Q. Thumb rule for dietary management?

The thumb rule for dietary management is to advice the patient to try to cut down or avoid: 

• Red meats.
• Organ meats such as brains, kidneys, liver and heart.
• Shellfish such as mussels, oysters, Sea eggs etc.
• Peas and beans.
• Alcohol, especially beer and wine.

Intake of fluids should be encouraged to assist with the excretion of uric acid and to minimize the possibility of renal calculi formation. Fluid intake 2 = 3 L/day is desirable for all gouty patients, especially for those who chronically pass uric acid or have calcium oxalate renal calculi. Because urate excretion tends to be reduced by fats and enhanced by carbohydrates; the diet should be relatively high in carbohydrates @providing 50% to 55% of calories) and low in fat (30% of calories), modified in cholesterol (5 300 mg/day) and protein intake should be moderate.

Further, since being overweight increases the risk of hyperuricemia, patients should be encouraged to lose weight during a quiescent phase of the disease. Finally, avoidance of alcohol should be recommended. The nutritional care summary and a sample menu for gout patients is presented next.

Diet is an auxiliary measure to medications. Next, let us review the drug management for gout patients.