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. His diet is quite satisfying, because the butchers today excel at making 鈥渕eat鈥� products such as sausages from chicken and turkey.
He takes 50 mg of allopurinol daily, even though his uric acid level is not elevated. There are extensive lists of the purine content of foods to help people avoid high-purine foods. However, avoiding the foods noted above has given him a life free of gouty pain.
In order to follow this diet, one must be scrupulous in looking for offending foods 鈥� especially mushrooms, and especially when eating out.
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. Since he drank one bottle of beer daily he wondered if that was his problem. We had a hops plant in the backyard (he was planning to make his own beer) that was in flower, so he ate a few flowers, and had an attack the next day.
He replaced his daily beer with wine and went more than 10 years without an attack. Gout sufferers should know that avoiding beer might help.
N.M.
Gout, a disease known to the ancients, 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 in many places; my favourite place to start is the National Institutes of Health site (type 鈥渕edline plus鈥� into your browser, then search the site for 鈥済out鈥�).
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 six ounces daily.
Dr. Roach Writes: Last month, I wrote about a man with pain down the back of his legs when driving for a prolonged period, and a surprisingly large number of readers wrote in to tell me to advise him to make sure he had removed his wallet from his rear pocket.
Certainly, the wallet can act to press the sciatic nerve against the bony structures of the pelvis, causing pain and tingling sensations from the buttock down to the calf or foot.
Apparently, this is far more common than I had realized. One man called it 鈥渨alletitis.鈥� Another suggested a 鈥渨alletectomy.鈥� One reader (one of the few without a wallet) told me that changing the seat position solved the problem.
As always, I appreciate the helpful comments from my readers.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
