Managing gout with diet

Gout is a type of arthritis that is caused by an inherited defect in the kidney's ability to excrete uric acid. In North America, gout afflicts about 21 out of every 1,000 people, about half of whom are overweight. As these tips suggest, there are a few ways managing your diet can help with gout.

1. Lose weight gradually. Many people who have gout are obese; losing weight — especially fat around the abdomen — often prevents future attacks. Weight loss should be gradual, however, because a rapid reduction can raise blood levels of uric acid and provoke gout. Fasting increases the blood levels of uric acid, therefore people with gout should avoid skipping meals. High-protein, low-carbohydrate diets should be avoided since these diets encourage the for­mation of ketones, metabolic by-products that ham­per the body's ability to excrete uric acid.
2. Modify your drug therapy. Sometimes gout is brought on by using aspirin or diuretics for high blood pressure. These medicines may interfere with normal kidney function and the elimination of uric acid. Your doctor may change treatment if you experience severe joint pain while on a drug therapy.
3. Avoid foods that are high in purines. Foods with a high content of naturally occurring chemicals called purines promote overproduction of uric acid in people with a tendency for gout. High-purine foods include anchovies, sardines, liver, kidney, brains, meat extracts, herring, mackerel, scallops, game, beer, and red wine; these should be avoided completely. Moderately high purine content is found in whole-grain cereals, wheat germ and wheat bran, oatmeal, dried beans and peas, nuts, asparagus, cauliflower, peas, and mushrooms; eat these in moderation.
4. Consume plenty of liquids. Try to drink at least two litres (two quarts) a day to dilute urine and prevent kidney stone formation. Although beer and wine, as products of fermentation, are the only alcoholic drinks known to be high in purines, any alcohol can interfere with the elimination of uric acid. Gout sufferers should drink only ­distilled alcohols in small amounts. Caffeinated beverages can also increase the production of uric acid and impair its removal from the body.
5. Eat fish rich in omega-3s. The omega-3 fatty acids in fish have been found to reduce pain and inflammation in people with rheumatoid arthritis and may have a similar benefit in gout, but this may be countered by the purine content of the fish.

Gout sufferers also may have hypertension, heart disease, diabetes, and high blood cholesterol. Counselling by a registered dietician may help in designing appetizing, healthful meals that strike a balance between these health concerns and the enjoyment of food.

Cherry juice — especially black cherry juice — is an old folk remedy for gout that's still popular today. But does it work? Nothing definitive has been proven. However, a study published in the Journal of Nutrition in June 2003 reported that eating cherries did indeed lower uric acid levels in the urine of the women in the study, which could explain any anti-gout effect.

When cherries aren't in season, you might consider purchasing cherry fruit extract, available at health-food stores, or drinking 125 millilitres (half a cup) of cherry or blueberry juice a day. Blueberries and strawberries may have effects similar to those of cherries. Eating pineapple or taking bromelain, an anti-inflammatory enzyme found in pineapple, is also said to work against gout, but it hasn't been shown that bromelain can be absorbed intact into the bloodstream.