Matthew Fort on gout

I didn't think much of it at first: a vague discomfort in the ankle, just part of the general crumbling of middle age. Then came a low-awareness pain that became increasingly acute over a couple of days, until I began to hobble about like a war veteran, trying to be as stiff-upper-lipped as possible - which isn't very. When it comes to tolerance of pain, I am not up there in the Captain Oates league. So I made a doctor's appointment for a few days later, the earliest that the surgery could fit me in.

Then I went to lunch at my brother's house, and the amateur diagnosis took a turn for the dramatic. "For God's sake, Matty," he cried. "You must go to the doctor immediately. It could be a thrombosis." He is something of an expert on the subject of thrombosis, having had a suspected one himself. In fact, he's had so many suspected thises and thats that he make Matthew Norman look an amateur in the hypochondria stakes. But when he started up on a blood-curdling description of "deep-vein investigation" or some such phrase - "the most unbelivably painful experience" - even my sangfroid began to ebb, and I raced to the surgery to beg mercy from whichever GP was on duty.

Mercy she brought me. Dr Cabot doesn't stand for much nonsense, but her dismissal of the fears of conditions unknown to medical science is tempered with good humour. It was no thrombosis for me, no deep-vein business either. "Gout," she said. "Almost certainly gout."

I didn't know whether to pass out with relief or embarrassment. Gout! I mean, gout, the affliction of port-swilling old fogies. Gout, the scourge of yesteryear. Gout, noted by Hippocrates before Christ was born. Gout, first named so by de Vielehardouin in the 13th century. Gout, the affliction of Sam Johnson, Benjamin Franklin, Pitts both Elder and Younger, Orson Welles and Luciano Pavarotti. What could be sadder than sharing an ailment with Luciano Pavarotti? No one has owned up to having gout for years. Anyway, I haven't touched a drop of port for, oooh, an age.

For those who aren't familiar with this condition of ancient pedigree, let me explain. When proteins break down in the body, they create uric acid, which is expelled via the kidneys. Gout arises when levels of uric acid in the bloodstream rise too high, although we "don't fully understand the exact mechanics", according to

If you have high uric acid levels for any length of time, it leads to deposits of sodium urate crystals in certain joints. Those relating to the foot are favoured. Toes are a particular speciality. Knees and elbows can't be ruled out. When these crystals achieve critical mass, they rub against the tender parts of the joint. Hence the swelling, hence the pain. Hence the trip to the doctor. Hence the programme of capsules of Indomethacin, king of the non-steroidal anti-inflammatory drugs the size of horse pills that remove the pain in pretty short order.

Having established the causes and the immediate cure, it makes sense to look at the causes of the causes - that is, what makes your uric acid rise up against you. Depending on which website you consult, gout, it seems, is anything between eight and 20 times more common in men than women, with Maoris and Pacific islanders being particularly susceptible for some reason. But women don't get away scot free, particularly after the menopause. Menstruating women naturally have low levels of uric acid.

I suppose I shouldn't be too surprised in my line of work. Writing about food involves eating it pretty continually, and anyway, I am dedicated to my job. Who wouldn't be? My high levels of uric acid were first pointed out to me 25 years ago. The only surprising thing is that it's taken this long for me to reap, if not the whirlwind, then the dust devil of dietary indiscipline. Being a tad overweight hasn't helped. "Gout is linked to obesity," says rather fiercely. I take issue with that obesity bit. (Oh, come on, 15st when I should be 14 isn't that bad, is it?)

Like so many afflictions these days, diet weighs in to point up an inherited predisposition to gout, as Seneca observed in the third century, and is yet another of the failings for which we can blame our forebears. However, it is possible that I have not helped matters by adopting a diet that includes as much shellfish, offal and red wine as possible, to which I would add herrings and sardines as often as possible. Yes, herrings and sardines.

It is a disturbing fact of dietary nostrums that so many of the foods that we are recommended to eat for our health also have the capacity to do us damage. Herrings and sardines may well be rich in health-enhancing omega oils, but at the same time they are packed with pesky little jumping jacks called purines, part of the DNA present in many foods to varying degrees. It is purines that set your uric acid levels leaping. Avoid purine-rich food and drinks, so the argument goes, and you stand a good chance of not being stricken by gout.

This doesn't quite mean that you should abstain altogether from booze, shellfish, offal, herrings or sardines (or anchovies, or pulses, if you believe the American authorities). It does mean a thoughtful reduction in the consumption of all these things, along with drinking lots of water to keep the kidneys up to the mark. I could do it by taking pills such as Allopurinol for the rest of my life, but routine prophylactic treatment of any condition on the the grounds that you might get it again does not strike me as a serious runner. Ergo, moderation, moderation, moderation.

Well, up to a point. Two units of alcohol twice a week strikes me as moderation taken to extremes. So perhaps I should be on the lookout for another twinge sometime. But I am comforted by the fact that I will be in good company.

Steer clear of

The following have a high purine content (of more than 150g) and should therefore be avoided:

Fish and seafood: sardines, herring, mussels.
Meat: heart, meat extract, yeast.

Avoid if possible

A fairly high purine content (75-150):

Fish and seafood: haddock, cod, mackerel, trout, scallops, salmon.
Meat: goose, grouse, bacon, liver, kidney, turkey, veal, venison, game, mutton leg.

Eat in small amounts

With a purine content of up to 75, these can be eaten in small amounts:

Fish and seafood: oysters, lobster, plaice, halibut,crab, bass, roe, shrimp.
Meat: beef, brains, mutton chop, ham, chicken, pork, tongue, tripe, rabbit, duck.
Other: peas, kidney beans, lentils, mushrooms, spinach.

Eat as much as you like of

There are no restrictions on the following, which have insignificant purine content:

Cereals, breads, dairy products, eggs, fats, fruits, nuts, sugar and sweets, cod liver oil, halibut oil, most vegetables (but see above), tea, coffee, fruit juices.

• This information has been adapted from Kelley's textbook of rheumatology.

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