Watch diet to control gout attacks

DR. ANTHONY KOMAROFF

Dear Doctor K: Could my diet be triggering my gout? If so, what foods and beverages should I avoid to prevent future episodes?

Answer: Your diet absolutely can trigger attacks of gout. As you know all too well, gout causes redness, swelling and extreme tenderness in one or more joints. Very often, the attack occurs in the big toe, and when an attack hits, it really hurts. I know from personal experience: I have gout.

Some people have gout attacks every few weeks. Others go years between attacks.

Gout occurs when there is too much uric acid in the blood and tissues. Crystals of uric acid form in the joints. They also can form in the kidneys, where they can cause kidney stones.

There are three main causes of the high levels of uric acid that lead to gout:

Your diet is rich in chemicals called purines, which the body breaks down into uric acid.

Your body chemistry produces more uric acid than that of most people.

Your kidneys do not get rid of enough uric acid, so it builds up in the blood. This

My Answer can happen with any kind of kidney disease. Also, drinking a lot of alcoholic beverages and taking certain blood pressure medicines can reduce the amount of uric acid that the kidneys expel.

You can’t do anything about your body chemistry, but you can control your diet. To decrease your risk of gout, avoid purine -rich foods. These include anchovies, sardines, oils, herring, organ meats (liver, kidneys and sweetbreads), legumes (dried beans and peas), mushrooms, spinach, asparagus, cauliflower, and baking or brewer’s yeast.

Also limit how much meat you eat at each meal. Avoid fatty foods. Stay hydrated. Don’t drink too much alcohol, and especially avoid binge drinking.

My last attack of gout occurred during a daylong family reunion. Along with the catching up, taking pictures, and meeting a lot of young grand-nieces and grand-nephews for the first time, there was more than a little food and drink. Specifically, a lot of beans, oils, anchovies, beer and wine. A lot. After about six hours, I became very aware of my left big toe. And I remembered what I had temporarily forgotten about the effect of diet on gout.

Unfortunately, you can still get attacks of gout even if you’re more careful about your diet than I was that day. However, there are effective medicines for preventing and treating attacks of gout.

Treatment usually starts with a prescription-strength nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen (Advil, Motrin, others), and another anti-inflammatory drug called colchicine. Avoid aspirin, which can raise the level of uric acid in your blood — but if you are taking low- dose aspirin for another medical condition, it’s OK to continue taking it.

If your gout attacks are frequent or severe, your doctor may prescribe medication to prevent future attacks. These include drugs that make your body produce less uric acid or excrete more uric acid. Either type of drug must be taken indefinitely. But don’t forget about diet. Gout is just one more reason to be prudent about what you eat .

Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions in care of Universal Uclick, 1130 Walnut S t., Kansas City, MO 64106 or AskD octorK.com.