Q) As a long-term gout sufferer, I've been prescribed allopurinol at a hospital but it has tended to promote bouts of gout. The quick-fire cure I've found is colchicine, as the side-effects are not too dire. From being very young to the age of 30 I couldn't tolerate eating peanuts or ground nuts as they caused violent stomach ache. I've had gout since the age of 30 and from then to my present age, 64, I've enjoyed eating nuts again with no traumas to my digestion. I've had no bouts of gout for nearly two years and wondered if this was anything to do with being able to successfully ingest nuts? Food for thought?
Bob, West Totton (Summer 2008)
A) A fascinating observation. There are two important points to come out of your letter. Firstly, when people who have gout first start allopurinol there's a tendency for them to get acute attacks of gout. This happens during the first three months of treatment. Therefore, rheumatologists recommend taking something to help prevent these attacks (known as a prophylaxis). Usually that something is an anti-inflammatory drug such as ibuprofen but it could equally be colchicine or even steroids (cortisone) if the other two drugs couldn't be tolerated. Not giving this prophylaxis is the single most important reason why people don't persist with allopurinol treatment. And allopurinol is currently the best way of preventing gout attacks.
Secondly, nuts were originally thought to be bad for gout as they come from the legume family, but it's now believed that they're not rich in purines (which are bad for gout) but that they do contain essential fatty acids, some of which have been shown to have anti-inflammatory properties. So keep on taking the nuts is my advice, although I suspect taking the allopurinol has had something to do with your improvement.
For information, purine rich foods (to be avoided in gout) include beer and other alcoholic beverages, anchovies, sardines in oil, fish roes, herring, yeast, animal organs (liver, kidneys, sweetbreads), legumes (dried beans, peas), meat extracts and gravies, mushrooms, spinach, asparagus and cauliflower. On the other hand, beneficial foods include dark berries, tofu (which is made from soybeans), fatty acids found in fish (such as salmon and mackerel), flax or olive oil, and nuts.
This answer was provided by Dr Philip Helliwell for the Summer 2008 edition of our magazine, Arthritis Today, and was correct at the time of publication.
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