You wake up in the middle of the night with excruciating pain in your big toe. You can hardly sleep. You think it will go away but it doesn’t. You finally hobble to the doctor’s office to find out you have gout. But you’re in your mid-40s – isn’t that something that happens with old age? Yes, but overindulging at any age can bring on gout in susceptible persons.
Gout used to be considered a disease of the aged and overindulgent. Today, over two million Americans suffer gout’s excruciating pain and swelling – a number that has doubled in the past 30 years. Symptoms are caused by uric acid accumulating in the joints but are most noticeable in the big toe. If ignored, gout can permanently damage joints.
In years past, your doctor would probably have prescribed a strict diet to treat your gout. The diet would restrict meat and other sources of purines that the body converts to uric acid.
Today many doctors simply prescribe drugs, first to reduce the inflammation and then to help prevent accumulation of uric acid, either by slowing its rate of production or by increasing its rate of excretion. Although such drugs tend to be effective, skin rashes, upset stomachs and nausea are common side effects.
A better recommendation is diet plus drug treatment. Although drugs such as allopurinol help prevent the formation of uric acid and reduce the need to follow a very strict low-purine diet, they may also cause significant side effects, including liver damage.
If you have had gout or have a family history of gout, the following diet tips will be helpful both in managing and avoiding attacks of gout.
– Avoid foods high in purines such as anchovies, kidney, liver, fish eggs (roe), mackerel, sardines, shrimp and sweetbreads.
– Moderate the amount of protein you eat to a maximum of 80 grams per day. As an example, 6 ounces of lean meat, 2 cups of milk, four slices of bread and a half-cup of cooked beans combine to provide about 80 grams of protein.
– Drink lots of fluids – two quarts a day – to flush uric acid from your body and prevent kidney stones.
– Avoid excessive and undiluted alcohol, especially on an empty stomach. Coffee and tea are OK in moderation.
– Lose excess weight. There is a clear link between gout and obesity.
Of the preceding recommendations, losing weight is probably the most important, though often the most difficult, to accomplish. Excessive weight gain during early adulthood is particularly risky for people prone to gout. However, crash dieting also is risky and can actually increase uric acid levels. A change in lifestyle that controls calories, reduces or eliminates alcohol, reduces protein foods high in purines and includes plenty of fluids and exercise is the best answer.
by Pat Kendall, Ph.D., R.D., Food Science and Human Nutrition Specialist, Colorado State University, Cooperative Extension