Dietary precautions in Gout

There are a lot of misconceptions about dietary restrictions for people suffering with gout. Most dietary advice given are so stringent and impractical that the patient finds it almost impossible to follow these for any length of time. “No Non-Veg”, “No eggs”, “No dals”, “No pulses”! It leaves you with only cereals and few vegetables like potatoes! Many patients just disobey all restrictions, saying that they would rather consider becoming ascetics and retire to the Himalayas to meditate for the rest of their lives. After all, we are human, and have preferences and tastes in food, and need some leeway at the very least so as to be able to stick to any particular diet. Yes, of course, there are some foods (and drinks) which are strictly off bounds such as alcohol, and red meats. Given below is a dietary chart which allows some liberties, and also lays down some non-negotiable instructions which we hope and feel will be a little friendlier for the patient.

Non Negotiable Restrictions

 

    1. Strictly Avoid Alcohol: Most people think that beer is OK because it has less alcohol content and thus a mild alcoholic beverage and by extension poses a lesser risk. Nothing could be further from the truth. In fact, beer is at the very least, as dangerous as all the other forms of alcohol. Additionally, beer makes you pass more urine, thus dehydrating you and inviting another attack of Gout.

 

    1. Drink plenty of Fluids: At least three litres per day. Keeping yourself well-hydrated is the key to avoiding attacks of gouty arthritis. Thus 3 litres of fluid intake is the minimum amount necessary. This means not just water but all kinds of liquids. This is good because the milk, juice, buttermilk  is hardly ever accounted for. On the other hand tea is also a liquid but it is a diuretic and hence will make you urinate more, causing fluid loss rather than gain. Hot, humid weather also increases fluid loss through sweating. So all in all there is a complex interplay of the quantity of fluids versus the amount lost. Obviously we are not going to sit and measure the exact amount of water consumed every day. A rough parameter that could be used is that we need to get up at least twice at night to pass urine. Again there is a caveat here. What about those middle-aged and elderly male patients who have developed prostate gland enlargement and hence anyway land up waking at night more than twice to answer nature’s call? Such patients would be completely exhausted from waking up so frequently at night. These patients would need to finish their required quota of 3 litres of fluid intake by evening time itself, to avoid repeated waking up through the night.

 

    1. The following foods have a high purine content and are thus to be avoided completely :
      • Meat extracts/ Soups and Gravies, liver, kidney, brain, shell fish (lobsters/prawns etc), fish roe, salmon, sardines.
      • Any aerated waters (soft drinks), sweets / sugar containing foods. Some studies maintain that a bottle of soft drink (colas) is as harmful as a bottle of beer and must be avoided completely

 

Negotiable Restrictions

The following foods have moderate purine content and can be consumed occasionally. (For non-vegetarians, say any one dish, once a week):

  • Chicken, pomfret, eggs – Now that doesn’t sound so bad, does it?! For vegetarians, green peas, cauliflowers, spinach and brinjals: For example if you eat green peas then don’t eat any of the other three this week. Next week you could probably have Brinjals once and avoid the other three and so on.
  • Custard apple, Chickoo, Banana: All very sweet and all dangerous!
  • Oat meal

All other foods not mentioned above can be taken without restriction. Which means all your dals and all other vegetables and fruits can be eaten without any inhibition. Of course having said this what works best is the support of the family in supporting and motivating the patient to stick to the diet. This may mean a few sacrifices but they are little sacrifices, if at all. If you don’t stand up for your own kin then who will? Do you think anyone can obey their dietary resolution when family and friends are seated at the same table and enjoying person can stick to his resolution when his own loved ones are sitting right there at the same table and enjoying the very cuisine forbidden to them? Healing is always a team effort: The patient, their rheumatologist and their family, together striving towards “Kennisha” … a beautiful life….