What Are Purines?

People who have trouble metabolizing purines, such as people diagnosed with hyperuricemia or gout, are advised to limit consumption of high-purine foods and drinks. Purines are found in the cells of all living things, including humans, animals, and plants, so there is no way to eliminate them from a diet.

Purines in the Body and Food

Purines are molecules made up of carbon and nitrogen atoms, and these molecules are found in cells’ DNA and RNA. In the human body, purines can be divided into two categories:

1. Endogenous purines

About 2/3 of purines in the body are endogenous. ¹ Liu D, Yun Y, Yang D, et al. What Is the Biological Function of Uric Acid? An Antioxidant for Neural Protection or a Biomarker for Cell Death. Dis Markers. 2019;2019:4081962. Published 2019 Jan 10. doi:10.1155/2019/4081962 These purines are produced by the human body and found inside its cells. A body’s cells are in a constant state of death and renewal, ² Gilbert SF. Developmental Biology. 6th edition. Sunderland (MA): Sinauer Associates; 2000. The Cell Death Pathways. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10103/ and the endogenous purines from damaged, dying, or dead cells must be processed by the body.

2. Exogenous purines

Purines that enter the body via food are called exogenous purines. These purines are metabolized by the body as part of the digestive process.

When endogenous and exogenous purines are processed in the body, they create a byproduct called uric acid. Normally, about 90% of uric acid is reabsorbed into the body, and the rest is excreted in the urine and feces. ³ El Ridi R, Tallima H. Physiological functions and pathogenic potential of uric acid: A review. J Adv Res. 2017;8(5):487-493. doi:10.1016/j.jare.2017.03.003

Purines and Hyperuricemia

If the amount of purines in the body is out of balance with the body’s ability to process them, too much uric acid can build up in the body’s bloodstream. This condition is called hyperuricemia.

In some people, hyperuricemia can cause kidney stones or lead to an inflammatory joint condition called gout. Many other people with hyperuricemia have no signs or symptoms—doctors call this condition asymptomatic hyperuricemia.

Read more: All About Gout - Symptoms, Diagnosis, Treatment

People with hyperuricemia (either symptomatic or asymptomatic) are advised to avoid eating foods that have high purine concentrations and encouraged to eat a whole foods, plant-based diet.

Avoid High-Purine Foods

While all plants and meats contain purines, certain foods contain higher concentrations. In addition, certain other foods may affect the body’s production and metabolism of purines.

Foods that should be avoided on a low-purine diet include ⁴ Ramirez-Sandoval JC, Madero M. Treatment of Hyperuricemia in Chronic Kidney Disease. Contrib Nephrol. 2018;192:135-146. doi:10.1159/000484288 :

• Sugary foods and beverages, particularly those made with high fructose corn syrup, such as sodas ⁵ Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-8. doi: 10.1001/jama.2010.1638
• Seafood, particularly scallops, anchovies, and herring ⁶ George C, Minter DA. Hyperuricemia. [Updated 2020 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459218/
• Meat, particularly organ meat or “sweetmeats,” such as liver, and game meats ⁶ George C, Minter DA. Hyperuricemia. [Updated 2020 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459218/
• Alcoholic beverages, especially beer

In addition to raising uric acid levels, alcohol can inhibit the body’s ability to process and eliminate uric acid, ⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973 so people with gout are advised to avoid alcohol or drink in moderation.

Limiting the consumption of these foods and drinks may help treat hyperuricemia and reduce the risk of gout flare-ups.

See Gout Prevention Diet

Eat a Healthy Diet

Just about everyone can benefit from eating a whole-foods, plant-based diet that emphasizes vegetables, fruits, nuts, legumes, and whole grains.

Special dietary considerations for gout

People who are diagnosed with hyperuricemia are encouraged to eat a healthy diet and consider the following:

• Moderate consumption of vegetables known to be high in purines, such as peas, asparagus, and oatmeal, does not seem to raise uric acid levels in the blood. ⁸ Parthasarathy P, Vivekanandan S. Urate crystal deposition, prevention and various diagnosis techniques of GOUT arthritis disease: a comprehensive review. Health Inf Sci Syst. 2018;6(1):19. Published 2018 Oct 8. doi: 10.1007/s13755-018-0058-9 Researchers suggest this variation may be due to their high fiber content. ⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973
• Low fat or no-fat dairy products ⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973 ^{, 9} de Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012;4:12. Published 2012 Apr 4. doi:10.1186/1758-5996-4-12 are low in purines and have an inverse relationship with hyperuricemia. (While a plant-based diet emphasizes vegetables, fruits, and whole grains, it may also include some animal products.)
• Drinking plenty of water may aid in digestion and lower uric acid concentrations in the blood.
• Coffee and tea will not elevate uric acid levels—in fact, coffee may help lower uric acid levels. ⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973 ^{, 10} Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y
• Many people believe unsweetened tart cherries help prevent hyperuricemia and gout flares, and some research supports this idea. ⁷ Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329. Published 2015 Sep 2. doi: 10.1177/1559827615601973 ^{, 11} Chen PE, Liu CY, Chien WH, Chien CW, Tung TH. Effectiveness of Cherries in Reducing Uric Acid and Gout: A Systematic Review. Evid Based Complement Alternat Med. 2019;2019:9896757. Published 2019 Dec 4. doi:10.1155/2019/9896757 ^{, 12} Collins MW, Saag KG, Singh JA. Is there a role for cherries in the management of gout?. Ther Adv Musculoskelet Dis. 2019;11:1759720X19847018. Published 2019 May 17. doi: 10.1177/1759720X19847018 ^{, 13} Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi HK. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012;64(12):4004–4011. doi:10.1002/art.34677
• Limited research suggests dietary supplements of vitamin C and folate may help treat or prevent hyperuricemia. ¹⁰ Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y

In addition to lowering uric acid levels and reducing the risk of gout, a whole-foods, plant-based diet may lower overall levels of inflammation and reduce the risk of developing other types of arthritis. ¹⁴ Philippou E, Nikiphorou E. Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis. Autoimmun Rev. 2018;17(11):1074-1077. doi:10.1016/j.autrev.2018.05.009 ^{, 15} Pattison DJ, Symmons DP, Young A. Does diet have a role in the aetiology of rheumatoid arthritis?. Proc Nutr Soc. 2004;63(1):137-143. doi:10.1079/pns2003319 Healthy food choices may also decrease symptoms related to existing, chronic arthritis conditions. ¹⁶ Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020;111(6):1203-1213. doi:10.1093/ajcn/nqaa019 ^{, 17} Little EM, Grevich S, Huber JL, et al. Parental Perception of Dietary Intervention in Juvenile Idiopathic Arthritis. J Altern Complement Med. 2019;25(6):643-647. doi:10.1089/acm.2018.0407 ^{, 18} van Vugt RM, Rijken PJ, Rietveld AG, van Vugt AC, Dijkmans BA. Antioxidant intervention in rheumatoid arthritis: results of an open pilot study. Clin Rheumatol. 2008 Jun;27(6):771-5. Epub 2008 Feb 15. PMID: 18274814; doi:10.1007/s10067-008-0848-6 ^{, 19} Lassus A, Dahlgren AL, Halpern MJ, Santalahti J, Happonen HP. Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis. J Int Med Res. 1990 Jan-Feb;18(1):68-73. PubMed PMID: 2139859. doi: 10.1177/030006059001800109

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