Best Water for Gout: A Science-Backed Hydration Guide

As a smart hydration specialist, I spend a lot of time with people who are living with gout and staring at their glass wondering, “Is this the right thing to drink?” Water and beverages are one of the most powerful tools you have for controlling uric acid, yet they are also one of the most confusing because of aggressive marketing around alkaline water, special ionizers, and miracle drinks.

In this guide, I will walk you through what the research actually says about water, alkaline water, and other common drinks for gout and high uric acid. I will lean on studies and guidance from rheumatology experts, kidney foundations, and large health systems, and I will flag where the evidence is strong and where it is still emerging.

This is not a substitute for medical care. Think of it as a practical, science-backed hydration roadmap you can discuss with your rheumatologist or primary care clinician.

How Gout, Uric Acid, and Hydration Fit Together

Gout is a type of inflammatory arthritis. It happens when uric acid builds up in the blood over time, forming sharp monosodium urate crystals that settle in joints and surrounding tissues. Multiple sources, including Cleveland Clinic and Mayo Clinic, describe classic gout attacks as sudden episodes of intense pain, redness, warmth, and swelling, often starting in the big toe but also affecting feet, ankles, knees, or hands.

Uric acid itself is a normal waste product. Your body makes it when it breaks down purines, which come from your own cells and from certain foods and drinks such as red meat, organ meats, some seafood, and alcohol. Normally the kidneys filter uric acid into the urine and you flush it out.

Problems start when either your body produces more uric acid than usual or your kidneys cannot get rid of enough. This state of chronically high uric acid is called hyperuricemia. A Cleveland Clinic overview notes that long-term treatment for gout aims to lower uric acid to below a target level, often under about 6 milligrams per deciliter, to prevent crystal buildup and flares.

Hydration sits right in the middle of this process. A large review of nonpharmacologic gout management reports that about two thirds of uric acid leaves the body through the kidneys. When you drink enough water, you increase urine volume, dilute the urine, and make it easier for uric acid to stay dissolved and move out instead of crystallizing. The review also highlights that dehydration, whether from heat, heavy sweating, or sauna use, raises uric acid by reducing urinary excretion and ramping up purine breakdown.

The China CDC has similar advice for people with gout or hyperuricemia. Their guidance recommends roughly 2,000 to 3,000 milliliters of fluid daily, spread across the day. That is about 68 to 100 fluid ounces, or roughly 8 and a half to 12 and a half eight ounce cups. They note that good hydration helps keep urine slightly acidic to mildly alkaline (around pH 6.3 to 6.8), which improves uric acid excretion and reduces the chance of crystals forming.

There is even real world data connecting water intake to flare risk. A study summarized in the nonpharmacologic review found that people with gout who drank at least about 1,920 milliliters of water, close to 65 fluid ounces, in the previous 24 hours had about a 46 percent lower risk of recurrent gout attacks compared with those who drank less.

The bottom line is that water is not just background for gout. It is an active part of the strategy because it supports the kidneys, dilutes uric acid, and shapes the chemistry of your urine.

Man with painful gout flare-up, holding his red, inflamed foot.

How Much Should You Drink If You Have Gout?

There is no single perfect number for everyone, but several consistent patterns appear across gout and kidney health sources.

Continental Hospitals, Summit Rheumatology, the China CDC, and the National Kidney Foundation all converge on a similar range. In plain language, most adults with gout who do not have fluid restrictions from kidney or heart problems generally do well with something in the neighborhood of 64 to 100 fluid ounces of total fluid per day. That is roughly half to three quarters of a gallon, or about 8 to 12 cups, including water in foods.

Summit Rheumatology notes that many people with gout need toward the higher end of that range in hot weather, with more physical activity, during illness or recovery, and during active gout flares. Their guidance for avoiding dehydration related flares is simple but important: keep drinking through the day, and sip steadily rather than chugging large volumes all at once. That approach supports the kidneys without risking extreme overhydration.

The China CDC makes two other key points that often get lost:

Plain heated water is sufficient. They specifically state that so called small molecule or structured water has no proven health advantage beyond normal water.

During a gout attack, you should keep drinking water. Some people instinctively cut back because they are in pain or not moving much, but evidence suggests that continued hydration may lower the frequency and severity of attacks over time.

If you have advanced kidney disease, heart failure, or are on a strict fluid limit, your situation is different. The National Kidney Foundation stresses that people with end stage kidney disease may need to restrict fluids and should get individualized targets from their care team. In that case, talk with your nephrologist or kidney dietitian before increasing your intake.

Hands pouring fresh water into glasses for healthy hydration and gout management.

Plain Water Versus Alkaline Water: What We Actually Know

Among my own clients, the biggest hydration debates rarely revolve around how much to drink. Instead, the question is what kind, especially when it comes to alkaline water systems and fancy bottled products.

Plain Water: The Foundation

Across rheumatology reviews, major clinics, and public health agencies, plain drinking water is the baseline recommendation for gout. Multiple sources, including Cleveland Clinic, Mayo Clinic, and the National Kidney Foundation, emphasize that consistent water intake helps the kidneys move uric acid out and lowers the risk of both gout flares and uric acid kidney stones.

The China CDC advises plain hot or warm water for people with gout and directly states that the pH of ordinary drinking water, whether neutral or weakly alkaline, has no proven special effect on gout outcomes. They caution that the tiny amount of sodium bicarbonate in natural soda water is too low to meaningfully alkalize urine or change uric acid excretion.

The message from these expert groups is clear: your first priority is enough clean water. Everything else, including pH adjustments, comes after that.

What Is Alkaline Water?

Alkaline water is simply water with a higher pH than regular tap water. Typical municipal water sits close to neutral pH 7. Alkaline products usually fall in the pH 8 to 9 range and often include added minerals such as calcium and magnesium. This can be done in bottling plants, with cartridges and ionizers on the counter or under the sink, or with add in drops.

Articles from the Arthritis Foundation and WebMD explain that alkaline water is marketed as having extra benefits for bone health, energy, acid reflux, and detoxification, but that broad clinical proof is limited. For gout in particular, the picture is more nuanced, because recent clinical trials have started to look specifically at alkaline water as an add on therapy.

The Gout Study Everyone Is Talking About

A single center randomized controlled trial from Guangdong Hydropower Hospital in China, published in the journal Medicine and summarized in several medical news outlets, followed 400 adults with chronic gouty arthritis over about a year. All patients took febuxostat at 40 milligrams once daily, a standard urate lowering medication. The control group also followed a low purine diet and drank about 2,000 milliliters of plain water each day, roughly 68 fluid ounces.

The experimental groups received the same febuxostat dose but were allowed a normal diet and instead drank about 2,000 milliliters of alkaline water at different concentrations. The alkaline water, branded Yufeng in the study, had pH ranges between 8.0 and 9.0, with low, medium, and high concentration subgroups.

Researchers tracked pain scores, joint swelling, range of motion, daily activity, inflammatory markers, and serum uric acid at baseline, 3 months, 6 months, and 12 months. Several important patterns emerged.

All patients improved, but those drinking alkaline water saw larger reductions in pain and swelling. The high concentration subgroup reported almost complete pain relief by 12 months and significantly greater improvement in joint swelling than the control group.

Inflammatory markers such as C reactive protein, interleukin 1 beta, and tumor necrosis factor alpha dropped more in the alkaline water groups, especially at lower concentrations. Erythrocyte sedimentation rate changed only modestly.

Serum uric acid stayed about the same in the control group but dropped significantly in each alkaline water subgroup. After 12 months, the high concentration alkaline water group saw an average reduction of about 77.95 micromoles per liter in uric acid, with smaller but meaningful drops in the medium and low concentration groups.

Safety looked reassuring in the study window. The overall rate of adverse reactions was around 1.5 percent, mostly mild issues like transient nausea or skin discomfort, with no serious events clearly linked to alkaline water.

The authors concluded that 2,000 milliliters of alkaline water daily, layered on top of febuxostat, can enhance pain relief, reduce swelling, improve function, and lower uric acid and certain inflammatory markers in chronic gouty arthritis. They also emphasized that more long term, multi center research is needed to confirm durability, understand why some markers change more than others, and fully map safety.

How Does That Fit With Other Evidence?

The idea that more alkaline urine helps your body get rid of uric acid is not new. A Nutrition Journal paper cited in an alkaline water overview, and a broader gout lifestyle review, both note that raising urine pH improves uric acid solubility and excretion, which is exactly why medications such as potassium citrate are sometimes used in patients with uric acid kidney stones.

Separate studies on athletes have shown that mineral rich alkaline water can increase urine pH and support acid base balance after intense exercise. A trial in postmenopausal people with osteoporosis found that adding around 1.5 liters, a bit over 6 cups, of alkaline water daily alongside calcium, vitamin D, and a bone medication modestly improved spine bone density more than standard treatment alone.

On the other hand, public health guidance from the China CDC and critical reviews from the Arthritis Foundation and WebMD point out that most claims about alkaline water curing disease or dramatically changing blood pH are not supported. They note that the stomach’s strong acid neutralizes much of the alkalinity of water and that the main concerns with alkaline products are cost, marketing overpromises, and potential mineral imbalances in people with kidney problems or certain medications.

Taken together, the gout trial suggests that alkaline water is a promising adjunct, not a magic replacement, in people already receiving proper urate lowering therapy. The rest of the literature supports the concept that urine alkalization can help, but also shows that the broader health claims of alkaline water are often overstated.

Plain vs Alkaline vs “Fancy” Waters

Here is a practical comparison based on the sources above.

Water option	What it may do for gout	Evidence summary	Practical cautions
Plain filtered tap water	Supports kidney filtration, dilutes uric acid, helps prevent crystal formation and kidney stones	Strong consensus from rheumatology reviews, China CDC, National Kidney Foundation, Cleveland Clinic	Main risk is not drinking enough; adjust total volume if you have heart or kidney failure under medical advice
Alkaline mineral or ionized water (pH around 8 to 9)	May modestly raise urine pH, improve uric acid solubility, enhance pain and swelling control when combined with medication	One year randomized trial in chronic gouty arthritis plus small studies in other groups; promising but still limited	Costs more; long term safety and ideal dose are not fully known; people with kidney disease or on certain drugs should ask their clinician before using high mineral products regularly
Commercial soda water with sodium bicarbonate	Provides hydration; theoretical mild alkalizing effect but at low bicarbonate levels	China CDC notes natural soda waters do not contain enough bicarbonate to meaningfully alkalize urine or improve uric acid excretion	Some products are high in sodium; flavored versions can contain sugar; not necessary solely for gout control
“Small molecule” or structured water marketed for gout	Claims to penetrate cells better and detoxify	China CDC specifically notes no evidence that such waters have health benefits beyond regular water	Often expensive and unregulated; prioritize basic hydration and sound medical care instead

If you already have good control of your gout and a reliable filtration system, there is no obligation to switch to alkaline water. If you are struggling with chronic gout despite conventional therapy and are curious about alkaline options, consider them as an add on, discuss them with your rheumatologist, and favor systems that also provide robust filtration and moderate pH rather than extreme levels.

Glass of cool water with condensation on wood, ideal for gout patients and managing uric acid.

Other Helpful Drinks for Uric Acid and Gout

Water is central, but other beverages can play supporting roles. Several clinical and observational studies provide insight into which drinks may help lower uric acid or reduce flares and which ones are better left on the shelf.

Lemon Water and Vitamin C

Lemon water shows up repeatedly in gout and uric acid discussions. Continental Hospitals describes a simple approach: squeezing the juice of half a lemon into warm water, taken in the morning or throughout the day. Healthline notes that lemons provide vitamin C and citric acid, both of which may raise urine pH and support uric acid excretion.

Small human studies reviewed by Healthline suggest that regular intake of diluted lemon juice can modestly reduce blood uric acid and increase urinary pH. Vitamin C itself has been associated with lower uric acid levels in several studies, and one lemon provides a significant, although not maximal, portion of a typical daily vitamin C intake.

The evidence is still limited and lemon water is not a stand alone gout treatment, but it is a reasonable complementary option for many people, especially when it replaces sugary drinks. The main cautions are dental enamel erosion and reflux. Experts recommend diluting lemon juice in water, drinking through a straw, and rinsing the mouth afterward, and they advise people with stomach ulcers or significant reflux to speak with a clinician before increasing acidic drinks.

Tart Cherry Juice and Other Fruit Drinks

Multiple sources, including Continental Hospitals, MedicineNet, and the National Kidney Foundation, highlight tart cherries for gout. Research summarized by these groups suggests that cherries and sour cherry juice contain anthocyanins and other antioxidants that may lower uric acid and reduce inflammation, translating into fewer gout flares for some people.

A practical intake mentioned in the literature summary is about one to two cups of unsweetened sour cherry juice per day, with attention to total sugar and calorie load, especially in people with diabetes or weight concerns. Whole cherries are also commonly suggested, for example around 15 fresh cherries in the morning in one APEC Water article, though that specific number is based more on tradition than strong clinical trials.

Fruit juices more broadly are a mixed bag. While citrus and berry juices provide beneficial phytonutrients, many commercial juices are highly concentrated sources of fructose. Fructose is the only common sugar known to directly increase uric acid production, and a gout lifestyle review links high fructose intake, especially from sugar sweetened beverages and high fructose corn syrup, with obesity, metabolic syndrome, hyperuricemia, and gout.

Most gout experts therefore recommend emphasizing whole fruits and small amounts of lower sugar juices, like tart cherry, while avoiding large glasses of sweetened juice.

Coffee, Tea, and Herbal Infusions

Coffee has surprisingly consistent data in favor of gout prevention. Continental Hospitals, the China CDC, Dr. Bolling’s gout guidance, and Harvard Health all mention that moderate coffee intake is associated with lower uric acid levels and fewer gout attacks in observational studies.

Practical advice from these sources centers on about one to two cups of coffee per day, taken with minimal sugar and, ideally, low fat or skim milk. Some people may tolerate more, but caffeine intake should be individualized based on blood pressure, heart rhythm, and sleep issues.

Tea is generally permitted for gout. The China CDC notes that both coffee and tea are allowed and mentions that fermented teas may be particularly suitable for people with high uric acid. Continental Hospitals and MedicineNet both suggest herbal teas such as ginger tea or other unsweetened options as fluid sources that can also provide anti inflammatory and soothing effects.

The National Kidney Foundation adds two important cautions. Some herbal teas can interfere with medications, and people with advanced kidney disease may need to limit both total fluid and certain herbs. Checking with your clinician or pharmacist before using high dose herbal infusions regularly is wise.

Low Fat Dairy and Plant Based Milks

Low fat dairy may be one of the quiet stars of an anti gout beverage plan. Several sources, including a Cleveland Clinic low purine diet guide, Mayo Clinic gout diet advice, and a National Kidney Foundation article, note that low fat or fat free milk and yogurt are associated with lower uric acid levels and fewer gout flares.

A study in the Journal of Dairy Science referenced by the National Kidney Foundation found that higher intake of low fat dairy and yogurt helped lower uric acid and reduce flares. Dairy proteins and certain amino acids appear to aid uric acid excretion.

For people who cannot tolerate lactose, fortified plant milks such as soy or other options enriched with calcium and vitamin D can be reasonable alternatives, as highlighted by Continental Hospitals, though the direct evidence for uric acid lowering is stronger for cow’s milk products.

Choosing plain, unsweetened versions and keeping an eye on overall calorie intake fits with the broader advice to maintain a healthy weight.

Bringing It Together: Helpful Versus Harmful Drinks

The table below summarizes some of the most common beverages discussed in gout and uric acid research.

Drink	Potential benefit for gout	Evidence and limits	Key cautions
Plain water	Increases urine volume, dilutes uric acid, supports kidney excretion, lowers risk of kidney stones and flares	Supported by multiple clinical and observational studies and public health guidance; more water intake linked with lower flare risk	Do not dramatically increase fluids without medical input if you have heart or kidney failure
Alkaline water	May raise urine pH, improve uric acid solubility, reduce pain and swelling when added to medication	One year randomized trial in chronic gouty arthritis shows benefit; more research needed; not part of traditional guideline core	Higher cost; long term safety unknown; caution in kidney disease or with certain medications
Lemon water	Provides vitamin C and citric acid; may slightly alkalize urine and help lower uric acid	Small human studies show modest uric acid reductions; best viewed as an adjunct	Acid can erode teeth and worsen reflux if not diluted and used carefully
Tart cherry juice	Anthocyanins and antioxidants may lower uric acid and reduce gout flares	Observational and short term studies suggest fewer flares; often recommended by arthritis organizations	Can be high in sugar and calories; portion control matters, especially with diabetes
Coffee (black or with low fat milk)	Associated with lower uric acid and reduced gout risk in observational studies	Several large cohort studies support a link; mechanism not fully clear	Avoid heavy sugar and cream; some people need to limit caffeine
Unsweetened tea and herbal infusions	Provide fluid and may offer anti inflammatory compounds (for example ginger)	Widely used in practice; some anti inflammatory herbs studied; data for uric acid is less direct	Certain herbs interact with medications or affect kidney function; check with your care team
Low fat milk and yogurt	Lower uric acid and flares, provide protein and calcium	Observational and small intervention studies show benefit; recommended by multiple gout guidelines	Choose low fat, unsweetened products; adjust for lactose intolerance
Sugar sweetened sodas, energy drinks, and large fruit juices	None for gout; fructose raises uric acid production and increases gout risk	Strong epidemiologic evidence links high fructose drinks with hyperuricemia and gout	Best minimized or avoided; replace with water, lemon water, or unsweetened options
Beer, spirits, and heavy alcohol	None for gout; increase uric acid production and decrease excretion, trigger flares	Well documented association between alcohol, especially beer and spirits, and gout; highlighted by China CDC and multiple reviews	Avoid during flares and keep intake low or abstain in general; red wine may be somewhat less impactful but is still discouraged for gout

Practical Hydration Strategies When You Live With Gout

Knowing which beverages are helpful is only half the story. The other half is weaving them into a day that actually works.

People with gout in humid summers often underestimate fluid needs. Summit Rheumatology describes how dehydration in hot weather, combined with outdoor work or exercise, can easily trigger flares. They recommend paying special attention to hydration on hot days, increasing intake beyond your usual baseline, and being alert to symptoms such as dark yellow urine, less frequent urination, headache, and fatigue as early signs that you need to pause and drink.

Continental Hospitals offers simple strategies that I also see working well in daily life. Flavor your water with lemon, cucumber, berries, or herbs if plain water bores you. Carry a reusable bottle and make a habit of sipping whenever you check messages on your cell phone. Use alarms or watch reminders if you typically forget to drink until late afternoon.

Exercise is another key piece. The nonpharmacologic gout review explains that high intensity exercise can temporarily increase uric acid and lactic acid, lowering excretion, whereas moderate aerobic activity below your anaerobic threshold does not produce the same spike. Coupling gentle to moderate movement with steady hydration is much more gout friendly than intermittent hard efforts with little fluid.

During acute attacks, it is tempting to retreat to the couch and drink less because you are not moving around. Both the China CDC and clinical reviews emphasize that you should continue drinking water throughout an attack. This can help your kidneys keep clearing uric acid and may reduce the chance that one flare flows into another.

Finally, weight management and hydration reinforce each other. Obesity and weight gain are strongly linked with higher uric acid and gout risk in long term studies. Gradual weight loss through calorie control and moderate exercise can lower uric acid and reduce flare frequency, and drinking water in place of sugary drinks makes it easier to cut calories without feeling deprived.

Choosing a Home Water Setup if You Have Gout

Because I work with home hydration systems, I am often asked whether a particular filter, ionizer, or hydrogen alkaline unit is “worth it” for gout. The honest answer is that it depends more on your overall habits and health than on the machine itself.

Marketing oriented blogs from alkaline water companies highlight features like smaller molecular clusters, antioxidant properties, and the ability to neutralize acids and lactic acid. Some promote soaking produce in alkaline water to neutralize pesticide residues and advertise bundled glass pitchers for making alkaline coffee and tea. While many of these systems produce perfectly drinkable water, the clinical backing for such broad claims is limited.

Here is how I encourage people with gout to think about it.

First, secure the basics. You want a dependable source of clean water that you enjoy drinking. For many households, that means a high quality filtration system that reduces common contaminants and improves taste without necessarily altering pH.

Second, consider your medical context. If you have chronic gout on standard medication and normal kidney function, and you are interested in experimenting with alkaline water, the one year gout trial suggests that drinking around 2,000 milliliters, about 68 fluid ounces, of moderate to high pH alkaline water daily can be a reasonable adjunct under your clinician’s supervision. There is no evidence that intermittent sips or tiny daily amounts have the same effect.

Third, avoid do it yourself extremes. The Life Sciences alkaline water blog contrasts professionally formulated alkaline mineral water with home mixtures of baking soda and lemon, warning that high sodium intake from baking soda can cause headaches, nausea, and stomach discomfort and may not be safe for everyone. WebMD notes that using baking soda or concentrated alkaline drops indiscriminately can also disturb mineral balance and irritate skin and eyes. If you are going to use alkaline water, it is safer to choose a product or system designed for regular drinking and to stick within moderate volumes.

Finally, treat any device as an accessory, not your primary gout therapy. Major gout guidelines and reviews, summarized in sources such as the nonpharmacologic management paper and large clinic websites, still center on urate lowering medications, weight management, and dietary changes like reducing meat, seafood, alcohol, and fructose. No filtration system replaces that foundation.

Brief FAQ: Water and Gout

Is alkaline water better than plain water for gout?

Based on a recent randomized trial in chronic gouty arthritis, alkaline water at around 2,000 milliliters per day can enhance pain relief, reduce swelling, and lower uric acid when added to a standard urate lowering medication. At the same time, public health agencies and arthritis organizations emphasize that plain water is already very effective for supporting uric acid excretion and that overall fluid volume is more important than pH for most people. If you are curious about alkaline water, view it as a possible add on, not a replacement for medicine or basic hydration, and involve your clinician in the decision, especially if you have kidney or heart issues.

Can I just drink lemon water and stop my gout medication?

Current evidence does not support that approach. Healthline, Continental Hospitals, and major rheumatology sources all state that lemon water and vitamin C may modestly lower uric acid and help alkalize urine, but they are considered complementary measures. Most people with gout need long term urate lowering medication plus lifestyle changes to maintain uric acid below target and prevent joint damage. Never stop a prescribed drug without discussing it with your rheumatologist.

What is the single most important drink change I can make for gout?

If you currently drink sugar sweetened sodas, sweetened teas, energy drinks, or large amounts of sweetened juice, replacing those with water, lemon water, unsweetened tea, or low fat milk is likely the highest impact change. Multiple reviews point to fructose containing beverages and alcohol, particularly beer and spirits, as major contributors to high uric acid and gout flares. Swapping them out improves both your uric acid profile and your overall metabolic health.

Does sparkling water or soda water trigger gout?

Plain sparkling water without sugar or alcohol is generally considered neutral for gout. The China CDC points out that natural soda water containing sodium bicarbonate does not have enough bicarbonate to meaningfully alkalize urine, so it is not a special treatment, but it also is not inherently harmful if sodium content fits within your diet. Flavored sparkling waters need closer label reading because many versions include sugar or sweeteners that may not be ideal for gout or other health conditions.

Closing Thoughts from a Hydration Specialist

When you live with gout, every sip is an opportunity either to support your joints and kidneys or to make their job harder. The strongest science still points to simple, consistent habits: plenty of clean water, minimal sugary and alcoholic drinks, smart choices like coffee, lemon water, low fat dairy, and, in selected cases, carefully used alkaline water alongside proper medication.

If you focus on building a hydration routine you can enjoy and sustain, and if you pair it with the diet and treatment plan you and your clinician design together, your glass becomes a daily tool for quieter joints and steadier uric acid control.

Hands squeezing fresh lemon into a glass of water to support uric acid balance for gout.

References

About the author

Dr. Elena Brooks

Certified Water Quality SpecialistEnvironmental ScientistSmart Home Wellness Advocate

Environmental scientist turned smart home expert. Elena decodes the science of hydration to help modern families choose technology that supports long-term health.

Best Water Choices for Gout Patients and Uric Acid Levels