Gout

Description

Alternative Names

Lifestyle Changes

Any activities that increase energy demands also increase metabolism or purines that produce uric acid. Avoiding stress and staying healthy are important for preventing attacks.

Dietary Recommendations

The American Medical Association recommends the following dietary balances for patients with gout:

• High in complex carbohydrates (fiber-rich whole grains, fruits, and vegetables).
• Low in protein (15% of calories and sources should be soy, lean meats, or poultry).
• No more than 30% of calories in fat (with only 10% animal fats).
• Of interest, however, was a 2001 study reporting a 67% reduction in gout attacks when patients limited their diet to 1,600 calories a day but only 40% were from complex carbohydrates while 30% were from protein and 30% from vegetable-based fats. Cholesterol levels also improved. More research is warranted on the optimal diet for gout patients.

Reduce Foods Containing Purines. Because uric acid levels are only minimally affected by diet, dietary therapy does not play a large role in the prevention of gout in the first place. Still, people who have suffered an attack of gout may benefit from reducing their intake of purine-rich foods if they habitually eat unusually large quantities of such foods. (Because purines are found in all protein foods, no one should eliminate all purines.)

Purine-containing foods include the following:

• Beer and other alcoholic beverages.
• Anchovies, sardines (in oil), fish roes, herring.
• Yeast.
• Organ meats (e.g., liver, kidneys, sweetbreads).
• Legumes (e.g., dried beans, peas).
• Meat extracts, consomm, gravies. (Note: Any meat, fish, or poultry has moderate amounts of purines. And diets high in protein, particularly animal protein increase uric acid. No studies have determined the value of reducing protein in gout patients, however.)
• Mushrooms, spinach, asparagus, and cauliflower.

Possibly Helpful Foods. Some specific foods may have benefits:

• Dark berries, such as blueberries, blackberries, and cherries, may contain chemicals that lower uric acid and reduce inflammation.
• Soybeans are also legumes, but one study of gout patients suggested that eating tofu, which is made from soybeans and is a source of complete protein, may be a better choice than meats.
• Certain fatty acids found in certain fish (e.g., salmon), flax or olive oil, or nuts may have some anti-inflammatory benefits.

Supplements. Vitamin C and folic acid supplements may also have some benefits. Vitamin A, however, may increase the risk for gout attacks.

Maintain Healthy Weight

A supervised weight-loss program may be a very effective way to reduce uric acid levels if the patient is overweight. Crash dieting, on the other hand, is counterproductive because it can increase uric acid levels and can cause an acute attack.

Maintain Fluids

Drinking plenty of water and other nonalcoholic beverages helps remove MSU crystals from the body. Some researchers are studying the anti-inflammatory properties of green tea, which might have some benefit for gout. It should be noted, a Japanese study reported a higher association between gout and tea drinking (although the study did not describe the type of tea).

Avoid Alcohol

Alcohol should be avoided, since it promotes purine metabolism and uric acid production; it also may reduce excretion of uric acid. Heavy drinking, especially binge drinking of beer or distilled spirits, should especially be avoided.

Avoid Joint Injury

People with gout should also attempt to identify and avoid activities that cause repetitive joint trauma, such as wearing tight shoes.

Preventing an Attack During Travel

Travel is an example of an activity that increases the risk for gout. It not only increases stress, but eating and drinking patterns may change. Before traveling, patients should discuss preventive measures with their physicians. The doctor may prescribe a prednisone tablet to be taken immediately at the first sign of a gout attack; in most cases this stops the episode.