DEAR DOCTOR: I've had gout three times in the last three years. I was prescribed Colcrys and indomethacin, but I'm finding confusing information about foods and beverages. One site told me to avoid potatoes and chicken. Other sites said I could drink wine. Any advice would be appreciated.
DEAR READER: The correlation between gout and elevated uric acid in the bloodstream was discovered in the mid-19th century. The problem is that in joints, where the temperature is cooler than in the bloodstream, elevations of uric acid cause the formation of monosodium urate crystals. This is most common in the big toe joint and in the ankle. White blood cells then engulf the uric acid crystals, creating even more inflammation. The result, as you know, is an extremely painful joint.
The first aspect you should assess is your weight. A 2005 study that followed 47,150 men for 12 years found that those with a BMI greater than 35 were three times as likely to develop gout than those with a BMI between 21 and 23. In addition, those who gained 30 pounds during the study were twice as likely to develop gout, while those who lost 10 pounds had a lower risk.
In line with this, the consumption of sugary sodas has also been associated with gout. A subsequent analysis of the data found men who drank five to six sugar-sweetened sodas per week had a 29 percent increased risk of gout compared to men who drank less than one serving per month. Those who drank one soda per day had a 45 percent increased risk, and those who drank two or more servings per day had an 85 percent increased risk. Researchers did not see an association between gout and consumption of diet soft drinks.
The next aspect you should assess is your alcohol consumption. Beer, wine and liquor have all been associated with gout attacks. In a study of people with a history of gout, two to four drinks within 24 hours increased the odds of having an attack by 51 percent. Even one drink increased odds by 13 percent. In regard to wine: If you have never had gout in the past, wine appears safe. But in this study, of those who had gout, even one glass or less of wine was associated with a 26 percent increased risk of a gout attack.
A low-purine diet is often touted as a way to decrease gout attacks. Foods that are high in purines -- a type of chemical compound -- include sardines, anchovies, herring, mackerel, scallops, liver and other organ meats. Beer is also high in purines. If you have gout, you'd be wise to eliminate or severely restrict such products in your diet. Other foods, including a variety of meats and fish, have moderate purine levels, but they won't make a large difference in your uric acid level, so there's no need to be overly restrictive toward them.
That said, other types of protein -- found in dairy, soy and other beans -- have been shown to lower uric acid levels when compared to the protein found in meat and fish. Cherries have also been shown to reduce the risk of gout attacks, although the mechanism is unknown. Vitamin C, too -- at a daily 500 milligram dose -- has been shown to slightly lower uric acid levels.
Lastly, check your medications. Hydrochlorothiazide (a diuretic), aspirin and niacin can all increase the uric acid level within your bloodstream and increase your chance of a gout flare.
My essential advice is: If you're overweight, try to lose weight. The most simple way to start is to avoid desserts and sugary drinks. Second, if you drink alcohol, either eliminate it or limit yourself to not more than one drink per day. Third, stay away from foods that are very high in purines.
Each of these steps will lower your risk of a new painful gout attack -- and put you on the road to an overall healthier lifestyle.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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