We seem to be bombarded with information about our diet nowadays and what gout foods we should be eating and avoiding if we’re suffering with this condition. Numerous articles in magazines and newspapers advise us to eat less fat (especially saturated fat from animals) and to increase the amount of fruit and vegetables in our diet. Most of us should also eat fewer calories and take more exercise to lose weight and increase our physical fitness, and this is especially true if we wish to reduce the strain on arthritic joints.
Gout is the only form of arthritis whose symptoms can definitely be helped through diet. No expensive ingredients or food supplements are required. Simply cutting calories can help most people with primary gout, but most important of all is to limit foods containing high concentrations of purines. Some people report that gouty attacks are triggered by other foods (such as strawberries, citrus fruit or tomatoes) that are not high in purines. If you find that these foods cause you trouble, cut them out too.
How do we know that classic gout is connected with what we eat?
First, there is the clear historical evidence of the well-fed, middle-aged gouty men beloved by cartoonists in the 17th and 18th centuries. An ordinary meal for such people consisted of several meat courses, washed down with copious wine and spirits. On the other hand, although most people drank beer because of fears of contaminated drinking water, gout was not found in poorer people with a restricted diet. Secondly, cases of primary gout were very infrequent during the two world wars in 20th-century Europe, when food was rationed and very little meat was available. As food supplies returned to normal, and indeed as the population began to eat better than ever before, gout (and obesity) became much more common among older men.
During the second half of the 20th century, a wide-ranging analysis of the chemical constituents of foodstuffs highlighted a direct link between a diet rich in purines and their role in triggering a gouty attack in susceptible people.
I’ve read somewhere that Henry VIII had gout. Is this so?
The well-known portraits of an overweight middle-aged Henry VIII certainly suggest that he enjoyed eating and drinking, both of which are risk factors for gout because they can lead to increasingly high levels of uric acid in the blood (hyperuricaemia) over several years. Other risk factors are high blood pressure (hypertension) and Type 2 diabetes (the ‘adult’ form), which we regard as diseases of plenty, as they are prevalent in the West. Most Western people today eat a diet that would have been regarded as rich by Henry’s subjects; they could only dream of eating meat and drinking wine every day but, as long as their meagre diet kept them alive, they were unlikely to suffer from gout. Hence gout has been known as the ‘king of diseases and the disease of kings’.
To answer your question, Henry VIII had a number of problems – among them syphilis, which can cause arthritis – and textbooks say that he had gout, too. Unfortunately, we cannot test him for high urate levels to confirm the diagnosis!
The Prince Regent (who became King George IV) definitely had gout. He was racked with pain until, in 1817, he gratefully began to use extracts of colchicum, an ancient remedy that had recently been accepted again by medical opinion (there’s more gout remedies available here)
I’ve been putting on a bit of weight. Does being over-weight make my gout symptoms worse?
If you are overweight, you should definitely try to cut the total amount of food you eat, to decrease the load placed on your joints, especially on your knees and feet. A high body weight arises from eating more than your body needs to keep going, and the excess is stored as fat.
Several factors are relevant if you are overweight and have primary gout. Overweight and obese people run the risk of developing hypertension and Type 2 diabetes, all of which can put extra stress on the kidneys and reduce the ability of the kidneys to excrete uric acid. Reducing your weight to the ‘healthy’ range also helps to lower the concentration of uric acid in the plasma, thus reducing the risks of crystals being deposited in the joints.
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A prophylactic (preventive) dose of colchicine ranges between 1 and 2 tablets (each of 0.5 mg) a day. This interferes with the response of the polymorph white blood cells to any urate crystals, reducing the potential for an inflammatory response. In acute gout the dose is usually sufficient to induce diarrhea, but the prophylactic dose should not produce any gastrointestinal side-effects such as abdominal discomfort, diarrhea or nausea.
These need to be prescribed and may need to be administered by a medical practitioner. The first couple of attacks of gout probably need to be seen by a medical practitioner, at least to establish the diagnosis. However, once the diagnosis is established, self-medication of previously prescribed medication is both necessary and desirable.
You should understand this and must be so motivated that any therapy, changes in lifestyle and gout remedies, once started, will be continued permanently, whether the hyperuricemia is corrected by correcting the cause or by taking medication. Usually the motivation comes from having experienced the attacks. Lifestyle changes and natural remedies are always preferable to continued use of drug treatments.