Dietary precautions in Gout
There are a lot of misconceptions about dietary restrictions in gout. Most dietary advice given is 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, leaves behind only cereals and few veggies such as potatoes etc. Such patients just give up 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 humans and so we need to have some leeway at least so as to be able to stick to any particular diet. Yes, surely there are some substances which are strictly off bounds such as alcohol, red meat etc for instance. 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
- 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 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.
- Drink plenty of Fluids: At least three liters per day. Keeping yourself well hydrated is the key to avoiding attacks of gouty arthritis. Thus 3 liters of fluid intake is a minimum amount necessary. This means not just water but all kinds of liquids. This is good because the amount of Milk, juice, buttermilk etc is hardly ever accounted for. On the other hand tea is also a liquid but it is a diuretic and hence would make you pass more urine causing fluid loss rather than gain. Again a hot humid weather would cause more 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 natures call? Such patients would be completely exhausted from the inadequate rest that they would get out of waking up so frequently at night. These patients would need to finish their required quota of 3 liters of fluid intake by evening time itself so that they do not have to wake up that often at night.
- 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 say that a bottle of soft drink is as harmful as a bottle of beer and hence to be avoided completely
Negotiable Restrictions
The following foods have moderate purine content and can be consumed occasionally. (Say any one dish, once a week):
- Chicken, Pomfret, Eggs – Now that doesn’t sound so bad, does it?! 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 then if you don’t stand up for your own kin then who will? Do you think any person can stick to his resolution when his own loved ones are sitting right there on the same table and enjoying a steak in front of him? It is a team effort: The patient, his rheumatologist and his family together striving towards “Kennisha” a beautiful life….
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