GOUT & ITS DIETETIC MANAGEMENT:-
Gout is considered a hereditary disease resulting from defective uric acid metabolism. Serum uric acid levels are raised and urates (sodium salt of uric acid) are deposited in the cartilage and articular cartilage of the joints. There are recurrent attacks of pain and swelling of the joints. Gout due to abnormality of uric acid metabolism is called primary gout. Gout resulting from excess uric acid production due to excessive breakdown of cell nuclei occurring in other diseases such as leukemia, pernicious anemia, hemolytic anemias and polycythemia is called secondary gout.
Uric acid metabolism in normal subjects:-
The body derives uric acid from two sources:
v Endogenous source and
v Exogenous source
Endogenous uric acid: – Purines derived from the breakdown of nucleoproteins or by synthesis are converted into uric acid. On a purine-free diet about 300-600 mg. uric acid derived from the endogenous source is excreted in the urine of a normal adult.
Exogenous uric acid: – The exogenous source of uric acid is the die with high purine and nucleic acid contents such as meat, fish and all other animal tissues. About 200-800 mg of uric acid may be derived from this source depending in urine of normal adults is about 1 g per day. The level of serum uric acid in normal subjects is about 3-6 mg/100 ml.
Uric acid metabolism in gout:-
The level of serum uric acid is generally high in patients suffering from gout (6-10 mg/100 ml). The possible mechanisms for the high serum levels of uric acid in gout are:
v Increased production
v Diminished excretion.
Increased production: – There is evidence that in gout there is increased synthesis of purines in the body, leading to increased production of uric acid.
Diminished excretion: – There is evidence that uric acid excretion by the kidney is diminished in gout. This abnormality in the kidneys appears to be hereditary.
Diets for subjects suffering from gout:-
The role of different constituents in the diet on uric acid metabolism is briefly discussed below:
Calories: – Obese persons are more prone to develop gout. The body weight should be maintained at normal level, as the joints in the legs are inflamed and cannot bear more weight. Further, a heavy meal supplying more calories tends to precipitate an attack. The calorie intake should be restricted to that required for sedentary persons.
Proteins and purines: – the protein intake should be between 50-60 g for an adult. The proteins should be derived from should be avoided as they are rich in purines and nucleic acids. Consumption of excess of proteins, may lead to excessive synthesis of purines in the body.
Fats: – Fat consumption should be restricted as high fat intake tends to decrease uric acid excretion in urine.
Carbohydrates: – During an attack of gout, the main source of calories should be from carbohydrates.
Fluids: – Liberal intakes of fluids should be advised as it helps to increase the volume of urine excreted.
Beverages: – Tea, Coffee and Cocoa contain methyl purines. They are not converted into uric acid in the body. Hence, 2 to 3 cups of tea of coffee or cocoa per day may be consumed.
Alcohol: – In some individuals, ingestion of alcohol precipitates an attack of gout.
Dietary Management during Acute Attack:-
The dietary management during the treatment is briefly described below: During the first two or three days of an acute attack of gout, the patient has very little appetite. The patient should be kept on a fluid diet consisting of porridge, milk, curds, fruit juices and soups. Bread, cooked cereals and boiled egg (one) may be consumed according to the preference of the patient. The patient should drink as much fluid as possible in order to facilitate the excretion of uric acid. Consumption of alkaline mixtures containing sodium bicarbonate or sodium citrate will help in the excretion of alkaline urine in which uric acid is more readily soluble and hence is less likely to from calculi.