Gout Pal Interactive

Not a day goes by without a request for gout food lists.

Today’s was:

Can you give me a complete list of foods that should be taken by a gout patient, as well as the food not to be taken?

How I wish it were so simple.

But it’s my job to make it simple.

So here is a simple explanation of gout and food.

Read the rest of this entry »

Tags: Gout Diet, gout food lists

I’ve just read a fascinating study about a substance called L-carnitine and it’s effect on uric acid.

The study is not concerned with gout, but anything related to uric acid interests me. This particular study looks at how uric acid rises after strenuous exercise. The fact that exertion raises uric acid is the reason why I recommend gentle exercise for gout sufferers - exercise is important to aid mobility and help weight loss, but too much can have a bad effect.

L-Carnitine

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L-carnitine is currently being promoted widely as an anti-aging / anti-dementia supplement. It is produced naturally in the body if sufficient lysine (an amino acid found in protein), vitamins B1, B6 and iron is available. It is available from diet - mainly muscle and organ meat, fish and milk products.

The study about uric acid, exercise, and l-carnitine (L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress) uses a commonly available carnitine supplement LCLT, combining L-carnitine with L-tartrate.

In the study, the subjects took the LCLT supplement for a 6 day rest period prior to starting the exercises. Although the study is mainly concerned with the effects during and after exercise, the volunteers on LCLT displayed lower uric acid levels even during the rest period.

The big question is - will it do any good for gout? If you’ve taken this supplement, please let me know how you got on with it.

Tags: l-carnitine

Another short gout question, just asked, is gout coffee.

There are a couple of important things to know about gout and coffee.

1. Recent research indicates that coffee drinkers have less chance of getting gout. Now that is not quite the same as saying that coffee protects you from gout, as it is a statistical, rather than clinical report.

   Having said that, the figures look quite convincing. It is also relevant that coffee is a source of antioxidants, so maybe that is the reason that coffee is good for gout.
   Read the rest of this entry »

   Tags: coffee, gout-coffee

Now that the latest issue of my free gout newsletter is finished, it’s catching up time once again.

It is time to answer your short question about recipes for gout.

First, a warning. I have seen hundreds of so-called recipes for gout, and books of gout recipes. Most of them simply regurgitate old, out-of-date, advice about foods low in purines. Purines and gout are not that important, and certainly not for vegetables. If you see any of these, and you are not sure about their true value for gout sufferers, please let me know about them, and I will appraise them for you.

You might have noticed that I have started a new Gout Recipes section. Over the next few months, I will be adding new recipes here - all of them with a full nutritional assessment showing the likely effects on gout.

Do you have a particular recipe that you love to eat, but not sure how it will affect your gout? Just send the recipe to me, and I will assess it for you. I will publish the best of these in my gout recipe section.

Those of you who read my newsletter will know about my new club. I will be publishing extra gout recipes for club members. If you are interested in this, but missed the August newsletter launch, it’s not too late. Sign up for the newsletter (see links above) and you will get a message that tells you where the back issues are.

This post answers a short gout question in the gout diet section. If you still have questions about recipes for gout, learn the best place to get answers on my Gout Questions page.

Yesterday, I was asked for information about Potential Renal Acid Load. This is usually abbreviated to PRAL.

Though PRAL is a precise calculation based on certain nutrient values in foods, it is not an exact measure. It is a shortcut measure to assess the affect of foods on the pH of the body. Experiments have shown that it is a reliable approximation of the acidifying or alkalizing effect of foods.

PRAL=0.49 Protein + 0.037 Phosphorous - 0.021 Potassium - 0.026 Magnesium - 0.013 Calcium.

This gives a positive value for acid forming foods and a negative value for alkaline forming foods. To ensure adequate nutrition it is important to chose a combination of foods with positive and negative PRAL values.

Many nutritionists and health-workers believe that a diet that has an overall negative PRAL total is healthiest.

For gout, an alkalizing diet reduces the chances of kidney stones forming, and helps to dissolve them if they form. It is important to also drink plenty of water to flush the dissolved salts from the kidneys.

A second effect of gout is that uric acid is more soluble in alkaline conditions. Though the pH of the blood is tightly regulated by the body, a tiny percentage increase in alkalinity is probably enough to dissolve slightly more uric acid. Again, it is vital to keep hydrated to ensure that the dissolved uric acid can be flushed from the body.

I have calculated PRAL values for all the foods in the USDA National Nutrient Database. I present these as tables for each food group in my Gout Food Section of my gout information website.

This post answers a short gout question in the gout diet section. If you still have questions about Potential Renal Acid Load, see my Questions page on how to get the best answers quickly.

Tags: ph, PRAL, _ph

Friends frequently ask me, “What foods can I eat with gout?”
Please do not think that I have a huge circle of gouty acquaintances.
I see all gout sufferers as friends, especially the ones who comment here, post in the gout forum, or tell me about their gout by email.

When I started developing my gout diet plan, I deliberately shied away from creating a fixed menu, for two reasons:

1. It takes up more time than I have available.
2. I do not agree with telling other people what to eat.
3. I feel it is irresponsible to plan a diet for somebody if you know nothing about them

Despite being unable to count, I try to explain how food might affect your gout. Most published dietary guidelines for gout are based on disjointed scientific facts (occasionally fiction) by people who have never experienced the agony of gout.

For most gout sufferers, weight is a major factor, and for many of these, getting down to normal weight will cure their gout.

Many gout sufferers have a genetic tendency to gout, or other problem with uric acid metabolism. If getting down to normal weight, and maintaining a gout-friendly diet, doesn’t cure their gout, then uric acid lowering medications are the answer. With these, they should be able to eat anything, though I still recommend a well balanced healthy diet to avoid other health problems.

If anyone wants to pay me to prepare a personal diet, then I am happy to work for them. I really don’t expect anyone wants to do this, so I have not begun to think about what charges should be.

I have thought about a private club where I would give individual dietary advice for members to share with other similar members. I guess the cost of this would be around $17 (£10) per month. I have not taken this idea very far because, again, I doubt that enough people would be interested to make it worthwhile.

Now, I would love to be flooded with offers of money, to prove me wrong, but it aint gonna happen. Is it? Go on, you know you want to click that button.

I believe that most people do not adapt well to sudden changes in diet, therefore I recommend that gout sufferers assess their own situation and gradually exchange poor habits for good ones. I have tried to put enough information on the websites to allow all gout sufferers to make healthier choices.

Very soon, I will add some recipes to the GoutPal site that highlight key points about healthy eating for gout. These will go a long way to answer “What foods can I eat for gout?”

If you are still stuck with ideas for how to improve your diet, please post details in the gout forum about yourself, and what you currently eat. I need to know age, weight, height, gender, how much exercise you get each day, and details of your daily diet. The more information the better. I will suggest what foods you should think about changing to help your gout.

In my search for antioxidants for my previous message, I found an interesting approach to healthy gout food. The article about food is not specifically about gout, but a lot of the food listed is high antioxidant. Certainly, none of it should make gout worse, and the presentation gave me a new idea for healthy gout food.

Dr David Heber is well known for his “What Color is Your Diet?” book. I found some fascinating information from him about nutrition and antioxidants. He has grouped food by color, and I think the plan is to try and eat something from each color group every day. Well, if he can do it, why can’t I?

The color groups are Red, Green, Green/Yellow, Red/Purple, Orange, Orange/Yellow, White/Green. Before I continue with these groups, I’d like to share some of Dr Heber’s comments, as they are very relevant to healthy gout food.

The first is very relevant to those gout sufferers, like me, who are trying to lose weight:

Another advantage of a diet rich in fruits and vegetables is that it reduces the number of calories per bite or “energy density.” It is only possible to eat a certain volume of food until you get full (at least for most of us), but there is no increased fullness when sugar or oils are added to a given volume of food.

He also offers practical advice that is very much in-line with my approach to healthy gout food:

Visualize your plate and fill it two-thirds with vegetables from the above categories and one-third with low fat protein foods such as chicken or turkey breast, ocean-caught fish or seafood, or soy protein meat substitutes. Have a dark green leafy salad beforehand and when everyone else is going for the Creme Brulee ask for a dish of mixed fruits for dessert such as kiwi, blueberries and strawberries. This way you won’t feel deprived and you will be eating very healthy foods that are good for you as well as taste good.

The table is developed for cancer, not gout, but it still has some relevance to us. I believe the color coding system is probably as much to do with certain nutrients as it is with color. The Red/Purple and Green/Yellow groups are a particularly strong indication of this, as you can see from this table:

7 Colors of Health: Color Code
1. Red:	Tomato juices, soups, or sauces, tomato, watermelon, pink grapefruit. Lycopene inhibits breast cancer cell growth in the laboratory.
2. Green:	Broccoli, Brussel sprouts, cabbage, bok choy. Isothio-cyanates increase liver proteins that defend against carcinogens.
3. Green/Yellow:	Spinach, collard greens, kale, mustard greens, avocado. Lutein protects vision, the heart, and inhibits cancer cell growth.
4. Red/Purple:	Grapes, strawberries, cranberries, raspberries, blueberries. Proanthocyanidins protect against urine infections. Ellagic acid inhibits cancer cell growth.
5. Orange:	Carrots, butternut squash, cantaloupe, sweet potato. Beta carotene protects vision and immune function, and is an antioxidant.
6. Orange/Yellow:	Oranges, lemons, pineapples, peaches, nectarines. Flavonoids inhibit tumor growth and repair DNA. Limonoids in the skin of lemons and oranges inhibit tumor growth.
7. White/Green:	Garlic, onions, chives, leeks. Allyl sulfides inhibit tumor cell growth.

You might like to try color-coding some of the items from the table in my last post about gout and antioxidants. It is not necessary to be too precise about this - just try to get as much variety as you can each day.

Gout and antioxidants are closely related. Uric acid is an antioxidant that we produce to help protect our bodies from free oxygen (free radicals) that can harm our bodies. Though we need this antioxidant for life, too much of this particular good thing can lead to gout.

Gout research tells us that food high in antioxidants can help reduce uric acid. My logic tells me that it makes sense for our bodies to produce less of our own antioxidant, uric acid, when we can absorb what we need from our food. One pillar of my gout diet plan is that food rich in antioxidants will help lower uric acid.

Up to now, I have simply advised you to increase antioxidant rich foods. Many of you want more than this, and so I will shortly be publishing a series of free gout recipes that will help you plan your own gout diet. In my next newsletter, I will also introduce a more detailed gout diet planning service for those who want to be told what to eat. As gout affects everyone differently, I will also show you how you can see for yourself, which foods raise or lower your own uric acid.

Antioxidant measuring is a new part of nutrition. Better measurement techniques and new research studies are adding to our knowledge daily. I focus on a simple list of foods that have been generally accepted as being high in antioxidants.

TABLE 4 The 50 foods with the highest antioxidant contents per serving size¹

Product Antioxidant content mmol/serving Blackberries 5.746 Walnuts 3.721 Strawberries 3.584 Artichokes, prepared 3.559 Cranberries 3.125 Coffee 2.959 Raspberries 2.870 Pecans 2.741 Blueberries 2.680 Cloves, ground 2.637 Grape juice 2.557 Chocolate, baking, unsweetened 2.516 Cranberry juice 2.474 Cherries, sour 2.205 Wine, red 2.199 Power Bar, chocolate flavor2 1.875 Pineapple juice 1.859 Latino beverages, guava nectar 1.858 Juice drinks, 10% juice, blueberry or strawberry flavor, vitamin C�enriched 1.821 Cranapple juice 1.790 Prunes 1.715 Chocolates, dark, sugar-free 1.675 Cabbage, red cooked 1.614 Orange juice 1.510 Apple juice, with added vitamin C 1.462 Latino beverages, mango nectar 1.281 Pineapple 1.276 Oranges 1.261 Bran Flakes, breakfast cereals3 1.244 Plums, black 1.205 Pinto beans, dried 1.137 Canned chili with meat and beans 1.049 Spinach, frozen 1.045 Canned chili with meat, no beans 1.040 Whole Grain Total, breakfast cereal4 1.024 Chocolate, sugar-free 1.001 Kiwi fruit 0.987 Molasses, dark 0.980 Potatoes, red, cooked 0.956 Cheese lasagna, frozen and cooked 0.942 Potatoes, white, cooked 0.918 Sweet potatoes, baked 0.900 Iced tea, brewed, unsweetened 0.881 Potatoes, russet, cooked 0.862 Baked beans, pork and beans in brown sugar sauce 0.852 Condensed tomato soup, one brand 0.826 Broccoli raab, cooked 0.823 Peppers, red, cooked 0.820 Broccoli, cooked 0.780 Latino beverages, tamarind nectar 0.761

¹ The antioxidant content per serving size was calculated as indicated in Table 6. Mean values are provided for products for which different brands are comparable.

² POWERBAR Co, Berkeley, CA.

³ Ralston Foods, Battle Creek, MI.

⁴ General Mills, Inc, Milwaukee, WI.

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Remember, antioxidant content varies widely with many factors including season, method of cooking, and variety. Do not get bogged down in the numbers, just use the list to try and improve what you are eating now.

There are several methods of measuring antioxidant values, and many different studies. These foods are only a selection, and do not cover all high-antioxidant foods. Another good list is the table of best sources of antioxidants in foods.

If you like a high antioxidant food that is not listed here, but you think it might help your gout, then add a comment, or, even better, discuss it in the gout forum.

Tags: gout and antioxidants, _gout diet, _uric acid

I wrote my personal opinion on gout and alcohol a few months ago. I’ve enjoyed reasonable, and occasionally excessive, amounts of wine and beer since, and my opinion is unchanged. However, I must point out that this is my personal experience, and will not apply to all gout sufferers.

I think I need to do an in-depth article on alcohol and gout. I’ll put it on the list of things to do. Or maybe on the list of things to put on the list

It is actually very confusing, but I fall back on my old maxim - each to their own gout.

Gout is a very complicated disease, caused by different factors. If you combine this with the fact that no individual food item (including drinks) is as important as total diet, then it’s easy to see why there are no simple answers.

As an overweight gout sufferer, I believe that my weight is the cause of my gout. Yes, alcohol contributes to weight gain, but I do not believe it directly makes my gout worse. In fact, as long as I remember to keep hydrated, I feel better after a drink. I am not condoning excessive alcohol consumption - my own or anyone else’s - but here is the place for gout opinions, and that is mine.

For a gout patient whose primary cause of gout is due to kidney problems then the picture is probably very different. It is vital that all gout sufferers have kidney function tests.

Beyond that, there are other things to consider. Do the health properties of red wine outweigh the effects of alcohol? At what point does alcohol stop being beneficial? Is there any point comparing different types of alcohol?

I think it’s too easy to get obsessed with these questions and forget that the best thing for gout is a healthy balanced diet and a healthy, happy lifestyle. Drinking too much or stressing over pleasures deemed to be forbidden will not contribute to those goals.

I will continue to report news on gout and alcohol as I get it. In the meantime, if you have some alcohol related questions or opinions, why not talk about them on your gout forum?

Tags: gout-and-alcohol

Whenever I’ve tried diets for gout before, I’ve always felt cravings, and ultimately disappointment. With my latest regime, I feel much happier, and more confident that I will continue.

OK, I know that I’ve only just started, but these first few weeks have been very positive. By making tiny changes, that I hardly notice, I’ve lost 7 pounds in five weeks - two pounds more than I planned.

I can look back and see the cumulative effects of these changes. For weight loss, I’m exercising more. Still not massive amounts, but 30 minutes per day walking is about twice what I used to do. I can tell I’m walking faster, and I will continue to increase distance and speed gradually for a few more weeks. I don’t have a target in mind - that isn’t what motivates me - but if you think a target will help you then think of something that is easily achievable. There is nothing to stop you from beating your own easy target, and you are more likely to succeed that if you get discouraged by failing to meet an unrealistic target.

The easiest changes to make have been introducing snacks. No other diets for gout that I have seen have looked at this aspect, but I think it is very important. Starvation and binge eating can both raise uric acid levels, and so this aspect of the GoutPal diet really helps. As long as you balance the snacks with smaller meals, they can also help with weight loss, as your body burns these mid-meal calories better. Snacks are also a good opportunity to add positive nutrients and natural compounds that can help gout. I’ve already mentioned figs, and later in the month I’ll start some lists of other gout friendly foods.

As for meals, I know I’m still eating too much. But that encourages me - I know I’ve still got plenty of opportunities to continue to slowly improve. And continue to slowly lose weight.