Ask Dr. K: Manage gout by preventing attacks

DEAR DOCTOR K: What caused my gout? Will avoiding certain foods prevent flare-ups?

DEAR READER: Gout is a painful joint condition. I know, because I’ve suffered from it. I spoke to my Harvard Medical School colleague, rheumatologist Dr. Robert Shmerling, to get the latest information.

Gout attacks come on suddenly, with sharp pain, often in a single joint.

Gout flares when the levels of uric acid, a chemical produced in the body, rise in the blood. Some of the uric acid leaves the blood and enters the joints. There, it forms crystals. The crystals trigger inflammation and severe pain, sometimes with fever and muscle aches. The crystals also can build up in the kidneys and cause kidney stones.

Everyone produces uric acid; some people just make too much. In other people, the kidneys don’t eliminate enough uric acid in the urine. Certain foods that are rich in a chemical that the body turns into uric acid can set off gout attacks in people who are already prone to them.

Gout attacks respond well to nonsteroidal anti-inflammatory drugs (NSAIDs). (The exception is aspirin, which can raise uric acid levels.) A drug called colchicine is a mainstay of gout treatment. A brief course of oral corticosteroids can also do the job.

Avoiding certain foods can help prevent gout attacks. But keep expectations realistic: Only about 10 percent of the body’s uric acid comes from food.

Avoid or limit:

• All meats, especially liver and sweetbreads

• Meat extracts and gravies

• Seafood, especially sardines and anchovies

• Yeast and yeast extracts

• Beans, peas and lentils

• Spinach and asparagus

• Cauliflower

• Mushrooms

• Beer or hard liquor

• Sugary (fructose-containing) soft drinks

Eating and drinking low-fat dairy products and eating cherries have been linked in some studies with lower attack rates of gout.

Finally, losing weight can lower uric acid levels and attacks of gout. And always drink enough water to avoid dehydration.