DEAR DR. GOTT: I just found out that the terrible pain I have been having is gout. Through many hours of research on the Internet, I have found out that I should not eat high-purine foods but should eat low-purine foods. However, I cannot find a list of what is acceptable versus what is not. Can you help? Also, is there a website, book or other resource where I could find menus? Thank you.
DEAR READER: Gout is a form of arthritis that causes a buildup of urate crystals in one or more joints. These crystals develop because of greater-than-normal levels of uric acid in the blood. Uric acid is created during the breakdown of purines. Gout most commonly affects the base of the great toe, but can also appear in other joints such as the feet, ankles, knees, wrists and hands.
Symptoms include intense pain in the affected joint. (Onset often occurs suddenly and often at night, with swelling and tenderness.) The joint may become red and hot. Pain is typically worse during the first 12 to 24 hours and is followed by discomfort that can last from a few days to a few weeks.
Treatment generally involves prescription medication. Some people opt for a low-dose daily pill, which can prevent an attack, while others prefer to take medication only after an attack has begun, which reduces the severity and length of an attack. Types of medications used include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids, xanthine oxidase inhibitors (which block uric-acid production) and probenecid, which increases uric-acid removal. Which medication and treatment type is best for you depends on several factors and is best discussed with your physician.
High-purine foods include organ meats, anchovies, herring, asparagus and mushrooms. Meats, fish and poultry are not high-purine foods, but consuming too much may present a problem. You should limit your intake to four to six ounces daily or consider alternative sources. Limiting or avoiding alcohol may also be beneficial.
As for what you can do to prevent an attack, this is easy. Drink plenty of water (between eight and 16 cups daily to assist uric-acid removal), consume low-fat dairy products (a good source of protein providing a possible protective effect against gout), maintain a healthy weight, and eat plenty of fruits, vegetables and whole grains.
I don’t know that there is a source for low-purine menus; however, I don’t believe one is necessary. If you take appropriate steps to avoid high-purine foods, maintain an otherwise healthful diet and weight, and follow your physician’s advice regarding medication, you should be fine. You probably won’t have to make drastic changes unless you currently eat large amounts of organ meats, which are rather unhealthful. Anchovies and herring are often salted and packed in oil, making them unfavorable to a healthful diet, except as an occasional treat.
Readers who are interested in learning more about gout can order my Health Report “About Gout” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039-0433. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
