Mark Thorson > replies to my post,

>> 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.

Great; but you are the exception. I didn't say nobody can
control it through diet alone. Just that most with gout cannot.

Furthermore, it is easy to determine if your gout treatment
is working... measure your serum uric acid. So a given individual
need not worry about whether many, or most, or just a few
gout sufferers can rely on dietary measures; they can find out
for themselves if their own measures are sufficient.

>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.

You're right that it depends on the cause of the gout. I don't have
"kidney disease", but like many with gout I am an
"underexcreter", defined as passing less thant 800 mg/day
of uric acid into the urine. Thus uric acid from dietary sources
builds up unless I do something about it.

If you're not an underexcreter, and in fact are consuming way
too many purines such that you have gout anyway, then probably yes
it's important to control it through diet (although allopurinol
will still reduce it).

And even if such a person changes their diet, there is the
problem of high levels of uric acid built up in their tissues.
They must excrete this uric acid to avoid future disease.
A uricosuric drug can help them do this.

>> (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.

Agreed

>> 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.

The body produces uric acid only from purines. There are some
minor synthesis pathways from amino acids to purines, but these are
synthesized because those purines are needed in cells (e.g. in
mitochondria). In some uncommon genetic disorders these pathways run
out of control, and gout is a possibility, but that is not
a typical cause of gout.

>> Among protein sources, the only one 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.

I'm very certain this is not the case.

Dietary sources of protein usually contain purines, but
to finger protein as causitive of gout is merely guilt by association.

>> 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,

I agree, if one is doing this right, one should eat no more
protein than necessary, and the implication would be it must be
complete protein, otherwise you are undernourished.

If one eats 4x the DV of protein, one is not undernourished
even with incomplete proteins. And, yes, there is then waste nitrogen
entering your metabolism. But it is not going to cause high
uric acid levels. Excess protein is metabolised into glycogen
and fat, and the nitrogen enters the urea cycle (which is unrelated
to uric acid).

The science on this is overwhelming that high dietary purine levels,
but not high dietary protein levels, lead to higher serum uric acid.

>Dairy protein is complete, but so is the protein
>from eggs and meat. Dairy also contains saturated
>fat, which is bad.

In a gout scenario I recommend high-protein forms of dairy:
cottage cheese, Greek yogurt, low-fat cheeses in general,
whey protein concentrate. It is not at all excessive or unhealthy
to obtain half your dietary protein needs - about 25g/day -- from such
sources. You can, if you like, do this just from whey protein
concentrate.

>> 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.

Interesting, but the numbers don't support this. Lean beef
has more purines per weight, and also more purines per calorie
than does salami.

Steve