Is Milk Good for Gout? Why Dairy May Actually Help

Most gout dietary advice is a long list of foods to avoid. Dairy is a refreshing exception. It’s one of the few food groups where research consistently points in a positive direction, with evidence suggesting that regular dairy consumption may actively lower uric acid levels and reduce gout risk.

What makes dairy particularly interesting from a gout science perspective is how it helps. It doesn’t work by being low in purines (though it is). It works by helping your kidneys excrete more uric acid, which directly addresses the core problem behind most gout: impaired excretion.

The Evidence: Large Studies, Consistent Results

The Health Professionals Follow-Up Study

The most frequently cited evidence comes from the 2004 Health Professionals Follow-Up Study by Choi et al., published in the New England Journal of Medicine. This massive prospective study followed 47,150 men over 12 years with no prior history of gout.

The dairy-related findings were striking:

• Men in the highest quintile of dairy consumption had a 42% lower risk of developing gout compared to men in the lowest quintile
• Each additional daily serving of dairy was associated with a ~13% decrease in gout risk
• The protective effect was strongest for low-fat dairy products
• The association held after adjusting for other dietary factors, BMI, alcohol intake, and other confounders

This wasn’t a small or short study. Nearly 50,000 men over 12 years represents robust epidemiological evidence.

The Nurses’ Health Study

The relationship has been confirmed in women as well. Analysis of the Nurses’ Health Study found similar protective associations between dairy intake and gout risk in women, though gout is less common in premenopausal women due to the uricosuric effect of estrogen.

Experimental confirmation

Beyond observational studies, controlled experiments have confirmed the mechanism. A study by Garrel et al. found that ingestion of milk proteins led to a measurable increase in uric acid excretion in urine within hours. A separate study showed that both casein and lactalbumin (the two main milk proteins) increased fractional excretion of uric acid, confirming the uricosuric effect.

How Dairy Helps: The Mechanisms

Understanding why dairy helps gout requires looking at the excretion side of the uric acid equation, which is where most gout patients actually have problems.

The uricosuric effect of milk proteins

The primary mechanism is elegantly simple: the proteins in milk, specifically casein and lactalbumin, promote uric acid excretion through the kidneys. When you consume dairy, these proteins are digested and appear to signal the kidneys to increase the rate at which they filter and excrete uric acid.

This is significant because approximately two-thirds of gout patients are under-excreters. Their kidneys don’t clear uric acid efficiently, leading to gradual accumulation and eventually crystal formation. Anything that enhances kidney excretion directly addresses this core deficit.

The uricosuric effect of dairy is not as strong as pharmaceutical uricosurics (like probenecid), but it’s a real, measurable effect from a common food group. And unlike medication, you get this benefit simply by incorporating dairy into your regular diet.

Orotic acid

Milk contains orotic acid, a compound that may additionally support uric acid clearance. Some researchers hypothesize that orotic acid helps with the renal handling of uric acid, though this mechanism is less well-established than the protein effect.

Anti-inflammatory properties

Dairy consumption has been associated with lower levels of systemic inflammatory markers, including C-reactive protein (CRP) and IL-6. Since gout flares are fundamentally an inflammatory response to urate crystals, any reduction in baseline inflammation may raise the threshold for triggering a flare.

Very low purine content

On top of its active benefits, dairy is also extremely low in purines:

Dairy Product	Purines per 100g
Milk	~0-5mg
Yogurt	~0-5mg
Cheese	~5-10mg
Butter	~0mg
Eggs (for comparison)	~2-5mg
Chicken (for comparison)	~141mg

Dairy gives you protein with virtually no purine cost while simultaneously enhancing uric acid excretion. This combination is unique among protein sources.

Types of Dairy: What Works Best

Low-fat and skim milk

Low-fat dairy products showed the strongest associations in the Health Professionals Study. This may be because participants consuming low-fat dairy tend to consume more of it (and therefore more of the beneficial proteins), or because saturated fat has independent effects on inflammation.

A glass of skim milk (8 oz) provides about 8g of protein (a mix of casein and whey/lactalbumin) with essentially zero purines.

Full-fat dairy

Full-fat dairy also appears beneficial, though the evidence is less robust. Recent nutritional science has moved away from the blanket avoidance of full-fat dairy, as the relationship between dietary saturated fat and cardiovascular disease is more nuanced than previously thought.

For gout specifically, full-fat milk, cheese, and yogurt still provide the beneficial proteins. If you prefer full-fat dairy, it’s likely still helpful.

Yogurt: dairy plus gut health

Yogurt deserves special attention for gout because it combines the milk protein benefits with probiotics that support gut health. This matters because up to 30% of uric acid excretion happens through the intestines, not the kidneys.

The gut microbiome plays a role in intestinal uric acid handling. Certain gut bacteria can break down uric acid, and a healthy, diverse microbiome supports this alternative excretion pathway. Yogurt with live active cultures feeds and supports beneficial gut bacteria.

Plain, unsweetened yogurt is the best choice. Greek yogurt is particularly good, as the straining process concentrates the protein content (up to 15-20g per serving) while maintaining the probiotic benefits.

Cheese

Cheese provides milk proteins and is very low in purines. However, the protein content varies by type, and cheese doesn’t provide the hydration benefit that milk and yogurt do. Harder, aged cheeses (cheddar, parmesan, gouda) tend to have higher protein concentration per ounce.

Cheese is a reasonable part of a gout-friendly diet, but milk and yogurt likely provide more consistent benefits due to their protein-to-serving ratio and additional hydration.

Kefir

Kefir combines the benefits of milk proteins with an even more diverse probiotic profile than yogurt. It contains dozens of bacterial strains compared to yogurt’s typical 2-7 strains. For gout sufferers interested in maximizing both the uricosuric and gut health benefits of dairy, kefir is worth considering.

The Fructose Trap: Flavored Dairy Products

Here’s where dairy can go wrong for gout management. The benefits described above apply to plain, unsweetened dairy products. Many commercially available dairy products are loaded with added sugars, and this changes the equation entirely.

Flavored milk

Chocolate milk, strawberry milk, and other flavored milks typically contain 20-30g of added sugar per serving. Much of this is fructose or high-fructose corn syrup. As a potent gout trigger, fructose both increases uric acid production (through ATP degradation during liver metabolism) and impairs kidney excretion. A glass of chocolate milk may deliver beneficial milk proteins, but the fructose works against them.

Sweetened yogurt

Most flavored yogurts contain 15-25g of added sugar per serving. Fruit-on-the-bottom yogurts, yogurt drinks, and flavored Greek yogurts are often more sugar than dairy. The sugar, particularly fructose from fruit syrups and HFCS, can negate the yogurt’s gout benefits.

What to choose instead: Plain yogurt with fresh berries (which are relatively low in fructose and provide their own antioxidants) gives you the dairy benefits without the sugar load.

Ice cream

Ice cream provides some milk protein, but the sugar content (typically 20-30g per serving, with significant fructose) likely outweighs the benefits. It’s not a therapeutic dairy choice for gout management.

Smoothies and milkshakes

Dairy-based smoothies and milkshakes can be either helpful or harmful depending on what else goes in. A smoothie made with plain yogurt, a handful of berries, and some spinach is gout-friendly. A smoothie made with flavored yogurt, fruit juice, honey, and banana packs a significant fructose load.

Dairy and the Bigger Metabolic Picture

Dairy’s benefits for gout fit neatly into the broader understanding that gout is fundamentally a metabolic and excretion problem.

Dairy supports excretion

The uricosuric effect of milk proteins directly addresses the primary deficit in most gout patients. This is the same side of the equation targeted by medications like probenecid and the uricosuric effect of high-dose vitamin C. Adding regular dairy intake is essentially a dietary strategy for improving uric acid clearance.

Dairy provides protein without purines

Gout sufferers need protein, and many traditional protein sources (meat, poultry, fish) come with moderate to high purine loads. Dairy fills the protein gap without adding to the purine burden, making it easier to keep total dietary purine intake moderate without sacrificing nutrition.

Dairy supports insulin sensitivity

Some research suggests that dairy consumption, particularly fermented dairy like yogurt, may improve insulin sensitivity. Since insulin resistance is a major driver of impaired uric acid excretion, any improvement in insulin sensitivity supports better gout management.

The gut connection

Yogurt, kefir, and other fermented dairy products support the gut microbiome, which handles up to 30% of uric acid excretion. This alternative excretion pathway is increasingly recognized as important in gout management, and maintaining gut health through fermented dairy products supports it.

Practical Recommendations

Daily targets

Based on the research, incorporating 2-3 servings of dairy daily aligns with the intake levels associated with the greatest gout risk reduction. A serving is:

• 1 cup (8 oz) of milk
• 1 cup of yogurt
• 1.5 oz of natural cheese

Best choices for gout

• Plain skim or low-fat milk: Highest evidence for benefit
• Plain Greek yogurt: Concentrated protein plus probiotics
• Kefir: Diverse probiotics plus milk proteins
• Natural cheese: Low purines, convenient protein source

Choices to limit

• Flavored milks: High added sugar content
• Sweetened yogurts: Sugar negates benefits
• Ice cream: Too much sugar relative to dairy benefit

Lactose intolerance options

If you’re lactose intolerant, you can still get dairy’s gout benefits:

• Lactose-free milk: Same proteins, enzyme added to break down lactose
• Hard aged cheeses: Naturally very low in lactose (parmesan, cheddar, Swiss)
• Yogurt and kefir: Fermentation reduces lactose content significantly
• Lactase supplements: Allow you to consume regular dairy products

Note that plant-based milk alternatives (almond, oat, soy, coconut) do not provide the same uricosuric benefit. They lack the casein and lactalbumin proteins responsible for the uric acid excretion effect. If you use plant milks for other reasons, they’re fine, but don’t count them as equivalent to dairy for gout management.

Tracking Your Dairy Response

While population-level evidence strongly supports dairy for gout, individual responses can vary. Consider tracking:

• Your daily dairy intake (type, amount, sweetened vs. plain)
• Flare frequency over weeks and months after increasing dairy
• Any digestive changes (especially when increasing fermented dairy)
• What other factors might be influencing your results

Over time, your personal data will show whether dairy is making a measurable difference in your gout management.

The Bottom Line

Dairy is one of the clearest dietary winners for gout management and among the most effective foods that lower uric acid. The evidence is consistent across large epidemiological studies, the mechanisms are well-understood (uricosuric milk proteins, anti-inflammatory effects, gut health support), and the practical implementation is straightforward.

The key insight is that dairy helps gout by improving excretion, which is exactly where most gout patients have problems. This aligns with the modern understanding that gout is fundamentally an excretion disorder, not just a dietary purine problem.

Stick to plain, unsweetened dairy products to avoid the fructose trap that undermines the benefits. If you’re not already including dairy in your daily routine, it’s one of the simplest and best-supported dietary changes you can make for gout management. For a broader look at how diet affects gout, see our gout and food guide.

This article is for informational purposes only and is not medical advice. Consult your rheumatologist or healthcare provider about your specific dietary needs.