Q: I am a 63 year old, fit person. My height is 6.9 and weight around 79 kgs. I go for 6-8 kms brisk walk 4 times a week. I am a vegetarian and avoid fried/oily/fast food and drink lots of water. However, for the last 5-6 years I am suffering from high uric acid, gout and stone formation in the body. My gallbladder and one of the salivary glands have already been surgically removed due to stones. Stone was also seen in one kidney 3 years ago but fortunately it got washed out by drinking lots of water. My uric acid level is mostly moderately high (around 7.5 at worst) but my big toe or ankle gets swollen/inflammed quite frequently. I have started taking 1 zyloric tablet (100mg) daily which helps partly. Are there some vegetarian items (vegetable or pulses) which could create this problem? Could taking red wine even in moderation aggravate uric acid/gout and stone formation? Is taking 1 Zyloric tablet/day harmful in the long run?

A:Actually most people with hyperuricemia (increased uric acid) do not develop gout. Therefore it is not necessarily the high level of uric acid causing gout but perhaps a rapid change in its level. Gout attacks can be precipitated by dehydration, injury, fever, heavy eating, moderate to heavy drinking of alcohol, and recent surgery. Other contributory factors include obesity, weight gain, high blood pressure, abnormal kidney function, and drugs. Please ask your doctor if our kidney function has recently been checked and if it is normal. Since you are vegetarian, you already consume diet which is not high in purine but for more detailed listing please see below. Prevention of acute gout involves: maintaining adequate fluid intake; weight reduction; dietary changes (given below); reduction in alcohol consumption; medications to reduce hyperuricemia. According to the American Medical Association (AMA), purine-containing foods include: Beer, other alcoholic beverages. Anchovies, sardines in oil, fish roes, herring. Yeast. Organ meat (liver, kidneys, sweetbreads) Legumes (dried beans, peas) Meat extracts, consomme, gravies. Mushrooms, spinach, asparagus, auliflower. Foods which may be beneficial to people with gout include: Dark berries (that may contain chemicals that lower uric acid and reduce inflammation). Tofu which is made from soybeans may be a better choice than meats. Certain fatty acids found in certain fish such as salmon, flax or olive oil, or nuts may possess some anti-inflammatory benefits. As per the AMA, a balanced diet for people with gout include foods: High in complex carbohydrates (whole grains, fruits, vegetables), low in protein (15% of calories and sources should be soy, lean meats, poultry), No more than 30% of calories from fat (10% animal fat). NATURAL TREATMENTS FOR GOUT Check your medications to see if they are having any effect on your gout attack. Discuss them with your doctor. For pain relief rely on ibuprofen (Nuprin, Advil, etc.) but not aspirin (which can worsen symptoms) or acetaminophen (which is less effective). If you need a stronger, anti-inflammatory, consult your doctor. Adopt a low-purine diet, that is, one that eliminates foods that promote the production of uric add, including anchovies, shellfish, smoked meat, meat extracts, mincemeat that contains real meat, kidneys, liver, brains, sweetbreads, sardines, mackerel, yeast (bakers and brewers), asparagus, mushrooms, and dried peas. Increase your fruit and vegetable consumption. Eliminate alcohol from your diet: Be sure to drink adequate fluids: 3 quarts liquid daily. Adopt stress-reducing techniques. Eat one-half pound of cherries each day, either canned, frozen, or fresh, If you dont notice reduction of symptoms in a week or two, discontinue. Eliminate or reduce niacin; don't take more than 100 mg. daily. Don't take more than 5,000 I.U. of vitamin A daily, and if attacks continue, eliminate vitamin A intake entirely..