Doc: Diet, alcohol and gout

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Dear Dr. Roach: After two major bouts of gout, my husband was treated with Medrol and colchicine, and has resorted to a low-purine diet in order to decrease the frequency of gout attacks, with their attendant pain and potential renal damage. He completely avoids beef, pork, lamb, mushrooms and rich seafood such as scallops. Chicken and turkey are OK. On this dietary regimen he has not experienced gouty episodes.

S.J.F.

Dear Dr. Roach: My husband once suffered from frequent bouts of severe gout. One day he read that beer could cause gout. He replaced his daily beer with wine and went over 10 years without an attack.

N.M.

Dear N.M.: Gout is caused by deposition of uric acid stones into soft tissues, especially joints. Humans cannot metabolize uric acid, and gout happens in people who either make too much uric acid or cannot excrete it (through the kidneys) adequately. Although some people do need medication despite doing all they can to reduce risk, these two letters show how important diet changes and avoiding alcohol can be. More-complete lists of high-purine foods can be found many places; my favorite place to start is the National Institutes of Health site (type “medline plus”’ into your browser, then search the site for “gout”).

Many authorities recommend avoiding alcohol entirely, but I agree with N.M. that wine tends to cause gout less often than beer does. Coffee and vitamin C (500 mg daily) reduce gout attacks in many people. I would note that even poultry can raise uric acid levels and should be kept to reasonable serving sizes, such as 6 ounces daily.

Email questions to ToYourGoodHealth@med.cornell.edu.