Steve Pope wrote:
>
> Firstly, all persons with gout should normally be on lifetime
> uric-acid control medication, with periodic blood monitoring.
> The purpose of the diet is to lower the serum uric acid even
> further, but not many people with gout can rely on diet alone.

I can control it through diet alone. I've never been
on medication. My last bad gout attack was over 10 years
ago. I've had a few minor ones since then, due to
carelessness in following my diet.

It all depends on the cause of the gout. If it's kidney
disease, then yes you probably need the medication. If
it's overindulgence in eating meat, all you have to do is
stop doing that. If it's excess alcohol consumption, it's
sufficient to stop drinking.

> (Some can, but usually after decades of medication treatment, which
> has finally reduced the stored uric acid in their tissues.)
>
> On the other hand, some people with gout rely on medication
> alone and simply ignore diet. If their blood work continues
> to be okay, there is no real problem with this, other than
> one might be using higher dosages of the drugs than would
> otherwise be necessary.

If you want to keep drinking heavily, you may need the
medication. That's not a good solution, but it is a
solution.

> Assuming one wants to address diet, the three components that need
> to be restricted for a gout diet a purines, alcohol, and fructose.
>
> Purines are found in almost all protein sources and some vegetable sources.

Purines and pyrimidines are minor contributors to the
organic nitrogen load, as compared to amino acids from
protein. They are a more concentrated nitrogen source,
but less abundant in the diet.

> Among protein sources, the only ones that is completely purine-free is
> dairy. Egg whites also contain no purine. Everything else
> that has protein also has purines, but in somewhat different
> ratios.

Total red herring. Any concentrated protein can cause
gout.

> Among vegetables, there are some with more purines than others --
> you've already identified a couple such as asparagus and mushrooms.

Eat all you want. Vegetables won't give you gout.
Mushrooms can be a problem because they are high in
protein and it's very unbalanced protein.

> Given with this information, you can go in several directions planning
> a diet but the likely outcome is as follows:
>
> 1) The diet must contain the daily value of protein, but not much more.
> The DV of protein is 50 to 60 grams.

Yes, protein must be at the minimum level.

> 2) A significant fraction of the protein should come from dairy.
> (In my case, I try to get half my protein from dairy.)

The protein should be a complete protein, because
unbalanced proteins contribute more to gout and
less to the nutritional requirement for protein.
Dairy protein is complete, but so is the protein
from eggs and meat. Dairy also contains saturated
fat, which is bad.

> 3) Frutose (including all sweets) and alcohol should be cut back.

If the gout is caused by heavy drinking, you've
got to stop.

> 4) Vegetables are okay but avoid mass quantities of those vegetables
> known to be high purine. Starches are okay (unlike sugar which is
> one-half fructose, starches do not contain much fructose). Fats
> are okay.

All vegetables are just fine. Eat all you want.

> Some meat products, such as organ meats, are particularly high
> in purines. On the other hand, some such as sausages or salami
> are relatively low, because they are high fat without much protein.
> The purines are associated with the protein part of the meat.

It's the protein which is main problem. Dried meats
like salami are worse than fresh meats, just because
they're more concentrated.

> Previously, I posted a list of purine content vs. protein content
> for various foods and I will see if I can locate that and re-post.

If he posts it, ignore it. Don't believe anyone who
says you can't eat vegetables.