Gout is a form of inflammatory arthritis that occurs when uric acid crystals build up in the joints. This causes sudden and severe pain, swelling, redness and tenderness in the affected joint, often the big toe. Gout flares are triggered by high levels of uric acid in the blood, which can be caused by diet, genetics, or other factors.
Fruit juices are a popular beverage choice for many people. However, when it comes to gout, there are conflicting opinions on whether fruit juices are OK to drink. On one hand, some fruits are rich in fructose, which may raise uric acid levels. On the other hand, fruits also provide antioxidants, vitamins and minerals that may help lower inflammation.
This article examines the effects of different fruit juices on gout. It provides science-based information to help you determine which fruit juices are more likely to prevent gout flares versus trigger them.
How Fruit Juice Affects Uric Acid
Uric acid is produced when the body breaks down purines, which are found naturally in some foods. High levels of uric acid in the bloodstream may cause crystals to form in the joints, resulting in gout pain and inflammation.
Some research shows that drinking fruit juice may raise uric acid levels and increase gout risk:
- One study found that drinking two or more sugary sodas or fruit juices per day was associated with a risk of developing gout that was 85% higher compared to drinking less than one per month.
- Apple and orange juice contain fructose, which can increase uric acid production. One study found that drinking two apples juices per day for two weeks increased uric acid levels by 9%.
- Fruit punch increased uric acid levels by 12% in another trial. Grapefruit juice and orange juice had more modest effects.
The fructose in fruit juices seems to drive up uric acid levels more than other sugars. Table sugar (sucrose) contains fructose too, but doesn’t have as big of an effect.
However, some juices like cherry and pineapple juice may help reduce uric acid levels, according to some studies.
So the type of fruit juice clearly matters when it comes to effects on uric acid and gout risk.
Low vs High Fructose Fruit Juices
Fructose is a type of simple sugar found in many fruits. It makes up about half of the sugar content in table sugar (sucrose) and high fructose corn syrup.
Fructose increases uric acid more than other sugars like glucose and sucrose. Limiting high fructose juices may be beneficial for gout.
Here is the fructose content in 3.5 ounces (100 ml) of some common fruit juices:
|Low Fructose Juices||Fructose (g)|
|High Fructose Juices||Fructose (g)|
In general, apple, grape and orange juice tend to be higher in fructose, while cranberry, pineapple and tomato juices are lower.
Consider limiting high fructose juices to 4–6 ounces (118–177 ml) per day. However, even low fructose juices should be consumed in moderation on a gout diet.
Other Factors that Affect Gout Risk
Uric acid levels are the main risk factor for gout. However, other components of fruit juices affect gout risk as well:
- Sugar: Fructose isn’t the only sugar that raises uric acid. Sucrose and high fructose corn syrup can too. Check labels and select juices with less added sugar.
- Calories: Higher calorie juices can lead to obesity, another risk factor for high uric acid and gout. Limit juice portions and focus on whole fruits and veggies for your produce intake.
- Vitamin C: Many fruits contain vitamin C, which may help lower uric acid levels and gout risk. Orange, grapefruit and other citrus juices are good sources.
- Flavonoids: Certain flavonoids found in cherries, grapes and some berries have anti-inflammatory effects that may lessen gout attacks.
- Fluid intake: Staying well hydrated is important for gout sufferers. Fruit juices may help increase fluid intake, as long as calorie and sugar intake remains controlled.
When considering which juices are best for gout, assessing the combination of these factors is important.
Do Cherry Juices Help Gout?
Cherries, especially tart cherries, have been studied extensively for their effects on gout symptoms.
Cherries contain high levels of antioxidants called anthocyanins. Anthocyanins may:
- Lower inflammation by reducing oxidative stress and nitric oxide production
- Decrease uric acid production and increase excretion
- Reduce painful gout attacks
In one study, consuming two 8-ounce (240-ml) bottles of tart cherry juice per day lowered uric acid levels and reduced gout flares by 62% over two days.
Other studies found that taking tart cherry capsules or concentrated juice lowered blood markers of inflammation in people with gout.
Tart cherry juice also contains fewer calories and less sugar than other fruit juices like apple or orange juice.
Look for unsweetened cherry juices and limit intake to 4–8 ounces (118–237 ml) per day. Sweet or sour cherry juice works, but tart cherry juice contains the most anthocyanins.
Pineapple Juice and Gout
Pineapple juice contains bromelain, an enzyme that may help break down uric acid crystals. It also has anti-inflammatory effects to potentially relieve gout pain.
In a four-month study in patients with gout, drinking a glass of pineapple juice (400 ml) three times daily significantly reduced uric acid levels and arthritis symptoms compared to a control group.
Other research found that bromelain supplements decreased uric acid levels in both healthy people and those with mild hyperuricemia when taken in doses of 500–2,000 mg per day.
Though more research is needed, there’s some evidence that pineapple juice could help reduce gout symptoms. Limit intake to about 4–8 ounces (118–237 ml) daily due to the moderate sugar content.
Which Juices Should You Avoid with Gout?
Some types of juices may increase the risk of gout attacks and inflammation when consumed often.
Apple, grape, and orange juice tend to be higher in fructose and sugar. One study associated drinking two or more apple or orange juices per day with an 85% increased risk of gout.
Grape juice contains moderate amounts of fructose but provides antioxidants like resveratrol. However, some grape varieties like Concord may contain up to 70 mg of oxalate per serving. High-oxalate foods like spinach and rhubarb may increase uric acid production and gout risk in some people.
Fruit punch drinks and lemonade are also made with high fructose corn syrup and contain few beneficial nutrients. They’re often best avoided on a gout diet.
To limit gout flares, avoid having more than 4–6 ounces (118–177 ml) daily of high fructose fruit juices like apple, orange and grape juice. Focus instead on low or moderate fructose whole fruits and veggies.
Other Tips for Managing Gout with Juice
Here are some other tips for incorporating juice into a low-purine diet for gout:
- Have juices in moderation as part of a balanced diet. Eat more whole low-purine fruits and vegetables.
- Always opt for unsweetened 100% juice without added sugar. Avoid fruit cocktails, punches, nectars and lemonades with extra sugar.
- Drink juices between meals rather than with meals to help reduce blood sugar and uric acid spikes.
- Combine with other uric acid-lowering foods like low-fat dairy, coffee, vitamin C-rich foods and celery.
- Stay well hydrated by having some water before and after juice.
- Limit overall fructose intake to under 50 grams per day if you have gout.
- Avoid alcohol intake, especially beer, since it increases uric acid levels.
Should You Take a Gout Supplement?
Dietary supplements that may help lower uric acid include:
- Vitamin C: 1000–1500 mg/day may help excrete more uric acid. Don’t exceed 2000 mg daily.
- Bromelain: 500–1000 mg, 1–2 times per day. May interact with some medications.
- Quercetin: 500 mg, 2 times per day. Found naturally in fruits like apples and berries.
- Cherry extract: 500 mg, 1–2 times daily. Look for products standardized to anthocyanins.
- Milk thistle: 250 mg, 3 times per day. May help excrete uric acid.
Talk to your healthcare provider before starting supplements, especially if you take any medications. While supplements can help, they work best combined with dietary and lifestyle changes.
The Bottom Line
Some fruit juices may raise uric acid, while others may help decrease it. Focus on low or moderate fructose juices like cherry, pineapple, plum, prune and tomato juice in moderation.
Limit high fructose juices like apple, orange and grape to 4–6 ounces (118–177 ml) per day. Avoid fruit punches, lemonades and juices with added sugar.
For best results, have juice between meals and combine with other gout-fighting strategies like staying well hydrated, managing weight and limiting alcohol.
While tart cherry juice has the most evidence for preventing gout attacks, other juices like pineapple and low-sugar orange or grapefruit juice can be part of a gout-friendly diet.