Gout is a form of arthritis that is
characterized by sudden, severe attacks of pain, redness and tenderness in
joints. The most common joint involved is the great
toe although other joints can be involved.
The cause of gout is a high
blood level of uric acid (hyperuricemia). Uric acid is a waste product formed from the breakdown of purines — substances which are found naturally in your body
as well as in certain foods.
Treatment of gout used to include severe
dietary restrictions. But newer medications to treat gout have reduced the need
for such restrictions. Still, some dietary modifications may reduce the
severity of gout attacks. They may also be useful for people who have problems
with gout medications.
Causes of Hyperuricemia
(see below), ethanol (alcohol), fructose (fruit sugar) consumption
- Hematologic: Myeloproliferative and
lymphoproliferative disorders, polycythemia
- Drugs: Ethanol, cytotoxic drugs used for
chemotherapy or autoimmune disorders, vitamin B12 (treatment of
Obesity, psoriasis, hypertriglyceridemia
renal excretion of urate
- Drugs: Ethanol,
cyclosporine (Sandimmune), thiazides
(hydrochlorothiazide found in Maxzide, Dyazide and others), furosemide
(Lasix) and other loop diuretics, ethambutol (Myambutol), pyrazinamide,
aspirin (low-dose), levodopa (Larodopa),
nicotinic acid (Niacin or Niaspan)
Hypertension, polycystic kidney disease, chronic renal failure (any
Dehydration, lactic acidosis, ketosis, hypothyroidism, hyperparathyroidism
Obesity, sarcoidosis, toxemia of pregnancy
The Purine Content of Foods and Beverages
High levels of purines include (Best to avoid):
Liver, kidney, anchovies, sardines, herring,
mussels, bacon, codfish, scallops, trout, haddock, veal, venison, and turkey
levels of purines (May eat occasionally):
bouillon, chicken, crab, duck, ham, kidney beans, lentils, lima beans,
mushrooms, lobster, oysters, pork, shrimp, spinach. Smaller amounts of purines
are found in all meats, fish and poultry. For this reason, limit animal protein
in your diet to no more than 5 to 6 ounces of lean meat, poultry or fish a day.
levels of purines (No limitation):
Carbonated beverages, coffee, fruits, breads,
grains, macaroni, cheese, eggs, milk products, sugar, tomatoes and green
vegetables (including lettuce and excluding vegetables listed above)
Some additional dietary considerations
alcohol or drink it in moderation. Drinking too much alcohol increases the
risk of hyperuricemia because it interferes with
the removal of uric acid from the body. If you're having a gout attack,
avoid alcohol completely.
plenty of fluids. Fluids can help remove uric acid from the body.
a healthy weight. Excess weight puts more stress on your joints and
increases the risk of hyperuricemia and gout.
Lose weight if you're overweight. But avoid
fasting or rapid-weight-loss diets because they can increase uric acid levels
in the blood. Also, avoid low-carbohydrate diets that are high in protein and
fat, which can increase hyperuricemia
Drugs Used in the Management of Acute Gout include NSAIDS,
and Corticosteroids. Urate-Lowering Drugs for the treatment of
gout and hyperuricemia include Sulfinpyrazone (Anturane), Probenecid (Benemid), and Allopurinol (Zyloprim) .