Got Gout?

uch! Don't even touch my big toe with a feather, let alone think of putting it in a shoe!

Those are the sentiments of anyone suffering from an acute attack of gout. Gout, also called the "disease of kings," is a common and painful condition that has both genetic and dietary ties.

Gout is a form of arthritis caused by the deposit of uric acid crystals in the joints. Uric acid is a by-product of protein metabolism. What that means is that as the body breaks down the protein that is eaten, uric acid (along with nitrogen and other metabolites) is released. The body usually processes these metabolites and excretes them through the kidneys and into the urine. During gouty attacks, however, the kidneys are either unable to flush out all of the uric acid or the body produces too much uric acid and it gets deposited in crystal form in the joints, usually in the big toe and ankle. Painful needle-like crystals also form in the instep, heels, knees, wrists, fingers, and elbows. The affected area also appears red and swollen on the outside.

Several factors are known to cause or exacerbate gout. Genetics play a role, but do not account for most causes. As I mentioned before, gout was nicknamed the "disease of kings" because it was associated with wealthy men who could afford to indulge in rich foods, especially meat and alcohol. It is still most common in overweight men in their 40s and 50s and increasingly common in overweight post-menopausal women-especially if they drink too much alcohol and caffeine, which can lead to the build-up of uric acid in the body. Certain medications, such as diuretics and aspirin, can impair the body's ability to excrete uric acid. Furthermore, purine-rich foods can also increase gout risk, since a class of proteins called purines help to form uric acid. High consumption of beef, pork, lamb, organ meats, and seafood (especially anchovies, herring and mackerel) appears to substantially increase the risk of gout. For every additional daily serving of meat, gout risk increases by 21% and, for each additional weekly serving of seafood, gout risk increases by 7%. Animal protein was always suspect in cases of gout, but so were many purine-rich vegetables. Surprisingly, though, purine-rich vegetables, including spinach, beans, cauliflower, mushrooms, and peas, do not contribute to gout risk.

Gout is an inflammatory disease and is associated with diabetes and heart disease. If you want to avoid gout or to help manage your symptoms, I recommend that you follow an anti-inflammatory diet, along with some specific gout-related modifications.

• Eat no more than 6 ounces of animal protein daily, including meat, fish, and poultry. Liver and other organ meats should be eliminated. Never take protein supplements if you are at risk for gout.

• Eat at least nine servings of fruits and vegetables a day, since they are excellent anti-inflammatory foods and are low in calories. Add back the once- forbidden purine-rich vegetables such as lentils, beans, peas, spinach, and cauliflower-they're healthy, anti-inflammatory and do not increase gout risk or blood sugar.

• Include omega-3 rich foods for their anti-inflammatory properties. Walnuts, flaxseeds, and fish oil supplements are good bets for gout sufferers.

• Include nonfat dairy products in your diet since they have been shown to protect against gout by reducing levels of uric acid in the blood. Aim for two servings of nonfat dairy, such as milk and yogurt, each day.

• Drink plenty of water to help flush uric acid out of your body and avoid caffeinated beverages, which can raise uric acid levels, and alcoholic beverages, which promote uric acid crystallization.

• If you are overweight, try to lose the excess you are carrying, since extra weight promotes inflammation and uric acid production. Follow the eating guidelines I mention above and study my August 2005 Nutrition Notes article, Inflammation Information. Please avoid high-protein and other rapid weight loss diets, since they will increase gout risk.

• Tell your doctor about any medications you are taking, including supplements. Niacin, often used to treat high cholesterol, can increase gout risk, and high doses of vitamin C (greater than 1000 mg per day) can increase the formation of kidney stones among gout sufferers.

• Exercise daily to help control your weight and your gout. Exercise helps relieve stress, which is a trigger for gout. Biking and swimming are good exercises for those who can't tolerate too much weight on their joints.

If you think you may have gout, see your doctor immediately, since untreated gout can lead to joint damage. Take your medication at the first sign of an attack and try to lead a healthful lifestyle to prevent acute attacks of gout.