Gout is an arthritis which occurs due to deposition of increased uric acid into joints. If not treated well, uric acid can deposit and cause damage to other organs too.
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One of the biggest problem in gout treatment is misconceptions about gout.
The biggest misconception for Indian population is to avoid dals, especially chana dal (split and skinned bengal gram). The Indian rheumatologists often meet patients in clinics, who have stopped taking all dals (lentils and pulses), nuts, dairy products, vegetables like spinach, tomato, cauliflower, refined flour (maida), spicy food etc. These patients survive just on daliya (wheat porridge) or boiled vegetables. They lose weight, but despite so much sacrifice on eating, they continue to have gout attacks and damage to other organs.
Let’s check why this is wrong and might be harmful for patients. Also as seen in this picture, most gout patients can have a tasty and healthy diet with some non-difficult measures.
1.The purines in chana dals (or other legumes) and vegetables don’t get easily converted to uric acid
Uric acid is formed by breaking down of purines. Purines are building blocks of our DNA or genes. Purines carry many important functions in body. Waste or excess purines are converted to uric acid in humans.
Dals and vegetables like spinach & cauliflower have higher purine content. It was thought that they can increase uric acid. Now, it is proven that purines from plant sources are not good at increasing uric acid. It is the purines from animal sources like red meat and sea food which has 50% more chance of increasing uric acid.
2. Uric acid is usually increased more by unhealthy food than plant food sources like chana dal, vegetables etc
It is well-known that red meat and alcohol can lead to excess uric acid and cause attacks. But, junk food, like burgers, pizzas, sugary colas (like pepsi, coke, mirinda) etc, sugary juices & foods, fried /oily foods, refined flour (maida) etc, are a much bigger reason for increased uric acid in gout patients. They also make one fat, unhealthy and puts them at increased risk of heart disease.
To understand how uric acid relates to gout, click here.
3. Pulses like chana dal have got fibre, vitamins and protein – which is good for gout patients
Gout patients are more likely to be fat, have diabetes and have heart disease. The fibre, protein and vitamins in vegetables, dals and low-fat dairy are healthy for the body. They can help manage these health issues in gout patients.
A large study published in a reputed medical journal (NEJM), studied dietary habits of more than forty thousand people (Click here to look at study). They clearly showed that vegetable food sources and dairy products do not increase risk of gout or gout attacks. Based on good research, the American and European Rheumatology guidelines recommend low-fat dairy products and plant food sources for gout patients (Click here to look at guideline, see page 1439).
4. Pulses (dals) are major source of protein in Indian diet – stopping it in gout patients can be harmful
Indian diet is predominantly vegetarian. An average non-vegetarian person in India mostly eats vegetarian food. They do not tend to consume more than 30-70 grams of dals per day. This quantity is too low for causing any significant increase in uric acid.
Dals or legumes become more important source of protein in gout patients, as they have to decrease non-veg food in their diet.
5. Why most Indian doctors and Ayurveda asks to avoid spicy foods, dals, many veggies and dairy in gout ?
They probably still follow old concepts. The Ayurveda concept that cold foods, dals and dairy products cause arthritis, hasn’t been proven correct in any good research studies.
6. Why did I have relief in gout attack when I stopped dals previously ?
The first few gout attacks are very painful, but they last for very short period. So, even if you stop something or don’t stop something, the attack will go away. It won’t come back for many months.
But the uric acid keeps depositing in your body due to genetic tendency. Later, even if you stop taking all purine foods you will get attacks without treatment.
Click here to understand how uric acid deposits and causes gout.
7. What to eat in gout then?
First confirm if you have gout. Take help of a rheumatologist who are experts in gout. Most doctors in India incorrectly give medicines for uric acid. You don’t need to take medicines just for increased uric acid. Uric acid itself does not cause harm without genetic tendency and actually having gout.
Limit red meat and alcohol in diet. Avoid junk food and refined flour foods (maida). Avoid sugar in form of colas, sweets or juices. Eat more vegetables, nuts, whole fruits, legumes (pulses/dals, beans etc), whole grain cereals / flour (wheat, oat, bajra etc ). Limit white rice or try brown rice. Drink lot of water as it washes uric acid. Low fat milk and yoghurt is also very good for gout patients.
Do some form of exercise, simplest form is walking.
Take your gout medicines properly.
‘Reach for six’ in gout : You have to keep uric acid below 6 mg/dl to stop gout attacks. Uric acid deposits into organs above 6. Note that normal person can have uric acid 7 – 7.5. Only gout patients need to keep it below 6. To meet this target, most gout patients need a lifelong medicine like Zyloric (Allopurinol) along with healthy diet . With proper medication, a gout patient can have limited quantity of meat and alcohol too.
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Author: Dr Nilesh Nolkha, Rheumatologist
Dr Nilesh Nolkha is a young and dynamic rheumatologist who keeps patients interests at forefront of everything he does.