Gout Recommendations

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.

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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.

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Acquired Causes of Hyperuricemia

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Increased urate production

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• Nutritional Excess: purines (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 pernicious anemia)

• Miscellaneous: Obesity, psoriasis, hypertriglyceridemia

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Decreased renal excretion of urate

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• Drugs: Ethanol, cyclosporine (Sandimmune), thiazides (hydrochlorothiazide found in Maxzide, Dyazideand others), furosemide (Lasix) and other loop diuretics, ethambutol (Myambutol), pyrazinamide, aspirin (low-dose), levodopa (Larodopa), nicotinic acid (Niacin or Niaspan)

• Renal/Kidney: Hypertension, polycystic kidney disease, chronic renal failure (any etiology)

• Metabolic/endocrine: Dehydration, lactic acidosis, ketosis, hypothyroidism, hyperparathyroidism

• Miscellaneous: Obesity, sarcoidosis, toxemia of pregnancy

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The Purine Content of Foods and Beverages

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High levels of purines include (Best to avoid):

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Liver, kidney, anchovies, sardines, herring, mussels, bacon, codfish, scallops, trout, haddock, veal, venison, and turkey

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Moderate levels of purines (May eat occasionally):

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Asparagus, beef, 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.

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Low 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)

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Some additional dietary considerations include:

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• Avoid alcohol or drink it in moderation. Drinking too much alcohol increases the risk of hyperuricemiabecause it interferes with the removal of uric acid from the body. If you’re having a gout attack, avoid alcohol completely.

• Drink plenty of fluids. Fluids can help remove uric acid from the body.

• Maintain a healthy weight. Excess weight puts more stress on your joints and increases the risk ofhyperuricemia and gout.

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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.

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Drugs Used in the Management of Acute Gout include NSAIDS, Colchicine, and Corticosteroids. Urate-Lowering Drugs for the treatment of gout and hyperuricemia include Sulfinpyrazone (Anturane), Probenecid(Benemid), and Allopurinol (Zyloprim) .