What is Gout?

Gout, which causes painful red swollen joints, occurs more commonly in middle-aged men of portly physique, but can afflict women and younger people, too. The cause of the disorder centers around a waste product of protein breakdown, called uric acid. Your body rids itself of this waste product through your kidneys; however, sometimes the kidneys fail to do the job and uric acid builds up. Uric acid resides not just in your blood, but in the fluid of your joints, where it can cause trouble in gout. If the levels of uric acid in your body increase, the levels in your joint fluids also increase, and when they become too rich in uric acid, crystals of this waste product begin to form in the fluid. The formation of these crystals incites an inflammation in the joint, which becomes red, swollen, and quite painful. The pain can be so extreme that you cannot bear the weight of a bed sheet on the gouty joint. When such symptoms occur, you suffer a "gouty" attack.

GoutThe joint where the great toe attaches to the foot is the joint most commonly afflicted with gout, but the bones of the middle of the foot, the ankle, the knee, and the elbow also are affected with fair regularity, and any joint can be affected. When the crystals of uric acid form in the soft tissues around the joint, they create a gouty tophus, a lump or bump filled with white, chalky matter. These tophi may also become red, warm, and inflamed in a gouty attack.

What does nutrition have to offer the person who suffers from gout? Let's take a look at what might help in Gout diet.

What makes Gout worse?

•  Eating a diet high in sucrose or table sugar increases the risk of gouty attacks because it raises your insulin level, which alters the way your body handles the uric acid. Don't be fooled into thinking of sugar in terms of "sugary" desserts and the stuff you sprinkle on your food. Besides the obvious frosted cereals, glazed doughnuts, soft drinks, cookies, cakes, pies, ice cream, and candy, sugar is added in abundance to processed foods to the point that American sugar consumption has skyrocketed in this century. From an intake of about 2 pounds of sugar by each man, woman, and child per year in 1890, by the 1980s, we Americans each consumed on average greater than 120 pounds per year. No, that's not a misprint; it really is 120 pounds of sugar for each of us per year. Recommendation: Eliminate or sharply reduce your intake of sugar and foods made with sugar, corn syrup, molasses, and high-fructose corn syrup.

• Don't be tempted to think that because fructose is the sugar in fruit, it is automatically healthful. Particularly in gout, that may not be the case, because fructose increases the production of uric acid, which increases the risk of gouty attack. Recommendation: Avoid sweetening with fructose in place of sugar. Don't use fructosesweetened candies, cookies, or soft drinks in a misguided effort to reduce sugar. In this case, you may be making matters worse. Eating a serving or two of raw, whole fruit daily is probably within the limit you can tolerate on fructose without increasing your risk for gout, but don't drink glass upon glass of fruit juices. And sweetening with artificial sweeteners (aspartame and saccharine) does not increase gouty risk.

• Alcohol has a position of long standing among the dietary promoters of gout, and with good cause. The metabolism of alcohol produces chemicals that compete with uric acid for removal from the body by the kidneys, allowing uric acid to build up to high levels. Beer, especially, triggers attacks of gout, because it contains more purines (see below) than either wine or distilled spirits. Recommendation: If you are at risk for gout, eliminate or sharply reduce your intake of all forms of alcohol. If you do imbibe, drink no more than a single ounce of distilled spirits, a single glass of wine, or a single "lite" beer per day.

• GoutFoods such as red meat, organ meat, seafood, lentils, beans, asparagus, anchovies, mushrooms, sardines, and peas increase your risk of gouty attacks because they contain high amounts of purines, a chemical that your body uses to make uric acid. Recommendation: If you suffer from gout or are at risk (male, overweight especially in the abdomen, take diuretic blood pressure medications, or borderline diabetic), reduce your intake of these higher-purine foods. Dine on lean fish, skinless poultry, egg white, and low-fat diary products as sources of protein.

• Supplementing vitamin A can bring on gouty attacks in people known to have gout, and possibly in people at risk for gout. Recommendation: Do not take vitamin A supplements in these instances.

•  Glycine is an amino acid that can be converted into uric acid more rapidly in people who suffer from gout.

• Adding high doses of niacin, such as you might take in attempts to reduce cholesterol, can provoke a gouty attack because the breakdown products of niacin compete against uric acid for removal from the body by the kidneys. This competition can lead to a rapid buildup of uric acid, which can cause the attack. Recommendation: If you suffer from gout or are at increased risk for gout, do not take doses of niacin above 50 to 100 mg per day.

• Being overweight can be especially harmful for people with gout. Losing weight lowers serum uric acid levels. Avoid crash diets, however. Abrupt elimination of foods or fasting for longer than 3 days can actually increase uric acid levels.

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