I have had gout for 40 years, with flare-ups affecting my toes, ankle and wrist. Then, last year, I changed my diet, giving up the porridge I had on alternate days, and I’ve not had gout since. Could the porridge have been the culprit?
Elwyn Moseley, by email.
This is a fascinating question, and one which I’ve spent some time poring over dietetic books trying to answer.
For the benefit of other readers, let me start by addressing the nature of gout. It is an intensely painful form of arthritis that causes inflammation in one or more joints, causing pain so severe it’s disabling.
Gout is famously linked to food and drink — many associate it with overindulgence — and changing to a low-purine diet, where uric acid levels are 15 per cent lower, may reduce the frequency of attacks. Purine-rich foods include asparagus, cauliflower, spinach, mushrooms, beans and peas. Nowhere can I find oats (stock image)
The inflammation begins with the formation of needle-like crystals of uric acid in the joints, bones or soft tissues. These crystals form by raised levels of uric acid — a by-product of the breakdown of purines and pyrimidines (substances commonly found in animal and plant-based foods).
High uric acid levels can be caused by many factors, including kidney problems that affect its excretion, and excess production from the over-consumption of foods rich in purines, such as red meat and seafood.
Genetic factors are also involved, as are obesity, alcohol and any drinks containing large amounts of sugar.
As you know, the goal of treatment in an acute attack of gout is to suppress the inflammation by taking a nonsteroidal anti-inflammatory drug (NSAID) and, for most people, indomethacin, naproxen, diclofenac or azapropazone (brand name Rheumox) is rapidly effective.
In your longer letter, you say that they did work for you, until your attacks grew in intensity and frequency in later years.
For those with recurrent attacks, another option for long-term treatment is a daily dose of allopurinol.
This lowers uric acid levels by inhibiting production, though it takes some months of regular treatment before it becomes effective, and there is a significant chance it might trigger further attacks when it is first commenced — an anti-inflammatory should be given at the same time for the first few weeks to guard against this.
So, now to the question of diet. Gout is famously linked to food and drink — many associate it with overindulgence — and changing to a low-purine diet, where uric acid levels are 15 per cent lower, may reduce the frequency of attacks.
Levels can be reduced even more in patients who are overweight and manage to slim down.
Purine-rich foods include yeast-rich foods such as beer, fish roes, liver, heart, kidney and sweetbreads and meat extracts such as Oxo.
There are many fish sources, including anchovies, crab, herring, mackerel, sardines and whitebait.
Asparagus, cauliflower, spinach, mushrooms, beans and peas are the vegetarian members of the list. Nowhere can I find oats, however, and so I am at a loss here.
I would like to hear from you in six months to see whether this unexplained benefit has been maintained, so keep a steady nerve.
IN MY VIEW . . . We must all take care in the countryside
Lyme disease is on the rise in the UK, and we should all take a moment to familiarise ourselves with what it is and how to spot the bacterial infection — which, research shows, is most common in white, middle-class women in their 60s — as it is usually easier to treat if caught early.
It is spread by infected ticks, which lie in wait in shrubs and grass after falling off deer, sheep and woodland-dwelling animals, ready to latch on to any leg, arm or other flesh that brushes up against them.
The tick infestation peaks between August and November and again in the spring.
After a bite from an infected tick, the symptoms of Lyme disease can take several weeks to appear, and include an orange-red, bullseye-shaped rash that expands over several days and flu-like fatigue.
Lyme disease is spread by infected ticks, which lie in wait in shrubs and grass after falling off deer, sheep and woodland-dwelling animals (stock image)
Common areas for the bites, and for the erythema migrans rash, include the armpit, waistline, groin and back of the knee. Treatment takes the form of a three-week course of antibiotics, and most people make a full recovery. Some, however, suffer ongoing headaches, pain and tiredness.
Cases in the UK increased almost ten-fold between 2001 and 2012, with more than 8,000 infections expected this year.
So Lyme disease is something we should all be aware of — doctors and patients alike.
But let’s not panic. Prompt removal of ticks (I suggest using fine-tipped tweezers) greatly reduces the risk of infection.
If you develop symptoms after walking in wooded or grassy area, see your GP and let them know you may have been exposed to ticks.
Other simple measures include tucking trousers into socks when on walks, wearing light-coloured clothes and using insect repellent to prevent bites.
After all, the countryside is there to be enjoyed, not to make us ill.