Giving gout the boot
Nuts, legumes and even purine-rich vegetables like cauliflower have no influence on gout, so eat hearthealthy doses
By Michael Zapf, DPM Special to the Acorn

David was a 32-year-old teacher who came to our office with a sudden onset of an excruciatingly painful right foot without any history of trauma. He pointed to the big toe joint and thought he had a bunion like his wife's. The good news, I told him, it was not a bunion- the bad news was he had gout. He was one of 2 million Americans with the somewhat inherited disease that is definitely modified by lifestyle.

Gout, which has become quite common, is associated with obesity, diabetes, high blood pressure and a protein rich diet. David was guilty on all counts. When proteins that contain purines are broken down, uric acid is produced. Gout is caused when high blood levels of uric acid form crystals in the cooler joints, like those in the feet. The body fights the crystals and mounts a large immune response resulting in a red, hot and swollen joint. Surprisingly, treating this joint with an ice bag only makes the situation worse by causing more crystals to form.

Uric acid is easy to measure with a blood test. Low uric acid levels of 4 or 5 mg/dl will not cause gout, but David had a level of 8mg/dl. That high level combined with his near miraculous one-day response to treatment with an anti-inflammatory pill, confirmed for me that he had gout. Once the attack was over I sent him back to his primary care doctor to get his uric acid levels to a lower level. There are some medicines, like allpurinol, that do this very effectively with minimal side effects.

When he asked me what he could do to prevent future attacks, besides taking medication, here is the game plan I gave him based on the most recent research by Dr. Choi of Harvard Medical School: Daily exercise and weight control. Keep diabetes and high blood pressure, if present, well controlled. Avoid red meat and lean towards chicken and other white meat. Avoid bread, potatoes and pasta unless they are made of whole wheat. Milk, especially low-fat, reduces the risk and two glasses or more a day are recommended.

Coffee and tea have no effect on gout. Fish increases gout risks slightly but is also cardioprotective, so giving it up is a tough call. Consider purified fish oil which has no goutcausing purine content.

Nuts, legumes and even purine rich vegetables like cauliflower have no influence on gout so eat heart-healthy doses. Dark cherries (1.5 cups worth) can dramatically lower uric acid levels. Beer increases the risk of gout but moderate wine, and probably other alcohol, does not and has cardioprotective benefits. Vitamin C (500 mg) seems to lower the risk.

Low dose aspirin and some diuretics increase the risk and you need to consult with your doctor on the relative risks of these medications

At last report, David spent a painless New Year's Eve. He was able to dance all night and toasted his health at midnight, not with his traditional glass of beer but with his new nonpurine favorite, champagne.

Dr. Michael Zapf is a board certified podiatrist in private practice with the Agoura- Los Robles Podiatry Centers. For information, call (818) 707-3668 or (805) 497-6979 or visit www .conejofeet.com.