Toast the path for beating gout

It occurs as a result of abnormally high levels of uric acid accumulating in the blood, and the formation of uric acid crystals that are deposited in the joints, triggering an inflammatory response and an acute and painful attack.

Most people with gout experience flare-ups interspersed with periods of remission, and not everyone with elevated uric acid levels develops gout.

Certain medical conditions and dietary factors have been associated with an increased risk of developing gout. These include high blood pressure, insulin resistance syndrome, genetics, gender, obesity, age, and some medication, such as diuretics. Dietary factors include meat, seafood and beer.

Although the management of gout usually involves the use of medication to help to decrease the levels of uric acid in the blood, the role of diet and lifestyle should not be overlooked.

Uric acid is formed in the body as a by-product of the metabolism of substances known as purines. Most purines are synthesised in the body, but some are also linked to diet.

Dietary recommendations for gout have shifted in recent years. Although conventional recommendations have focused on restricting purine intake, more recent studies suggest that rigid restrictions on purine intake should no longer be the mainstay of dietary intervention.

However, patients do need to be aware of the dietary factors that may influence uric acid levels, and take the necessary precautions.

This is especially important since there seems to be considerable individual variability in foods that have been found to be problematic.

Conventional guidelines typically advise individuals with gout to avoid food with a high purine content.

Some guidelines suggest that individuals with gout intersperse or alternate days where they eat food containing purines with purine-free days.

Food with a high purine content includes:

• Anchovies
  
• Bouillon, broth and consommé
  
• Brains, heart, kidney and sweetbreads
  
• Goose and partridge
  
• Gravy
  
• Herring, sardines, mackerel
  
• Meat extracts
  
• Mincemeat
  
• Mussels and scallops
  
• Roe
  
• Yeast supplements (baker's yeast and brewer's yeast)

Cutting out certain foods implicated in increasing the risk of developing gout may not always be advisable, as they may play a beneficial role in other aspects of health. You need to consider overall health implications of dietary restrictions that are advised.

It is important to consider, for example, that dietary guidelines for health promotion and disease prevention recommend including "fatty" omega-3-rich fish, such as sardines and mackerel, in the diet. If you do have gout, but don't find these foods particularly problematic, it is not advisable to avoid them.

Diets higher in red meat and seafood have been associated with increased blood uric acid levels and gout. More recently, so too have diets with high intakes of fructose - found in some sweetened soft drinks and in juices, as well as fructose crystals used as a sugar substitute by some people.

However, although fruit is a source of fructose, you don't have to avoid it, if you are prone to gout. Fruit is beneficial for health promotion and disease prevention, and the recommended intake of five servings of fruit and vegetables - amounting to a minimum of 400g - daily should still be encouraged.

A high alcohol consumption, and specifically beer, has been found to increase the risk of gout. Guidelines recommend that alcohol be avoided or limited to a moderate consumption - a maximum of one drink a day for women and two drinks a day for men, or less according to individual tolerance.

Keeping a food and symptom diary can be helpful in trying to identify any trends or links between the intake of certain foods and flare-ups of gout.

Research shows that certain dietary factors may have a protective effect against gout. These include low-fat dairy products, eggs, coffee and vegetable protein.

This does not mean that you should be excessive in consuming these foods. However, it is helpful to know that including these foods in moderation in the diet may aid in reducing the risk of gout, and that you don't have to avoid them.

You also need to ensure an adequate fluid intake; increasing your fluid intake can improve the elimination of uric acid from the body, which will reduce the symptoms of gout.

The American Dietetic Association recommends the following tips to during an acute attack of gout:

• Drink eight to 16 cups of fluid daily, with at least half of this being water, to assist the elimination of uric acid from the body.
  
• Include a moderate amount of protein from sources such as lowfat or fat-free dairy products, eggs, tofu and nut butters.
  
• Restrict your intake of animal foods. Limit meat, fish and poultry to between 100g and 170g a day.
  
• Avoid alcohol (discuss this with your doctor).

What to do when you are in remission, and to avoid another attack of gout: