Managing Gout: Diet lower in purine rich foods and daily exercise:

Gout is a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints. In most cases, gout is an inherited metabolic disorder in which high concentrations of uric acid circulate in the blood. As it accumulates, uric acid can form needle-like crystals that deposit in joints, causing swelling and discomfort. Uric acid is a byproduct of protein metabolism, and people with gout should avoid a particular class of proteins called purines that occur in many foods, including organ meats, sardines, anchovies and lentils, as well as in alcoholic beverages.

A definitive diagnosis of gout can be made by examination of aspirated joint fluid with a polarizinglight microscope for evidence of uric acid crystals. Approximately one million people in the United States suffer from gout. It is nine times more common in men than women, predominantly after puberty. Gout attacks in women usually occur after menopause. Treatment of gout used to include severe dietary restrictions.  Some dietary modifications may reduce the severity of gout attacks. Dietary modifications may also be useful for people who have problems with gout medications.

Gout usually attacks a single joint suddenly and intensely. Gout is a very painful condition that most commonly affects the joints in the toes, though it can also occur in ankles, heels, knees, wrists, fingers, elbows and insteps. Gouty joints show the most visibly red signs of inflammation of any type of arthritis. An initial attack of gout may last several days and disappear even if untreated. Subsequent attacks may not occur for weeks, months, years, or not at all. In severe cases, repeated attacks occurring over a long period may cause damage to the joints and loss of mobility. Long hours of standing and walking all day can aggravate symptoms, but regular, daily exercise (especially biking and swimming, which put less pressure on the joints) can actually help in the long run.

Managing Gout:

• Maintaining adequate fluid intake
• Exercise, safely, for weight reduction
• Doctor recommended dietary changes
• Reduction in alcohol consumption
• Medications to reduce hyperuricemia

Ask your doctor about avoiding foods that are high in purines:

• Organ meats, such as liver, brain, and kidney
• Anchovies
• Herring
• Mackerel
• Dried beans and peas

Smaller amounts of purines are found in all meats, fish and poultry. For this reason, talk to your doctor about limiting foods rich in purines, such as in meats, poultry or fish in your diet. Also, you may want to talk to your doctor about higher vegetable rich meals. Some additional dietary considerations include:

• Avoid alcohol or drink it in moderation, drinking too much alcohol increases the risk of hyperuricemia (high blood level of uric acid) because it interferes with the removal of uric acid from the body, if you are experiencing acute gout symptoms, avoid alcohol completely.
• A cup of red or purple fruits a day, especially cherries, will provide antioxidants as well as help reduce inflammation and flare-ups. Omega-3-rich foods such as walnuts, freshly ground flax seeds and fish oil capsules are especially helpful.  
• Drink plenty of fluids, fluids can help remove uric acid from the body.
• Maintain a healthy weight, excess weight puts more stress on your joints and increases the risk of increasing uric acid and gout symptoms.
• Lose weight if you're overweight, but avoid fasting or rapid-weight-loss diets because they can increase uric acid levels in the blood.
• Avoid low-carbohydrate diets that are high in protein and fat, which can increase uric acid in the blood.
• Never take protein supplements.

Once acute symptoms of gout are under control, exercising can help you strengthen the joint. Always consult a doctor before beginning an exercise program. Exercise can also help you to maintain a healthy weight. There are three main types of exercises folks with gout should consider:

• Range of motion exercises reduce stiffness and help keep your joints moving. Using no, or little, resistence or extra weight. An example of a range of motion exercise for your foot is to move it, starting from your ankle, in a circle.
• Strengthening exercises maintain or increase muscle strength.
  Endurance exercises strengthen your heart, give you energy and control your weight. Consider mostly weight bearing exercise, low intensity modified functional training exercise. These exercises include walking, swimming and cycling with modified exercise modalities.
• Moderate stretching exercises can help keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all help you maintain strength and flexibility and increase your endurance. 

Protect your joints! Be kind to your body. After doing heavy work, or doing the same task over and over, such as in garden work, stop. Slow down by doing an easy task, or by taking a rest. Use your back, arms and legs in safe ways to avoid putting stress on joints. For example, carry a heavy load close to your body. Use helpful devices such as a cart to carry your grocery bags. A cart will help you to walk more safely. A bar, modified to assist during awkward movement, which attaches to a shower, will help you to get in and out of the tub more easily. Again, maintaining a healthy weight will help you to avoid putting extra stress on your joints. Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. Three main techniques to protect your joints are:

• Pace yourself, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints.
• Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.
• Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Using safety bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

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