KICK GOUT WITH DIET

Definition

Gout, a painful form of arthritis, occurs when high levels of uric acid in the blood cause crystals to form and accumulate around a joint.

Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it's also found in certain foods. Uric acid is eliminated from the body in urine. A gout diet may help decrease uric acid levels in the blood. While a gout diet is not a cure, it may lower the risk of recurring painful gout attacks and slow the progression of joint damage. Medication also is needed to manage pain and to lower levels of uric acid.

A Little History:

Gout has been associated for centuries with overindulgence in meats, seafood and alcohol. The condition was, in fact, considered a disease of the wealthiest people — those who could afford such eating habits. And long before the cause of gout was understood, doctors had observed some benefit of a restricted diet on gout management.

Once the cause was understood, a gout diet focused for many years on eliminating all foods that had moderate to high amounts of purine. The list of restricted foods included the following:

*Beer and other alcoholic beverages

*Organ meats, such as liver, kidney, heart and gizzard

*Poultry, especially goose

*Red meat

*Seafood

Current understanding

More recent research on gout and specific foods has created a much clearer picture of the role of diet in disease management. Some foods should be avoided, but not all foods with purines should be eliminated. And some things should be included in your diet to control uric acid levels.

The purpose of a gout diet today is to address all factors related to disease risk and management. Above all, the goals are a healthy weight and healthy eating — a message that applies to lowering the risk of many diseases.

Diet details:

Because dietary management of gout is so restrictive and of limited benefit, medication is the best way to treat gout. In addition to medications that treat the inflammation and other symptoms that occur during a gout attack, medications exist that can treat the underlying metabolic condition of hyperuricemia – too much uric acid in the blood. Hyperuricemia can occur either when the body produces too much uric acid or when the body does not excrete enough uric acid. Drugs exist to treat both causes.

Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Dietary management focuses on reducing the amount of uric acid in the system and on managing the disorders that occur frequently among patients with gout, including diabetes mellitus, obesity, hyperlipidemia (high blood levels of fats), hypertension and atherosclerosis (hardening of the arteries).

Dietary Management of Gout:

The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. People with gout should learn by trial and error what their personal limit is and which foods cause problems.

The general principles of a gout diet are essentially the same as recommendations for a balanced, healthy diet:

Weight Loss:

Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lowers uric acid levels and reduces the number of gout attacks. Losing weight also lessens the overall stress on joints.

Complex Carbohydrates:

Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods such as white bread, cakes, candy, sugar-sweetened beverages and products with high-fructose corn syrup.

Hydration:

An increase in water consumption has been linked to fewer gout attacks. Aim for eight to 16 glasses of fluids a day with at least half of that as water. A glass is 8 ounces (237 milliliters). Talk to your doctor about appropriate fluid intake goals for you.

Fats:

Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products.

Proteins:

Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your diet with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, which are associated with reduced uric acid levels.

Recommendations for specific foods or supplements include the following:

High-purine vegetables:

Studies have shown that vegetables high in purines do not increase the risk of gout or recurring gout attacks. A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus, spinach, peas, cauliflower or mushrooms. You can also eat beans or lentils, which are moderately high in purines but are also a good source of protein.

Organ and glandular meats:

Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.

Selected seafood:

Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna.

Alcohol. The metabolism of alcohol in your body is thought to increase uric acid production, and alcohol contributes to dehydration. Beer is associated with an increased risk of gout and recurring attacks, as are distilled liquors to some extent. The effect of wine is not as well-understood. If you drink alcohol, talk to your doctor about what is appropriate for you.

Vitamin C:

Vitamin C may help lower uric acid levels. Talk to your dietitian about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.

Coffee:

Some research suggests that moderate coffee consumption may be associated with a reduced risk of gout, particularly with regular caffeinated coffee. Drinking coffee may not be appropriate for other medical conditions. Talk to your doctor about how much coffee is right for you.

Laura Rall, PhD, nutrition researcher at Tufts University in Boston, says, "Begin by eliminating foods in the 'high-purine' category while reducing your intake of foods in the 'moderate-purine' category. If you don't have gout attacks after trying this, you may add more foods from the 'moderate' category or occasionally try a food from the 'high' category. Using these guidelines, you may be able to determine a safe level of purine consumption and enjoy some of your favorite foods without experiencing attacks."

High-Purine Foods Include:

Alcoholic beverages (all types)

Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock

Some meats, such as bacon, turkey, veal, venison and organ meats like liver

Moderate Purine Foods Include:

Meats, such as beef, chicken, duck, pork and ham

Shellfish, such as crab, lobster, oysters and shrimp

Non-Medication Pain Relief

In addition to medication and diet, these self-care tips may help your gout flare-up pain:

Use Cold Compress:

If the pain isn't too bad, try cold packs or cold compresses on the joint to lessen the inflammation and help the pain. Ice the joint for 20 to 30 minutes several times a day.

Rest the joint:

It's a good idea to rest until the pain lessens. Most people having an acute attack of gouty arthritis probably won't want to move the joint much anyway. Raise the joint if you can on a pillow or other soft object.

Drink water:

A lack of water in your body can make your uric acid levels rise even higher than they already are. Drinking water will help your body stabilize uric acid to a normal level.

Watch what you eat and drink. Foods that are high in purines (seafood, organ meats like liver, and even some vegetables) can increase the uric acid in your blood even more. So can fructose-sweetened drinks and alcohol -- especially beer.