I have had gout for 40 years, with flare-ups that affect my toes, ankle and wrist. Then, last year, I changed my diet, giving up the porridge on other days and since then I no longer have gout. Could the porridge have been the culprit?
Elwyn Moseley, by e-mail.
This is a fascinating question that I have spent some time studying books about diets that I have tried to answer.
For the benefit of other readers, I want to begin by addressing the nature of gout. It is an intensely painful form of arthritis that causes inflammation in one or more joints, making the pain so severe that it is eliminated.
Gout is famously associated with eating and drinking – many associate it with excessive admission – and changing a diet low in purine, where uric acid levels are 15 percent lower, can reduce the frequency of attacks. Purine-rich foods include asparagus, cauliflower, spinach, mushrooms, beans, and peas. I can't find oats anywhere (stock image)
The inflammation begins with the formation of needle-like crystals of uric acid in the joints, bones or soft tissues. These crystals are formed by elevated levels of uric acid – a by-product of the degradation of purines and pyrimidines (substances that are often found in animal and vegetable foods).
"DIY" DNA TESTS ARE BAD NEWS
Who wants bad news? Not me. That's why I'm struggling to understand the growing popularity of "DIY" DNA tests that claim to show if you're genetically susceptible to certain diseases. Flora Gill, daughter of former Interior Minister Amber Rudd, burst into tears after such a test said she had a 60 percent chance of developing dementia in old age.
It's hard to put such findings out of your head – like the many others who try similar tests, but who get equally bleak predictions, will certainly discover it.
High levels of uric acid can be caused by many factors, including kidney problems affecting excretion, and excessive production of over-consumption of foods rich in purines such as red meat and seafood.
Genetic factors also play a role, as do obesity, alcohol and beverages that contain large amounts of sugar.
As you know, the goal of acute gout attack treatment is to suppress inflammation by taking a non-steroidal anti-inflammatory (NSAID) and, for most people, indomethacin, naproxen, diclofenac or azapropazon (brand name Rheumox) effective.
In your longer letter you say that they have worked for you until your attacks grew in intensity and frequency in later years.
For people with recurrent attacks, another option for long-term treatment is a daily dose of allopurinol.
This lowers uric acid levels by inhibiting production, although it takes several months of regular treatment to become effective, and there is a significant chance that it may cause further seizures when it is first started – at the same time an anti-inflammatory agent must be given for the first few weeks to guard against this.
So now about the issue of diet. Gout is famously associated with eating and drinking – many associate it with excessive admission – and changing a diet low in purine, where uric acid levels are 15 percent lower, can reduce the frequency of attacks.
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Answers must be taken in a general context and always consult your own doctor if you are concerned.
Levels can be lowered even more in overweight patients who manage to lose weight.
Purine-rich foods include yeast-rich foods such as beer, fish roe, liver, heart, kidney, and sweet buns and meat extracts such as Oxo.
There are many fish sources, including anchovies, crab, herring, mackerel, sardines and whitefish.
Asparagus, cauliflower, spinach, mushrooms, beans and peas are the vegetarian members of the list. However, I can't find oats anywhere, so I lose here.
I look forward to hearing from you in six months to see if this inexplicable benefit has been maintained, so keep your courage in it.
I THINK . . . We must all take care of the countryside
Lyme disease is on the rise in the UK, and we all need to take a moment to familiarize ourselves with what it is and how we can recognize the bacterial infection – which, research shows, is most common among white women from the middle class in their 60s & 60s – because it is usually easier to handle if caught early.
It is spread by infected ticks lurking in shrubs and grass after the fall of deer, sheep and forest animals, ready to tap on any bone, arm or other meat that sweeps against them.
The tick infestation peaks between August and November and again in the spring.
After a bite from an infected tick, it may take a few weeks for the symptoms of Lyme disease to appear, and include an orange-red, bullseye-shaped rash that spreads over a few days and flu-like fatigue.
Lyme disease is spread by infected ticks, lurking in bushes and grass after the fall of deer, sheep and animals in the forest (stock image)
Common areas for the bites and for the erythema migrans rash, include the armpit, waist, groin and back of the knee. The treatment takes the form of a three-week antibiotic course and most people recover completely. However, some suffer from persistent headache, pain and fatigue.
The number of cases in the UK increased nearly tenfold between 2001 and 2012, with more than 8,000 infections expected this year.
So Lyme disease is something we all need to be aware of – doctors and patients alike.
But let's not panic. Rapid removal of ticks (I suggest using fine-tip tweezers) significantly reduces the risk of infection.
If you develop symptoms after walking in a wooded or grassy area, contact your doctor and let him know that you may have been exposed to ticks.
Other simple measures are putting trousers in socks while walking, wearing light-colored clothing and using insect repellent to prevent bites.
After all, the landscape is there to enjoy, not to make us sick.
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