“The Gout,” by James Gillray, published May 1799. In a 2005 article in London’s “The Independent” newspaper, art critic Tom Lubbock calls this “perhaps the first close-up” and says “this framing reflects how, for the sufferer, the gouty foot looms large and separate, the centre of attention.” Gout was a much talked-about ailment in the 18th century—to people then “what melancholy was to the high Renaissance, or stomach ulcers were to the 1950s,” says an article in the April 14, 2012, issue of “The Lancet.” Alcohol-based “bitters” was one purported remedy.

by James Hubbard, MD, MPH

Several readers have asked me what to do for gout. Do natural remedies help? What’s a “gout foods to avoid list?”

No one needs a gout flair-up during a disaster. For those who don’t know, a gout attack usually consists of an extremely painful, red, swollen single joint. The most common is at the base of a big toe, but it can happen to any joint. If someone comes in and tells me they can’t even let a bedsheet touch the joint area because of the pain, I’m pretty sure it’s gout.

For an acute attack like the above, the best treatment is an anti-inflammatory drug (NSAID) such as ibuprofen (200 mg to 800 mg) or naproxen (500 mg). Of course ask your doctor about this, especially if you’re taking other medications or have stomach, kidney, or liver problems. There are some prescription medicines that may be a little better, but the NSAIDs usually do the job within 24 hours. Ice packs for about five minutes at a time on the joint can help. You can read more of the American College of Rheumatology guidelines here (PDF download).

The long-term goal, though, is to prevent these flair-ups in the first place. They‘re caused by your body’s build-up of the chemical uric acid (a byproduct of the breakdown of the protein purine). Everyone accumulates uric acid—no problem—but some of you are born with a tendency to make too much or an inability to excrete it efficiently in your kidneys. The extra uric acid builds up as urate crystals in your joints and leads to the flair-ups. But even when you’re pain-free, the uric acid can be entering your joints and can lead to arthritis. The crystals can also form into kidney stones.

Bottom line is your going to need to lower that uric acid down to normal levels by taking prescription medications. But diet and other measures, such as losing excess weight, exercising, and drinking eight eight-ounce glasses of water per day can help.

And guess what. The American College of Rheumatology just came out with a gout foods to avoid list. They list food to avoid completely, foods to limit, and foods to eat more of. Here it is, with a few comments of my own in parenthesis.

Gout Foods to Avoid
  • Organ meats (liver, kidney, sweetbreads).
  • High-fructose-sweetened foods or sodas.
  • Alcohol: No more than 2 ounces of liquor, 8 ounces of wine, or 16 ounces of beer per day in males. No more than half of that in women. (More increases the risk of breast cancer, or women would have the same limit as men.) No alcohol at all during acute attacks, if acute attacks are frequent, or if gout is poorly controlled (always the situation if you’re out of your prescription medicine).
Gout Foods to Limit
  • Beef, lamb, pork.
  • Seafood high in purines, such as sardines, shellfish, etc.
  • Any sweets, including naturally sweetened fruit juices.
  • Salt.
  • Alcohol, especially beer (see “Gout Foods to Avoid” above).
Gout Foods to Encourage (Eat More)
  • Low-fat products.
  • Nondairy products.
  • Vegetables.
Special Gout Food: Cherries

Cherries have long been touted as preventive treatment for gout by lowering uric acid. A recent study in the prestigious medical journal Arthritis and Rheumatism lends new credence to this theory. Although the entire study isn’t available free online, the Medscape website (a site for medical professionals from WebMD) interviewed the author (membership required at the link).

The researchers studied 633 people with known gout for a year. The ones taking prescription medicine had 53 percent fewer attacks than those who took nothing. The ones who ate 10–12 cherries, or the equivalent extract, a day had 32 percent fewer attacks (less of a reduction than with the prescription medicine but still significant). Those who ate the cherries and took the prescription medicine had 75 percent fewer attacks.

Bottom line, do all of the above, and your risk of gout attacks and gout damage go down dramatically. But until you can get your prescription medicine, you can decrease your risk of acute gout attacks by avoid certain foods and eating more of others.

Do you or does someone you know have gout? What’s been your experience?

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