Causes
Most cases of gout are hereditary. It is a disorder in which the kidneys' ability to excrete uric acid is diminished. Uric acid comes from purine, a substance that is contained in the cell nucleus. Purines are not only found in food, but are also produced by the body itself. If uric acid is not adequately excreted, it accumulates in the blood. If the concentration of uric acid in the blood rises above a certain level, it forms crystals that can be deposited in the joints or in the kidney. Uric acid kidney stones, gouty nodules and painful gouty joints are the result.

Change of diet
The change of eating habits recommended in cases of gout is an accompanying measure and no substitute for medical care. The primary aim of dietary change is to reduce the uric acid concentration in the blood. A secondary objective is to restrict the amount of purines getting into the body.

Reduction of uric acid concentration in the blood
The liquid intake should be at least 2, but ideally 3 litres, a day (8 to 12 glasses a day). Unsweetened, alcohol-free beverages are preferred.

Alcoholic beverages, in particular beer, should be avoided as far as possible. If total abstinence is difficult, the consumption of alcohol should be reduced to a minimum. Alcohol extracts water from the body, leading to a concentration of uric acid in the body fluid that remains. Alcohol also reduces the ability of the kidneys to excrete uric acid. In addition, alcohol stimulates the body's own production of uric acid. Alcohol is thus poisonous for people with a tendency towards gout.

Restriction of purine intake
Meat and meat products: consume only 1 - 3 portions per week (80 - 120 g). If possible, remove the skin (e.g. in the case of chicken), since this is particularly rich in purine. Intersperse meat-free days. Offal (liver, kidneys, tripe, sweetbreads): all these are very rich in purine and should be avoided if possible. Eat fish without skin where possible, because this is particularly rich in purine. Do not eat tinned fish (tuna, sardines) or shellfish (shrimps, mussels etc.). Use a vegetable stock instead of beef or chicken stock or meat or fish soup broth.

Further nutritional factors
If you are overweight, try to lose some pounds and regain your normal weight. (see Losing Weight the Healthy Way). Fasting is not advisable. An increase in the metabolism of the body's fat cells leads to the production of substances (ketone bodies), which inhibit the excretion of uric acid. This can just as easily lead to an attack of gout as excessive feasting.
What should be done when an acute attack of gout occurs?

• Consult your physician.
• Abstain from alcohol, but drink a lot of liquid instead, in the form of unsweetened beverages where possible.
• Abstain from eating meat, meat products, poultry, fish and shellfish.
• Eat 5-6 small meals a day.
• Do not fast!

Dietary recommendations in cases of gout
Many factors affect our dietary behaviour; individual needs and desires, our day-to-day condition, the social environment, the food currently on offer, advertising etc. The following recommendations ensure a balanced and varied diet that provides an adequate intake of energy, nutrients and protective substances and thus a healthy approach to nutrition. The figures quoted are intended for the "average person", i.e. for adults who engage in normal physical activities and thus have an average energy and nutrient requirement. The figures would vary for other groups (such as children and adolescents, top athletes, pregnant women etc.). The quantities and portions given are likewise average values; they cannot be adhered to precisely every day. Those passages that appear in italics are particularly important for persons with a tendency towards gout.

Fats and oils:
Use 2 teaspoonfuls (10 g) of high-quality vegetable oil (e.g. sunflower oil, thistle oil, corn oil, olive oil, rapeseed oil) per day, unheated, e.g. for salad dressings.
Use not more than 2 teaspoonfuls (10 g) of cooking fat or oil per day (e.g. peanut oil, olive oil) for the preparation of meals.
Do not eat more than 2 teaspoonfuls (10 g) of spreading butter or margarine per day on bread.
Avoid high-fat meals as much as possible, but certainly do not partake of such meals more than twice a week (e.g. deep-fried or breaded food, cheese dishes, fried potato, sausage, cream sauce, puff pastry, cakes, chocolate).

Sweets:
Eat sweets in moderation - many sweets contain hidden fat.

Meat, fish and eggs:
Do not eat more than one portion (80 - 120 g) of low fat meat per day, 2 - 4 times a week - more is unnecessary, less is no problem. Eat poultry as far as possible without the skin.
Do not substitute salted meat products (ham, sausage, bacon etc.) for meat more than once a week. As far as possible completely avoid offal (liver, kidneys, tripe, sweetbreads).
Eat 1 - 3 portions of fish (100 - 120 g) per week instead of meat; remove skin. As far as possible completely avoid tinned fish and shellfish.
Eat 1 - 3 eggs per week (including processed eggs e.g. eat in cakes and pastries, soufflés or creams).

Pulses, pulse products:
Eat 1 portion a week (lentils, chickpeas, kidney beans, tofu etc.).

Milk and dairy products:
Eat 2 - 3 portions per day (1 portion = 2 dl milk or 1 cup of yogurt or 30 g hard cheese or 60 g soft cheese), preferably fat-reduced products.

Cereal products and potatoes:
Eat at least 3 portions of carbohydrate-rich foods per day (e.g. bread, potatoes, rice, cereal, pasta, etc.), preferably wholemeal products.

Fruit:
Eat 2 - 3 portions of fruit per day (e.g. 1 apple, 3 plums or a dish of berries), ideally raw.

Vegetables:
Eat 3 - 4 portions of vegetable per day, at least one of them raw (e.g. mixed salad).

Beverages:
Drink a lot of liquid (2 - 3 litres, or 8 - 12 glasses per day), preferably unsweetened and alcohol-free beverages.

Alcoholic drinks:
Avoid alcohol if possible.

Gout - chief points to remember:

1. Lose weight, if necessary.
2. Drink at least 2 litres of liquid a day, as calorie-free as possible.
3. Avoid alcohol.
4. No fasting.