Step 1. Understanding the link between gout and food
Gout is a type of arthritis which usually affects the joints of the big toe. Gout is caused by deposits of urate crystals in the joints. Urate is one of the breakdown products of compounds called purines. People who suffer from gout tend to either produce more urate than normal or to excrete less in the form of uric acid. Gout is usually accompanied by raised blood urate levels.

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Purines which are broken down to urate and uric acid originate from two sources, dietary protein and body synthesis.

Men are much more prone to develop gout than women, although post-menopausal women also run an increased risk.

Factors that can precipitate a gout attack, include:

• overweight - many patients who suffer from gout are overweight or obese
• alcohol - acute attacks of gout are often precipitated by overindulgence in alcohol
• dietary purines - eating foods rich in purines (meat, fish, fish roes) can cause an attack
• starvation or very-low-energy diets - blood urate levels rise dramatically when body proteins are broken down due to starvation or very low energy intake
• kidney disease - any disease, such as chronic renal failure, which prevents the kidneys from functioning properly and excreting sufficient urate can cause gout
• other diseases - diseases such as leukaemia or psoriasis can cause increases in urate production
• drugs - chemical compounds which decrease the excretion of urates, such as the so-called thiazide diuretics, can cause a gout attack

It is clear that your diet can play a role in your attacks of gout.

Step 2: Adopting new healthy habits

You can reduce your risk of another gout attack. Follow these guidelines:

• Reduce weight
• Avoid alcohol: Cut down on alcohol intake drastically. If necessary avoid all alcohol or restrict drinking to less than two drinks a day. A harsh, but effective way of preventing gout.
• Avoid gorging: Avoid rich, heavy meals which contain lots of fat and purines - i.e. the typical Christmas dinner is an excellent example of a meal laden with fat and purines.
• Avoid purines: Avoid high-purine foods like liver, kidneys, sweetbreads, sardines, anchovies, fish roes (eggs and caviar) and meat extracts.
• Drink water: Drink six or more glasses of water throughout the day and a glass at night before going to bed to help the kidneys excrete urates.
• Go easy on caffeinated drinks: Don't overdo tea and coffee drinking and switch to rooibos tea if you find your joints start aching after a coffee/tea binge.

Moderation and abstinence from alcohol - those are the solutions to gout.

Step 3: The basic principles of restricting dietary purines

• Water – Drink at least six glasses per day and make sure that you have one of the glasses before you go to sleep. It helps getting rid of uric acid.
• Tofu (bean curd) - Use as protein source. Research suggests that it increases uric acid secretion.
• Macronutrients – Diet should be relatively high in carbohydrate (like bread, rice and pasta), moderate in protein (e.g. tofu) and low in fat.
• Alcohol – An excess of alcohol should be avoided. Total abstinence and avoidance of alcohol may be required in severe cases.
• Body weight – Maintenance of, or gradual reduction to, ideal body weight could prove helpful.

The absolute don’ts:
Avoid foods with a high purine content. The following foods contain 100 to 1 000 mg of purine nitrogen per 100 g of food:

• Anchovies
• Brains
• Consommé
• Goose
• Gravy
• Heart
• Herring
• Kidney
• Mackerel
• Meat extracts
• Mincemeat
• Mussels
• Roe
• Sardines
• Yeast (baker’s and brewer’s, taken as supplement)

The maybe’s, and in moderation
Foods with a moderate purine content
These foods contain 9 to 100 mg of purine nitrogen per 100 g of food. One serving of meat, fish or poultry (90 g) or one serving of vegetables (1/2 cup) from this group, is allowed per day, depending on the condition of the patient:

• Asparagus
• Dried beans
• Lentils
• Meat, fish and poultry (except the above-mentioned)
• Mushrooms
• Dried peas
• Shellfish
• Spinach

The yes-foods
The foods with a low purine content
These foods contain negligible amounts of purine and may be used daily:

• Bread (white) and crackers
• Butter or margarine (in moderation)
• Cake and cookies
• Carbonated beverages
• Cereals
• Cheese
• Chocolate
• Coffee
• Cream (in moderation)
• Custard
• Eggs
• Fats (in moderation)
• Fruit
• Gelatin desserts
• Herbs
• Ice cream
• Milk
• Noodles
• Nuts
• Oil
• Olives
• Pickles
• Pasta
• Popcorn
• Puddings
• Relishes
• Rice
• Salt
• Sugar and sweets
• Tea
• Vegetables (except those mentioned in the first group)
• Vinegar

Source: Krause’s Food, Nutrition, & Diet therapy, 10th edition (Mahan LK, Escott-Stump S)

Visit our Joint Pain Centre for up-to-date information on gout.
 

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	Gout 2011/11/29 08:10:48 AM I am a gout sufferer - the following affect me - red meat, red wine and to a lesser extent white wine, tomatoes, chocolate. Maybe this will help other people. BL - Barry Lane   Puricos 2011/11/29 11:33:38 AM There is a cure, a very cheap harmless medication called Puricos. - Dave   GOUT 2011/11/29 11:54:14 AM Hi I suffer from gout and would like to ask you the following: 1. I have growths on joints on my toe and right finger. Because of the growth I have not been able fold a fist in two years. I hear the growths can be removed surgically. Please recommend which institution I can get this removed. 2. You mention that alcohol should be minimsed to 2 drinks a day. what happens if you dont drink for 6 days and get to drink 12 on the 7th day. Humphrey - humphrey mpundu   easy prevention 2011/11/29 11:56:53 AM Drink a glass of ant-acid (citrus soda or enos or alka fizz, etc) every morning before breakfast. Double-up dosage if you've been over-indulging. - Ric   Vit C = Geen Gout 2011/11/29 12:15:32 PM Ek het jare lank gesukkel met Gout. Kon amper nie meer loop nie, Die een aanval na die ander gekry. Toe het iemand vir my 'n studie met Vit C gestuur. Ek drink elke dag 2gram Vit C (stadige vrystelling) Dit is nou amper 3 jaar lank wat ek nog NOOIT weer gout gekry het nie. Ek het ook geen las van nierstene soos wat baie mense sê  jy gaan kry as jy 'n groot hoeveelheid Vit C drink nie. So al wat ek kan sê  is Vit C = GEEN Gout - Herman   Gout 2011/11/29 12:41:19 PM I am a new gout sufferer, got it quite bad the last year, I had to go see the qwaq - I don't know yet which foods affect me. How do you find out which foods affect you? Thanks - Pockello   Gout 2011/11/29 01:30:24 PM As dave said, Puricose every morning will prevent it. What most do not know is that the puricose must first rid the body of stored acid build up in the joints and can sometimes precipitate an attack, but you must persist, it took me 18 months to clear my body, now first thing I do every morning is take my inexpensive daily puricose 300mg presto! I eat and drink for the A side, I eat wors, fatty biltong, pork, tomatoes you name it, gout has gone. - Bluce   Gout 2011/11/29 01:55:53 PM Not convinced with this report. I get gout from excess tomatoes, orange juice, grapes, and chilli - none of which are mentioned. I eat loads of red meat, fresh salmon and fish in general and drink red wine and beer - NO PROBLEM. Stange!!! - Cheeky Monkey   Gout 2011/11/29 02:03:06 PM I sometimes get an attack if I sweat a lot. Typically during the summer months. I struggle with the 6 glasses of water a day. I guess I have high levels of whatever in my blood and doesn't need much for an attacked. Sometimes I can eat lots of red meat and drink red wine and nothing will happen and sometimes I get an attack only thinking about steak and red wine. Water seems to be the key for me, but it is not easy. - Pieter   gout 2011/11/29 02:08:53 PM gout is caused by an unclean colon. a high fibre cleanse like psyllium husks for 3 months with lots of water wil sort it out until you muck becomes stagnant in the colon again. may take years. take one tablespoon of husks twice a day on empty stomach and a meal at least half hour later. then goodbye gout. avoid all kinds of meat and get a good vegetarian cookbook. you wont be sorry - Rob   No easy fix 2011/11/29 02:09:15 PM Had extreme gout for 20 years which went undiagnosed. Gout is called Metabolic Arthritis- ou get severe lumps which look awful, and you lose mobility in joints, when the attacks are bad enough. I take puricos, colchicine, voltaren daily and have been gout free for close on to 4 years!! humphrey: I had growths removed from my ankles, successfully although healing process was slow - acid residue keeps woundbed from healing. I had 2 followup ops, and a drainage unit post-op. Speak to rheumatologist - Gout suvivor   Gout 2011/11/29 02:49:14 PM I have been suffering from gout for a good couple of years.I have sarted taking puricos& it has made a big difference in my life. - Geoff Julsing   Gout 2011/11/29 03:04:13 PM I suffer from gout and since I started to use Puricos about 4 years ago I never had a accute attack of gout. Food that I try not to eat is Mince, Liver, Kidneys, Biltong, All processed meats, Beer, Red wine. - PW Beytell   Keep Gout at Bay 2011/11/30 07:58:50 AM I am 41 and have suffered with gout since I was in my late 20's. I went through years of hell until I found a Doctor who prescribed Puricos. I have been taking them once a day for the past 2 years and have never had another attack. I used to get at least 2 bad attacks per month before that. It hit my feet mostly, especially my ankles. Now I eat what I want. NO RESTRICTIONS! It's wonderful stuff this Puricos. - Leigh Ridgway   Keep Gout at Bay 2011/11/30 08:01:13 AM I am 41 and have suffered with gout since I was in my late 20's. I went through years of hell until I found a Doctor who prescribed Puricos. I have been taking them once a day for the past 2 years and have never had another attack. I used to get at least 2 bad attacks per month before that. It hit my feet mostly, especially my ankles. Now I eat what I want. NO RESTRICTIONS! It's wonderful stuff this Puricos. - Leigh Ridgway   Tomatoes 2011/11/30 03:08:04 PM Like a couple of others have mentioned, uncooked tomatoes, especially cherry or rosa tomatoes are a killer for me. They have a high acid content. I also suffer from chronic psoriasis which I know leads to psoriaic arthritis. A couple of other things that have also set it it off are white wine, soft (cool) drinks with fructose and high acid juices (OJ, prineapple). I take citric soda every morning and this has reduced the attacks. - David   @Gout Survivor 2011/11/30 03:11:40 PM Glad this works for you but I believe you should consult a doctor about taking Voltaren (especially the tablets) daily, especially for the last 4 years. - David
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