How to keep Gout at Bay

I am a 35-year-old man. I recently developed pain in my ankle and big toe. A blood test revealed uric acid levels of 7 mg/100ml. My doctor said I am suffering from gout. Can you explain exactly what it is and give me some dietary guidance as well?

I am a tennis player. For two summers I have been developing shooting pain in my wrist and ankle. A blood test revealed high uric acid levels.

Gout is a condition in which uric acid level in serum of the blood is raised and this results finally in urates or uric acid crystals forming and getting deposited in the cartilages of the joints. Swelling and attacks of pain results and joints subject to trauma like elbows, wrists, knees, ankles and toe joints are commonly affected.

Gout is usually an inherited disease but also seen in those who consume large amounts of protein rich foods like fish, seafood, mutton, chicken, beef, glandular meat like liver, kidney or vegetarians who eat a lot of beans, spinach and pulses. Those who are regular heavy drinkers of alcohol may also suffer with gout. Men are more prone to it than women. Women usually get it after menopause. The normal uric acid levels are below 6mg/dl for men and below 5mg/dl for women.

Athletes and sportsmen like tennis, badminton, cricket, etc. players are also seen to be quite susceptible to gout. This could be due to increased perspiration during training and insufficient water consumption. Also players seem to be in and out of special training camps where lots of non-veg food is available. They eat large amounts of it thinking it will build their body. You need the protein but try to consume milk, egg and dhals, along with the non-veg so that you eat lesser quantities of it.

Weight Control

Obese persons may be more prone to gout. Therefore if you are over weight the first step would be to reduce weight. This will not only prevent recurrence of attacks of pain and gout, but also give relief to the weight bearing joints of the body. A word of caution those suffering from gout should not go on a drastic weight reduction programme, which involves starvation, skipping of meals or diets like only fruit juices or only vegetables throughout the day and cabbage soup diet etc. which do not contain any form of protein. This causes breakdown of protein within the body, leading to the formation of large amounts of uric acid, which will get deposited in the joints and result in acute pain suddenly. Over indulgence or feasting in rich fatty foods, meats and alcohol will also bring on an attack of pain over night. Therefore it is very important to follow a balanced regular diet and all party eating and drinking must be in moderation.

Besides pain in joints, uric acid crystals can cause stone formation should not be taken lightly. This shooting pain of gout may be seen more frequently in summer, as the normal water intake may be insufficient.

Dietary Restrictions

Many animal foods contain high amounts of a substance called purine. In the body uric acid is derived from these purines. Foods with high purine content are fish roe (eggs) or caviare, fish like herring, salmon, mackerel, sardine, pomfret, shellfish- like prawns and lobster. Organ meats like liver and kidney are very high in purine and should be avoided completely. Extracts of beef, pork and mutton are most dangerous. So soups of meats and gravies should be strictly avoided. Chicken may be eaten occasionally, two-three times a week. But here too avoid chicken soups and gravies. You may consume chicken but restrict it to only 2 pieces at a time. Try to avoid it at night and have it only at lunch. Please note that 100gms chicken is all you need to eat at a time to get your protein supply. 100gms gives you 20-25gms protein and excess of this in one meal may only get converted to fat and also tax your kidneys. The protein requirement in the diet should be met by milk, egg and dhals. Also make it a rule to eat less non-veg in the summer days. Try to eat it only once a day and preferably only at lunch so that there is time to digest it. Soups and gravies of meat or fish produce high levels of uric acid, so please avoid. In a restaurant never order a non-veg soup as it will be made of stock which contains all cuts of meats which are available in the restaurant kitchen namely pork, mutton, beef and chicken

Pulses like channa, rajma, moong, bean sprouts, French beans and green peas are high in their purine content, so after an attack of pain or high recording of uric acid in the blood try to avoid these foods completely for atleast a month. Thereafter they may be eaten once or twice a week in moderate portions (half a cup). Palak (spinach) and other green leafy vegetables are also high in purine and must be similarly restricted. Green chutneys must be avoided on a daily basis. Many believe that tomatoes should be avoided by those with gout but this is not true. Tomato is safe to consume as it does not have a high purine content. However those who have kidney stones which are of the oxalate form must avoid tomatoes as tomatoes are high in oxalates. Chickoo and custard apple are fruits with high purine content and must be restricted. All other fruits are safe to eat for a gout patient.

Alcohol

Consumption of alcohol is a major issue in gout. Alcohol has the effect of decreasing excretion of uric acid or urates through the urine. If large amount of alcohol is consumed, uric acid is retained and blood levels will shoot up. Stay away from beer and red wines. White wine or whiskey 30+30ml=60ml is all that is allowed at a time. More than that can be dangerous. We have also observed sudden gout attacks of pain after the consumption of too much alcohol, so please avoid alcohol binges.

Water

The most effective and immediate mode of treatment for a gout attack of pain or if you have suddenly seen a high blood level of uric acid is to pump water into your body. 2 and a half liters of water is the minimum health requirement for an adult. So a gout patient should be drinking atleast 3 liters daily and if you are a sportsman then 4 liters is a must. Sports people working heavily with weights, please note that there will be more muscle breakdown when you train so if you have a tendency for gout be very particular about keeping your water intake very high.

 

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