Gout could be considered a defect in the body's chemistry. Part of the chemical structure of our genes and the genes of plants and animals, is provided by the compounds called purines. Normal production of uric acid during digestion can be increased to excessively high levels if the diet is high in purine-rich foods such as high-protein foods, organ meats, some oily fish and shellfish, yeast, and some kinds of vegetables including dried beans, lentils and mushrooms.
How Uric Acid Crystals are Formed
When the purines are metabolized (broken down in the cells), they form uric acid. Uric acid is not necessarily a bad commodity, as it serves as an antioxidant and helps prevent damage to our blood vessel linings. Under certain circumstances, however, the overabundance of uric acid will cause a buildup of uric acid crystals (monosodium urate crystals) which then are deposited in tendons, joints, kidneys and other organs. This accumulation is referred to as "gouty arthritis."
When only the rich maintained a daily diet of high-protein foods such as filet mignon, shellfish, anchovies, and so on, the term "rich man's disease" was coined. The pain most often manifests itself in the big toe, leading to countless cartoons of the overweight gentleman with his bandaged foot elevated on an ottoman, while he raised a glass of port and smoked a cigar!
Purines in the Modern Diet
The average diet today is much more apt to consist of daily helpings of beef, poultry, some types of fish and shellfish, yeast breads and other "dainties" at every meal. Consequently this painful form of arthritis appears more frequently but tends to be overlooked as a diagnosis. It often appears in middle-aged, overweight, mostly sedentary males and females who like a few drinks in the evening. "A high-purine diet, obesity, regular alcohol consumption, and diuretic therapy can all contribute to elevated uric acid levels in individuals with gout. Preliminary research suggests that insulin resistance may also play a role in the development of gout." In fact, people with diabetic neuropathy may find following a low-purine diet may help as it also restricts proteins.
Gout and Diuretics
Gout may appear as a side effect of some diuretics used to control edema, such as Lasix (furosimide). This leads to a "catch-22" situation, because while one part of the treatment for gout recommends drinking plenty of water, those who are on a fluid-restricted regime for their edema (caused, for example, by congestive heart failure) cannot risk this approach. Since patients on a diuretic like Lasix are probably also on a restricted diet, when told the treatment for gout includes a new set of diet restrictions, panic may ensue. However, it is possible to follow both sets of restrictions with some determination and patience.
Avoiding High-Purine Foods
While one must avoid the high-purine foods:
- Liver
- Sweetbreads
- Sardines and anchovies
- Kidneys
- Meat concentrates like consommé, bouillon, and stocks
- Herring, scallops, mackerel
- Game meats
- gravy
protein should not be completely avoided. Choose dairy products such as cheese and milk, and eggs. Nuts, fruit, cereals other than oatmeal, and many vegetables all contain some protein and are rich in other nutrients as well.
Foods that are moderately high in purines can be eaten in moderation, such as mushrooms, spinach, oats and oatmeal, soy proteins, whole grain breads, green peas, asparagus. Limit the consumption of these and meat, fish and poultry to one serving of 4-6 ounces a day. If you are not on a fluid-restricted treatment for edema, drink plenty of water to help flush excess uric acid from the body. Limit or eliminate alcohol consumption, especially beer which contains yeast.
Try to lose weight, as obesity is both a high-risk factor and an aggravating condition. Staying within a healthy weight range will reduce uric acid production by the body. Don't follow a low-carb diet as this can worsen gout conditions. Speak with a health care professional about changes to your diet and exercise routines, before making major changes.
For More Information:
World's Healthiest Foods.com
Drugs.com "Low Purine Diet"
Dietaryfiberfood.com "Purine Foods"
MayoClinic.com "Gout"
AllAboutArthritis.com
Rehabilitation Institute of Chicago (www.ric.org) Arthritis Glossary
