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Gout is a form of arthritis, and it is common in Singapore — about 4 in 100 middle-aged and older Chinese adults here report a doctor's diagnosis of gout. It happens when uric acid in the blood rises high enough to form needle-shaped crystals of monosodium urate in a joint, most often the big toe. The crystals trigger sudden, intensely painful flares. Uric acid comes from purines — compounds in the body's own cells and in food — and that is where diet comes in. But diet is only part of gout management, and this page starts by saying so plainly: for many people with gout, urate-lowering medication is the mainstay, and no food list replaces it. The American College of Rheumatology's 2020 guideline strongly recommends urate-lowering therapy — allopurinol first — titrated to a serum urate target below 6 mg/dL, and its diet recommendations sit alongside that treatment, not in place of it. If you have gout, talk to your doctor about medication; do not rely on food lists alone.
This page does not tell you what to eat. It explains which foods carry purines, what the evidence says about diet and flares, and where the common advice is wrong — with real examples from this site's own panelled pages, and the honest limits where the evidence is thin. It is information, not treatment guidance, and it is not medical advice for any individual.
Three things it is for:
Purines are compounds found in every cell. When the body breaks them down, the end product is uric acid, which the kidneys mostly excrete. When uric acid in the blood climbs past about 6.8 mg/dL — the point at which blood is saturated with it — monosodium urate crystals can form in joints and soft tissues. A flare is the immune system reacting to those crystals: sudden pain, swelling, redness and heat, usually in one joint, often starting at night. Between flares the crystals can sit silently, and uric acid can look normal during a flare, so a single blood test does not tell the whole story. Who gets it: men far more often than women — in Asia, men's prevalence is roughly three times women's, and women's risk rises after menopause — and people with reduced kidney function, higher weight, a family history of gout, high blood pressure, or medicines such as diuretics that raise uric acid. About two-thirds of uric acid comes from the body's own cell turnover and about a third from food, so even a perfect diet cannot remove most of the load — which is exactly why the guidelines treat diet as an addition to medication, not a substitute.
Each entry says what it does, how strong the evidence is, and where it actually appears on this site — nothing here is invented, and every example is linked to the page that panelled it.
What they are: liver, kidney, sweetbreads (thymus), heart and brains — the organs, not the muscle meat. They are the highest-purine foods in every published table, at roughly 200–550 mg of purines per 100 g, and they are the one category every guideline agrees should be limited or avoided. There is no organ-meat category on this site yet — offal is not sold as a packaged category in the same way as the foods below — so no panel is quoted here. The Singapore relevance is at the hawker centre, not the supermarket shelf: see the Singapore section for kway chap and pig organ soup.
How much it matters: organ meats are a small part of most people's diets, so for most shoppers they are a smaller lever than the everyday foods below — but per gram, nothing else comes close.
What it does: in the Health Professionals Follow-up Study — 47,150 men followed for 12 years, 730 new cases of gout (Choi et al., New England Journal of Medicine 2004) — men in the top fifth of meat intake had 41% more gout than men in the bottom fifth (relative risk 1.41). Beef, pork and lamb average about 100–150 mg of purines per 100 g — far below organ meats, but the portions are large and the eating is frequent, which is what makes the total load add up.
On this site: SPAM Classic and Lite and Ma Ling Premium Luncheon Meat (pork) — see canned luncheon meat; cooked hams — see ham and cold cuts; bacon — see bacon; sausages and frankfurters — see hot dogs and other sausages. Processed meats are not higher in purines than fresh meat gram for gram — their place on this page is that they are red meat eaten often, in large portions, and usually with beer and sugary drinks at the same meal.
What it does: seafood had the strongest signal of any food group in the same 2004 study — men in the top fifth of seafood intake had 51% more gout than men in the bottom fifth (relative risk 1.51). The reason is concentration: small oily fish and shellfish carry far more purines per gram than large fish. Anchovies and sardines sit at about 240–480 mg per 100 g depending on the table (see the numbers table — the tables disagree), mackerel at about 200–300 mg, mussels and scallops in the same high band. Tuna and most white fish are much lower, at about 50–150 mg.
On this site: Ayam Brand Brisling Sardines in Extra Virgin Olive Oil and Ayam Brand Sardines in Tomato Sauce — see canned sardines; Ayam Brand Mackerel Fillet in Extra Virgin Olive Oil 125 g — see canned mackerel and other canned fish. The fish is the point; the sauce is not — a sardine in tomato sauce carries the same purine load as a sardine in olive oil, and the tomato sauce adds salt and sugar on top.
What it does: alcohol is one of the few food-related factors with a clear signal across studies, and the ACR guideline conditionally recommends limiting it. In the same Health Professionals cohort (Choi et al., The Lancet 2004), each daily serving of beer raised gout risk by about half, each daily measure of spirits by about 15%, and moderate wine showed no clear increase. Beer is singled out for two reasons: alcohol itself interferes with uric acid excretion — it is converted to lactic acid, which competes with uric acid for the same route out through the kidneys — and beer also carries purines from brewer's yeast, which the NHS diet sheet notes. In people who already have gout, drinking in the previous 24 hours raised the odds of a flare, wine included, by about a third at more than one or two drinks.
On this site: Asahi Super Dry is panelled on the beer page — Tiger Lager, the flagship, is still not panelled there, because the lists found for it conflict with each other (glucose syrup vs cane sugar vs rice as the fourth ingredient), so no single list can be quoted. The purine point does not depend on the ingredient list: every beer carries the yeast purines, whatever the fourth ingredient is.
What it does: this is the dietary factor that surprises people most, because sugary drinks contain no purines. Fructose is the only sugar that directly raises uric acid: in the liver, fructose metabolism burns through ATP, the cell's energy currency, and the breakdown products feed straight into uric acid production. In the Health Professionals cohort (Choi & Curhan, BMJ 2008), men drinking two or more sugar-sweetened soft drinks a day had 85% more gout than men drinking less than one a month, with a dose-response in between; in the Nurses' Health Study the same comparison in women showed a 139% increase. A 2025 meta-analysis of 22 studies (235,790 participants) put the pooled odds at 1.21 for sugar-sweetened beverages and 1.66 for fructose itself. Fruit juice sits in between — a modest association (odds 1.28, and the confidence interval crossed 1, so it is not a firm finding) — while diet drinks showed no association.
On this site: Coca-Cola Classic — carbonated water, sucrose, caramel colour, phosphoric acid, flavourings and caffeine, no sweeteners — see soft drinks and cola; Sunquick and the other cordials — see cordials and syrup drinks. The fructose mechanism is covered in full in the sugar and salt guide and is not repeated here. One practical note: sucrose is half fructose, so "sugar-sweetened" and "fructose-sweetened" are not two different problems — a sucrose-sweetened drink carries the same fructose load as one sweetened with high-fructose corn syrup.
Purine content is measured in milligrams per 100 g of food. The bands below are the standard ones — under 50 mg is low, 50–150 mg is moderate, over 150 mg is high — but the numbers themselves are the honest problem with this subject: published purine tables disagree, sometimes by twofold for the same food, because they measure different samples, different preparations and different methods. The ranges below show the disagreement rather than hiding it. Figures are for raw food as sold; cooking changes them (see the next section).
| Band | Purines per 100 g | Foods |
|---|---|---|
| Very high | about 300–550 mg | Organ meats — beef liver about 220–550 mg (the tables disagree), chicken liver about 243 mg; dried anchovies; sardines in oil about 345–480 mg; brewer's yeast |
| High | about 150–300 mg | Anchovies about 240–410 mg (the tables disagree); sardines; mackerel about 200–300 mg; herring; mussels; scallops; meat extracts and gravy powders; dried soybeans about 173 mg |
| Moderate | about 50–150 mg | Beef, pork, lamb (beef average about 133 mg); dark chicken meat; white chicken, tuna; lentils; asparagus, spinach, mushrooms, cauliflower — see the vegetables note below |
| Low | under 50 mg | Milk, yogurt, cheese, eggs; rice, bread, pasta, potatoes; most vegetables and fruit; nuts; tofu 20–31 mg and soy milk 19–22 mg (Kaneko et al. 2014, measured in Japan) |
Sources for the numbers: Kaneko et al. 2014 (Biological and Pharmaceutical Bulletin 37:709–721), which measured purines in Japanese foods by HPLC — tofu 20.0–31.1 mg, soy milk 19.3–22.0 mg, dried soybeans 172.5 mg; and the widely reproduced USDA-based tables (anchovies about 410 mg, sardines about 345 mg, beef liver about 220 mg) against the Grahame/Simmonds/Carrey table in Gout (sardines in oil 480 mg, beef liver 554 mg, anchovy 239 mg). Where the two disagree, the range above spans them. The Japanese guideline for hyperuricaemia and gout recommends keeping total daily purine intake below 400 mg — and a 2024 study that calculated the purine content of whole recommended diets (Japanese, MyPlate, Mediterranean, DASH) found they all land at roughly 310–490 mg a day, which is the point: a balanced diet already sits near the target, and it is the extras — the organ meats, the sardines, the beer, the sugary drinks — that push it over.
Purines are water-soluble, so they move. Boiling transfers them out of the food and into the cooking liquid: a 2019 study of marine fish (Li et al., PeerJ) found boiling significantly reduced purine content in the fish because the purines moved into the water, and an earlier study of tilapia (Lou et al. 2001) found adenine and hypoxanthine fell by 46.4% during boiling. Two consequences follow. First, boiling and discarding the water lowers the purine load — it does not remove it, but it cuts it. Second, the broth, stock and gravy are where the purines went — a meat stock, a long-simmered soup or a gravy made from cooking liquid concentrates them, which is why meat extracts and gravy powders sit in the high band above. Dry cooking — roasting, grilling, frying — retains the purines in the meat, because there is nowhere for them to go. None of this changes the ranking: boiled liver is still a high-purine food. It only changes the size of the load.
Each entry says what the evidence actually is, how strong it is, and where the food appears on this site. Where the evidence is observational only, it says so. Where the guideline disagrees with the observational evidence, both are stated.
What it does: in the 2004 Health Professionals study, dairy ran in the opposite direction to meat and seafood — men in the top fifth of dairy intake had 44% less gout than men in the bottom fifth (relative risk 0.56), and the effect was concentrated in low-fat dairy (skim milk and low-fat yogurt). The proposed mechanism is that milk proteins — casein and lactalbumin — increase uric acid excretion by the kidneys. This is the most consistent protective association across cohorts, and it is observational: people who eat more low-fat dairy may differ in other ways, and the study cannot prove the dairy caused the difference. But unlike the other entries in this section, no study has found the opposite.
On this site: Marigold HL Low Fat Milk and Magnolia Low Fat Hi-Cal — see fresh milk; Chobani Fit low-fat yogurts and the plain unsweetened yogurts (FAGE, Chobani plain, Farmers Union Natural) — see yogurt. Note the sweetened yogurts on the same page are a different product: a low-fat yogurt with added sugar is still a sugary food, and the fructose in it works against the dairy benefit.
What it does: in a case-crossover study of 633 people with gout followed online for a year (Zhang et al., Arthritis & Rheumatism 2012), eating cherries over a two-day period was associated with 35% lower odds of a gout attack (odds ratio 0.65), cherry extract with 45% lower odds (0.55), and cherries combined with allopurinol with 75% lower odds (0.25) — the benefit levelled off after about three servings (a serving is half a cup, or 10–12 cherries) over two days. The authors themselves said randomised trials were needed to confirm it. The ACR's 2020 guideline judged the evidence too weak to recommend cherries. And a small randomised trial since — 50 people with gout, 28 days of tart cherry concentrate — found no difference in urate or flares. So: one well-run observational study with a striking result, a guideline that does not endorse it, and a small trial that did not reproduce it.
On this site: cherries are not yet a panelled category — there is no cherry page among the 112, so no product is quoted here. The cranberry juice page carries Rabenhorst and other 100% juices — see cranberry juice — but cranberries are not cherries, and the cherry evidence does not transfer to them.
What it does: vitamin C nudges uric acid down, by a small amount. A randomised trial (Huang et al. 2005, 184 non-smokers, 500 mg a day for two months) found uric acid fell by 0.5 mg/dL against no change on placebo. A meta-analysis of 13 randomised trials (Juraschek et al. 2011, 556 people, median dose 500 mg a day) found an average drop of 0.35 mg/dL. In a 20-year prospective study (Choi et al. 2009, 46,994 men), intakes of 1,500 mg a day or more were associated with 45% lower gout risk than intakes under 250 mg a day. But in people who already have gout, the effect is smaller: a pilot trial in 40 gout patients (Stamp et al. 2013) found 500 mg a day for eight weeks lowered urate by about 0.23 mg/dL, against about 1.9 mg/dL for allopurinol. And the ACR's 2020 guideline conditionally recommends against adding vitamin C as a gout-specific treatment, regardless of disease activity — the effect is too small, next to medication, to justify it as therapy. Vitamin C from food is a different question from a supplement: the observational benefit is for intake from diet, and no guideline objects to eating vitamin C-rich foods.
On this site: the vitamin C-rich foods are the juices — Natural One Pure Orange, Homegrown Orange, Florida's Natural — see fresh orange juice — with the caveat from the fructose section: fruit juice carries a fructose load of its own, and the 2025 meta-analysis found only a modest association between fruit juice and gout. Whole fruit, with its fibre slowing absorption, is the better vehicle for the vitamin C than juice.
What it does: in the Health Professionals cohort (Choi et al. 2007, 45,869 men), men drinking 4–5 cups of coffee a day had 40% lower gout risk than non-drinkers (relative risk 0.60), and men drinking 6 or more cups had 59% lower risk (0.41). In the Nurses' Health Study (Choi & Curhan 2010, 89,433 women followed 26 years), women drinking 4 or more cups a day had 57% lower risk (0.43). Decaffeinated coffee showed the same direction, and tea showed no association — so the effect is not caffeine alone, and the mechanism is not established. This is observational evidence from two large cohorts, and it is an association with developing gout, not with preventing flares in people who already have it. It is not a reason to start drinking six cups a day: the doses in the studies are high, and coffee brings its own trade-offs.
On this site: Maxim Stick Black — ingredients: coffee beans, one item — see instant coffee; the ready-to-drink coffees — see ready-to-drink coffee. The 3-in-1 mixes on the instant-coffee page are a different product: creamer and sugar, not coffee alone.
What it does: there is no trial showing that drinking more water prevents gout flares — the ACR-era literature found no trial of fluid intake in gout at all. The mechanism is plausible: dehydration concentrates uric acid and slows the kidneys' ability to clear it, and dehydration is listed among flare triggers in patient guidance. The 2-litre-a-day urine output figure that sometimes appears in gout advice comes from the allopurinol label, where it is there to prevent kidney stones, not to prevent flares. So: stay hydrated, especially in Singapore's heat and after alcohol — but do not treat water as a treatment, and do not expect a number of glasses to move uric acid on its own.
The strongest trial evidence for diet and uric acid is not about one food at all. In a randomised crossover feeding trial (Juraschek et al., Arthritis & Rheumatology 2016), 103 adults ate the DASH diet — rich in fruit, vegetables, low-fat dairy and whole grains, low in red meat, sugary drinks and salt — and a control diet, with every meal provided and weight held constant. The DASH diet lowered serum uric acid by 0.35 mg/dL overall, and by 1.29 mg/dL among the small group who started at 7 mg/dL or above. The endpoint was uric acid, not flares, so whether the reduction means fewer attacks was not tested — but the design is the strongest in diet research, because the investigators controlled the food. The same point comes from the other direction: the 2024 study that calculated the purine content of whole recommended diets found the Japanese, MyPlate, Mediterranean and DASH diets all land at roughly 310–490 mg of purines a day, near the Japanese guideline's 400 mg target. A balanced diet already sits near the target. The foods in the sections above are the extras that push it over — or, for dairy and coffee, the parts of the pattern that pull it down.
Gout is common here: about 4.1% of Singapore Chinese adults report a doctor's diagnosis, and Singapore's age-standardised prevalence is among the highest in Asia. It is also under-treated: in a 2023 study of 8 public primary-care clinics in Singapore, 28.2% of gout patients had poorly controlled disease (two or more attacks in a year), and of those only 46.3% had been prescribed allopurinol, and only 13.4% at a dose of 300 mg or more. Gout was added to Singapore's Chronic Disease Management Programme in July 2022, and the Ministry of Health's Agency for Care Effectiveness issued clinical guidance on gout in December 2023 — both of which point the same way as the ACR guideline: treat to a urate target, and use diet alongside, not instead.
The local dishes that matter most are the offal ones. Kway chap — flat rice sheets in a dark soy braising liquid, served with braised pork belly, intestines, ears, tongue and stomach — is built from the highest-purine foods on the page, and pig organ soup is the same story in a clear broth: liver, heart, intestines, kidney, stomach, tongue and lungs. Bak kut teh, pork ribs simmered in a peppery broth, is a moderate-purine meat in a broth that has collected the purines leached from it during the long simmer — the cooking section above explains why the broth carries the load. Beer with hawker food and kopi or teh with sugar are the everyday drinks that add to the same total. None of this is a reason to stop eating hawker food; it is a reason to know which dishes carry the load, and how often they appear in your week.
Three checks, in order, for any food or drink you are weighing for gout:
Pages where these checks are most useful: canned sardines and canned mackerel and other canned fish (the highest-purine panels on this site), canned luncheon meat, ham and cold cuts, bacon and hot dogs and other sausages (red and processed meat), beer, soft drinks and cola and cordials and syrup drinks (fructose), fresh milk and yogurt (low-fat dairy), instant coffee and ready-to-drink coffee (coffee), fresh orange juice and cranberry juice (vitamin C — with the juice caveat), and tofu and tempeh (the soy correction).