich vegetables and gout (Choi et al., 2004). In people with gout, purines from animal sources were linked to flares far more strongly than plant purines (Zhang et al., 2012).

How many purines does a typical paleo day contain?

Japan’s guideline for preventing gout and high uric acid recommends keeping dietary purines under 400 mg a day (Kaneko et al., 2014). US guidelines don’t set a number, but it’s a useful yardstick. Here’s a common high-protein paleo day, then the same day with three swaps.

Worked example: a typical paleo day vs a lower-purine version

Worked example: a typical paleo day vs a lower-purine version
Meal	Typical paleo day	Purines (mg)	Lower-purine version	Purines (mg)
Breakfast	3 eggs (150 g) + 60 g spinach	31	Same	31
Lunch	150 g chicken breast + 70 g avocado	225	100 g chicken breast + 2 eggs (100 g) + 70 g avocado	154
Dinner	150 g salmon + 100 g broccoli + 150 g sweet potato	274	100 g salmon + 100 g zucchini + 150 g sweet potato	158
Snack	30 g almonds	9	Same	9
Total purines		539		352
Total protein		98 g		87 g

Purines from Kaneko et al., 2014 (raw weights). Protein calculated from USDA FoodData Central SR Legacy entries for raw egg 171287, chicken breast 171077, Atlantic salmon 175167, spinach 168462, avocado 171705, broccoli 170379, zucchini 169291, sweet potato 168482 and almonds 170567. Cooking fats, fruit and drinks not included.

Three changes cut purines by about 35%: trimming the two big meat and fish portions from 150 g to 100 g, adding eggs back at lunch, and swapping broccoli for zucchini. Protein only fell from 98 g to 87 g, which is still well above the 50 g Daily Value (FDA). If you want to set a protein target for your body weight first, use our paleo diet protein guide, then build purines down from there.

The broccoli swap is the least important of the three, given that vegetable purines weren’t tied to gout in the cohort study. Keep broccoli if you like it; trimming the meat and fish portions does most of the work.

What does the ACR gout guideline say about diet?

The 2020 ACR guideline, written by an expert panel that graded the evidence formally and took patient input, makes these lifestyle recommendations for people with gout (FitzGerald et al., 2020; free full text linked from the PubMed record):

Limit alcohol (conditional; low-certainty evidence). The guideline notes that urate levels were 1.6 mg/dl lower in patients who limited or stopped alcohol.
Limit purine intake (conditional; low certainty).
Limit high-fructose corn syrup (conditional; very low certainty). The guideline notes that 1 g of fructose per kg of body weight raises urate by 1-2 mg/dl within 2 hours.
Lose weight if you’re overweight (conditional; very low certainty). In one small cohort, an average 5 kg weight loss lowered urate by 1.1 mg/dl.
Don’t add vitamin C supplements (conditional recommendation against).

The panel reviewed cherries and dairy protein but rated the evidence too weak to make a recommendation either way. Notice how all of these are “conditional”: the panel’s strong recommendations are about medication, not food.

Are paleo-friendly foods like fruit, honey and wine a problem for gout?

Some are worth watching.

Fruit juice and fructose-rich fruit. In the 46,393-man BMJ cohort, the highest fifth of fructose intake had about twice the gout risk of the lowest fifth, and fruit juice and fructose-rich fruits such as apples and oranges were also associated with higher risk (Choi & Curhan, 2008). That doesn’t mean whole fruit causes gout; the authors wrote that these fruits “may also increase” risk. A sensible paleo approach is whole fruit in normal portions and no juice.

Honey and maple syrup. These are mostly sugar, including fructose. Our paleo sweeteners guide compares them. Use small amounts.

Cherries. In a one-year study of 633 people with gout, eating cherries over a two-day period was linked to a 35% lower risk of a gout attack compared with no cherries (Zhang et al., 2012). It’s an observational finding the ACR panel didn’t think was strong enough for a recommendation, but cherries are paleo and there’s no reason to avoid them.

Alcohol. Beer carried the highest risk in the Lancet cohort and isn’t paleo anyway. Spirits carried a smaller risk; moderate wine showed no significant link (Choi et al., 2004). See is alcohol paleo for how each drink fits the rules. If you have gout, NHS guidance is to have some alcohol-free days each week and stay under 14 units a week (NHS).

How do you make paleo work if you have gout?

Use paleo’s structure, but change the proportions. These steps follow the studies and guidance above:

Set meat and fish portions at about 100 g per meal, not 150-250 g. Fill the rest of the plate with vegetables.
Lean on eggs for one or two meals a day. They’re paleo, filling and nearly purine-free.
Limit the high and very high purine foods in the Kaneko table: organ meats, sardines, anchovies and bonito.
Skip juice, soda and beer. Paleo already removes soda and beer; don’t replace them with fruit juice or honey-sweetened drinks.
Drink plenty of water. NHS advice for gout is to drink plenty of fluids and avoid dehydration (NHS).
Lose weight gradually if you need to, and skip the feasts. The NHS says to lose weight if you’re overweight but avoid crash diets (NHS), and it lists eating a very large meal and getting dehydrated among the things that can trigger an attack (NHS).
Consider relaxing the dairy rule. Dairy was the one food group linked to lower gout risk in the NEJM cohort. Some people with gout choose a primal-style approach that keeps yogurt or milk; see is cheese paleo for how that fits.

A plant-protein point is worth knowing too. In a feeding trial of 163 adults, a DASH-style diet with about half its protein from plants lowered serum urate slightly (by 0.16 mg/dl) while carbohydrate- and fat-focused versions did not (Belanger et al., 2021). Paleo excludes legumes, the main plant protein in that trial, which is one more reason people with gout may want to compare paleo vs the DASH diet before committing.

When should you talk to your doctor about gout and diet?

Talk to your doctor before starting paleo if you’ve had gout, kidney stones or kidney disease, or a uric acid result above the normal range. Get urgent help if a joint is suddenly painful and swollen and the pain is getting worse, or you also have a very high temperature or feel sick; the NHS says these symptoms could mean an infection inside the joint (NHS).

Diet alone is rarely enough for recurring gout. The ACR guideline strongly recommends urate-lowering medication for people with frequent flares, tophi (lumps of crystals under the skin) or joint damage from gout, with a target blood urate below 6 mg/dl (FitzGerald et al., 2020). Don’t stop or change a gout medication because you’ve changed your diet; ask your doctor first. The NHS lists diuretics and some blood pressure medicines among the things that make gout more likely (NHS), so mention every medicine you take.

Frequently asked questions about the paleo diet and gout

Can the paleo diet trigger a gout flare?

It can if your meals are built on large portions of meat or seafood. In a study of 633 people with gout, the highest purine intake over two days was linked to almost five times the risk of an attack compared with the lowest. Purines from animal foods drove most of that link. Moderate portions and plenty of eggs lower the load.

Is paleo good for gout?

Paleo is neither proven good nor proven bad for gout, because no trial has tested it. It removes sugary drinks and beer, which are linked to higher risk, but it can increase meat and seafood and removes dairy, which was linked to lower risk. A modified paleo plan with moderate meat portions is more defensible than strict high-meat paleo.

Which paleo proteins are lowest in purines?

Eggs are the lowest, with essentially no purines in laboratory testing. Among meats, bacon, beef brisket, beef rib loin and pork shoulder measured 60 to 82 mg per 100 g, lower than chicken breast at 141 mg. Sardines, anchovies, bonito and organ meats are the highest and are the ones to limit.

Does paleo raise uric acid?

It might, depending on how much meat and seafood you eat, but there are no published trials measuring uric acid on a paleo diet. Large studies link high meat and seafood intake with more gout. Your uric acid also depends heavily on genetics, kidney function, body weight and medicines, so the only way to know is a blood test.

Are vegetables like spinach and cauliflower bad for gout?

No. They contain moderate purines, but in a 12-year study of 47,150 men, purine-rich vegetables weren’t linked to a higher risk of gout. In people who already had gout, plant purines were linked to flares much more weakly than animal purines. You don’t need to cut vegetables on paleo for gout.

Should I stop paleo if I have gout?

Not necessarily. Talk to your doctor, keep taking any prescribed gout medicine, and change the proportions: smaller meat and fish portions, more eggs, no juice or beer, and plenty of water. If flares continue, your doctor may suggest a different eating pattern or adjust your treatment.

Your next step: check your portions before you check your food list

Before cutting foods, weigh your meat and fish portions for two or three days and total them against the purine table above. Most people find that portion size, not the food list, decides whether paleo works with gout. Then use the paleo diet guide to rebuild your plate around eggs, vegetables and moderate protein.

Consider this general nutrition reading, not a replacement for advice from your doctor. Talk to your doctor before changing your diet if you have gout, kidney disease or take medication that affects uric acid.

Paleo Diet and Gout: Purine Numbers for Paleo Foods, What the Studies Show, and a Lower-Purine Day