Question

This is the third site I have researched on gout. Everyone has a different opinion. One says stay away from poultry, this one says eat poultry. One says don't eat fish or shellfish, this one says eat fish. Don't eat beans, this one says eat beans. What's the deal?

Answer

"The deal" is that the most important thing is to avoid foods that trigger your attacks. With a little care, you can find this out; if necessary, keep a food-diary that you can look back on from time to time. In this way you can be responsible for yourself, and you don't need to listen to a lot of other opinions.

Gout is a disease in which a defect in uric acid metabolism causes an excess of the acid and it's salts (urates) to accumulate in the blood stream and the joints, respectively. It results in attacks of acute gouty arthritis and chronic destruction of the joints. The excess of urates also damages the kidneys, in which stones may form.

Treatment with drugs that increase the excretion of urates (uricosuric drugs) or with allopurinol, which slows their formation, can control the disease. Acute attacks are treated with anti-inflammatory painkillers.

As we said before, the most important thing is to avoid foods that trigger your attacks. Traditionally this has meant avoiding high-purine foods, such as the inner organs (liver, kidneys, sweetbreads, etc).

Recently research has challenged the "low-purine, high-carbohydrate" diet usually advised for gout patients. Perhaps we need to re-think our recommendations regarding the most appropriate diet for gout patients. Certainly, further research should be done to substantiate these results. See the link below "The Right Diet for Gout Victims?".

For those gout patients who want to try to follow the diet used successfully by the South African investigators, you can come close to it by following the recommendations in "How to Eat if You Have Cardiovascular Disease" - see the second link below.

- Diet: it is important to avoid foods that trigger your attacks, but there are other factors which should also be considered.

- Alcohol: avoiding (or at least limiting) alcohol intake can be helpful for individuals with gout, since alcohol can cause both overproduction and under excretion of uric acid.

- Fluid Intake: because dehydration can trigger acute gout attacks, it's important that persons with gout consume adequate amounts of fluids. Being well hydrated also helps to prevent kidney stones, which can develop as a result of high uric acid levels.

- Food Intake at Regular Intervals: plasma uric acid levels rise during starvation. Therefore, individuals with gout should avoid going for extended periods of time without eating.

- Weight: research has shown that blood uric acid levels are higher in overweight individuals, and that moderate weight loss can reduce uric acid levels. Individuals who have gout benefit from attaining and maintaining an appropriate weight for their height.

- Repetitive Joint Trauma: persons with gout should avoid repeated trauma in areas susceptible to gout attacks. For example, tight-fitting shoes should be avoided.

Links

• The Right Diet for Gout Victims?
• How to Eat if You Have Cardiovascular Disease