The main three primary objectives of gout management are:
(i) quick relief from the inflammatory condition,
(ii) to stop recurring attack, and
(iii) to lower the rate of deposition of uric acid crystals in the joints and to increase the rate of excretion of it through urine.
Dietary management in gout
In this disease, although some relief from the pain can be achieved by temporarily excreting out uric acid from the body by medicine, but total cure is not possible. It is only by restriction of the diet, that is, by proper diet control that relief from gout can be obtained. The primary condition of this diet control is to have only purine-less foods. But one may take foods containing very less amount of purine as well. If the amount of daily intake of purine can be restricted to 100 - 150 mg, then the symptoms of gout and hyper-uricaemia will be considerably less. The following chart shows the level of purine in different types of foods:
Purine level maximum (150 - 825 mg / 100 g )- to be avoided completely:
Liver, kidney, red meat, shellfish, herring, sardine, meat extract, gravy, broth, chopped meat, sweet bread, soyabean, rajma, lentil, alcoholic drinks (specially beer and wine).
Purine level medium (50 - 150 mg / 100 g)- can be taken occasionally:
Wholegrain bread, spinach, grains, cauliflower, peas, mushroom, asparagus, oatmeal, wheatgerm & bran, chicken, sweet-water fishes.
Purine level minimum (0 - 50 mg / 100 g)- can be taken plentifully:
Tea, coffee, soda, refined cereal, egg, cheese, milk, nuts, cream soup, macaroni/noodles, fruits & fruit-juices, vegetables, butter, vegetable oil.
Food policy in gout
Since carbohydrate meal is very helpful to increase the amount of urate excretion, therefore, 50 - 55% of the total calorie content of the diet of any gout patient should come from carbohydrate foods. The amount of protein intake should be restricted to 1g / kg ideal body weight. The amount of fat intake should also be controlled. Only 30% of the total calorie should come from fat. The amount of cholesterol, anyway, should not exceed 300 mg / day.
Generally, majority of those who suffer from gout or hyper-uricaemia also suffer from the problem of obesity. So to keep the disease under control, it is necessary to keep the body-weight under control. For this, it is required to cut short the daily calorie requirement by 400 - 500 calories.
Beside these, it is to be seen that there are adequate amounts of Vitamin A, Vitamin E, Vitamin D, Calcium, Potassium and Phosphorus in the daily diet chart. It is required to control the uric acid level in the blood and to eradicate the chance of kidney stone. It is necessary to drink at least 3 - 4 litres of water daily. Vegetables, fruit juice, milk and milk-products are very useful in this case.
Foods that can be taken in gout
* refined cereal & cereal products, cornflakes, bread, flour, arrowroot, sago, suji, tapioca, noodles, rice, rice flour, etc. -- 150 - 250 g
* milk, milk products, cheese, paneer
* egg (1no.), linfish/linmeat (30 g, 3 - 5 times/week)
* potato, carrot, garlic, onion, cabbage, pumkin, capsicum, gourd, etc.
* guava, tomato, amla, cucumber, melon, papaya, apple
* giletin, sweets, dessert, pudding
* butter, vegetable oil, olive oil (10 - 30 g/day)
* tea, coffee, cocoa, fruit juice, vegetable juice, pure drinking water.
But if the condition of gout is too severe, then beside avoiding high and medium purine containing foods, egg, butter, cheese and fries should also be avoided.
Do tea & coffee increase the uric acid level?
Many people think that tea and coffee should be completely avoided in gout since both of them contain purine. But, in actuality, the purine present in tea or coffee does no harm in gout. Because, tea or coffee contains methylated purine, which gets converted to methyl uric acid. It does not get deposited in the body, but is excreted out through urine.
A sample diet chart to control gout
Breakfast:
* breakfast cereal/bread + jam/butter
* apple pudding
* tea/coffee
Before noon:
* cucumber + orange juice
Lunch:
* rice/chapatti
* vegetable (potato-pumkin curry or gourd curry)
* small fish/paneer
* white curd
Tiffin:
* mixed fruit salad
Dinner:
* vegetable pulao
* cucumber + tomato salad
* pudding/custard
This is a sample diet chart. But considering the individual health condition, age, body weight, height and ability to work, for the actual diet chart, it is needed to consult a specialist.
Precautions
It is very dangerous to fast completely in order to lose body weight in gout, since due to fasting the fat deposited in the body starts breaking down which creates pressure on the liver. Moreover, the nucleic acid in the cell breaks down and increases the uric acid level in the blood. Due to higher rate of fat metabolism, the chance of severe gout condition increases very much. Apart from these, the lactic acid level in the blood may increase and complicate the condition more. It is also essential to control the blood sugar level always.
(i) quick relief from the inflammatory condition,
(ii) to stop recurring attack, and
(iii) to lower the rate of deposition of uric acid crystals in the joints and to increase the rate of excretion of it through urine.
Dietary management in gout
In this disease, although some relief from the pain can be achieved by temporarily excreting out uric acid from the body by medicine, but total cure is not possible. It is only by restriction of the diet, that is, by proper diet control that relief from gout can be obtained. The primary condition of this diet control is to have only purine-less foods. But one may take foods containing very less amount of purine as well. If the amount of daily intake of purine can be restricted to 100 - 150 mg, then the symptoms of gout and hyper-uricaemia will be considerably less. The following chart shows the level of purine in different types of foods:
Purine level maximum (150 - 825 mg / 100 g )- to be avoided completely:
Liver, kidney, red meat, shellfish, herring, sardine, meat extract, gravy, broth, chopped meat, sweet bread, soyabean, rajma, lentil, alcoholic drinks (specially beer and wine).
Purine level medium (50 - 150 mg / 100 g)- can be taken occasionally:
Wholegrain bread, spinach, grains, cauliflower, peas, mushroom, asparagus, oatmeal, wheatgerm & bran, chicken, sweet-water fishes.
Purine level minimum (0 - 50 mg / 100 g)- can be taken plentifully:
Tea, coffee, soda, refined cereal, egg, cheese, milk, nuts, cream soup, macaroni/noodles, fruits & fruit-juices, vegetables, butter, vegetable oil.
Food policy in gout
Since carbohydrate meal is very helpful to increase the amount of urate excretion, therefore, 50 - 55% of the total calorie content of the diet of any gout patient should come from carbohydrate foods. The amount of protein intake should be restricted to 1g / kg ideal body weight. The amount of fat intake should also be controlled. Only 30% of the total calorie should come from fat. The amount of cholesterol, anyway, should not exceed 300 mg / day.
Generally, majority of those who suffer from gout or hyper-uricaemia also suffer from the problem of obesity. So to keep the disease under control, it is necessary to keep the body-weight under control. For this, it is required to cut short the daily calorie requirement by 400 - 500 calories.
Beside these, it is to be seen that there are adequate amounts of Vitamin A, Vitamin E, Vitamin D, Calcium, Potassium and Phosphorus in the daily diet chart. It is required to control the uric acid level in the blood and to eradicate the chance of kidney stone. It is necessary to drink at least 3 - 4 litres of water daily. Vegetables, fruit juice, milk and milk-products are very useful in this case.
Foods that can be taken in gout
* refined cereal & cereal products, cornflakes, bread, flour, arrowroot, sago, suji, tapioca, noodles, rice, rice flour, etc. -- 150 - 250 g
* milk, milk products, cheese, paneer
* egg (1no.), linfish/linmeat (30 g, 3 - 5 times/week)
* potato, carrot, garlic, onion, cabbage, pumkin, capsicum, gourd, etc.
* guava, tomato, amla, cucumber, melon, papaya, apple
* giletin, sweets, dessert, pudding
* butter, vegetable oil, olive oil (10 - 30 g/day)
* tea, coffee, cocoa, fruit juice, vegetable juice, pure drinking water.
But if the condition of gout is too severe, then beside avoiding high and medium purine containing foods, egg, butter, cheese and fries should also be avoided.
Do tea & coffee increase the uric acid level?
Many people think that tea and coffee should be completely avoided in gout since both of them contain purine. But, in actuality, the purine present in tea or coffee does no harm in gout. Because, tea or coffee contains methylated purine, which gets converted to methyl uric acid. It does not get deposited in the body, but is excreted out through urine.
A sample diet chart to control gout
Breakfast:
* breakfast cereal/bread + jam/butter
* apple pudding
* tea/coffee
Before noon:
* cucumber + orange juice
Lunch:
* rice/chapatti
* vegetable (potato-pumkin curry or gourd curry)
* small fish/paneer
* white curd
Tiffin:
* mixed fruit salad
Dinner:
* vegetable pulao
* cucumber + tomato salad
* pudding/custard
This is a sample diet chart. But considering the individual health condition, age, body weight, height and ability to work, for the actual diet chart, it is needed to consult a specialist.
Precautions
It is very dangerous to fast completely in order to lose body weight in gout, since due to fasting the fat deposited in the body starts breaking down which creates pressure on the liver. Moreover, the nucleic acid in the cell breaks down and increases the uric acid level in the blood. Due to higher rate of fat metabolism, the chance of severe gout condition increases very much. Apart from these, the lactic acid level in the blood may increase and complicate the condition more. It is also essential to control the blood sugar level always.
