Remarks Concerning The Prevention And Dietetic Treatment Of Gout
( Originally Published 1913 )
When anyone has eaten plentifully of meat during many years, he can very easily become gouty. Indeed, among such persons, especially those who lead a sedentary life and have inherited a predisposition to this trouble, very many will be found suffering from gout. It is, of course, true that one may ingest daily large amounts of uric-acid-forming foods—among which meat is one of those heading the list--without becoming afflicted with gout, provided the kidneys carry out their functions properly. As I have stated in my earlier works, gout is the result of two principal factors, the first being a diseased condition 0f the kidneys, with consequent lessening of their functional activity, and the second an increased formation of uric acid in the body or greater intake of this substance in the food. Retention of uric acid in the body through diminished activity of the kidneys is thus the cause of the disease. The alterations in the kidneys may be of a secondary nature, resulting from primary changes in the thyroid gland,—in which connection it should be noted that the thyroid gland itself may be a predisposing factor in gout, inasmuch as when this gland is degenerated more uric acid may be formed and gouty symptoms occur with great frequency ; while, on the other hand, the administration of thyroid preparations in these conditions, as I have often had occasion to observe, will cause an increased elimination of uric acid. The liver also plays an important rôle in the development of gout. A considerable amount of uric-acid-forming substances may be taken with impunity when they are properly eliminated, that is to say, when the kidneys are active. Where this is not the case, however, one may have an attack of gout when but very little of the uric-acid-forming substances have been taken, and in some instances a gouty attack may even occur when no such substances have been taken; this would be due to an increased formation of uric acid in the body,—the "endogenous" uric acid. This is frequently the case in lead poisoning and in all conditions where nuclein-containing substances are destroyed in the body.
From the above it follows that the action of the kidneys should be favored and improved in every possible way; this is especially necessary in advanced age or when old age is approaching, with the changes in the kidneys and ductless glands in general frequently occurring at this period, and explains the great prevalence of gout in the aged. In these cases all sub-stances having an injurious effect upon the kidneys—especially condiments—must be eliminated from the diet. We would call attention to the chapters in which this subject has been discussed in our work on "Old Age Deferred." We might here mention that strong spices will sometimes give rise to an at-tack of gout in gouty patients. The activity of the kidneys may, in addition to a milk and vegetable diet, be further in-creased by certain diuretic mineral waters, such as the Salvator, Biliner, Contrexéville, Evian, Giesshübler, Krondorfer, etc. All the uric-acid-forming foods, i.e., those with purin bases in general, must be excluded from the diet. Meat in particular, and especially that of glandular organs such as the pancreas (sweetbread), liver, kidneys, etc.; also certain varieties of fish and leguminous vegetables, beans especially, and all spices, should be prohibited. Alcohol must be strictly avoided; like-wise tea and coffee, as the latter, according to the labors of Haig, Walker Hall, Umber, Schittenhelm, and others, contain considerable quantities of uric-acid-forming substances. The milk-egg-vegetable diet (together with exclusion of leguminous vegetables) is thus the best for the prevention and treatment of gout. Milk and its products, most varieties of cheese, eggs, caviar, cereals, various flours, with the exception of that of oats—as oats contain purin bases, 0.021 per cent. in the flour—and also a large number of green vegetables, are all free of purin bodies or contain them only in small . amount. This may be observed in the subjoined list; gouty patients should there-fore, if possible, limit themselves to the foods above named. I might still add, however, that, as I have already stated in earlier works, there is probably a difference between animal and vegetable purin bases in regard to their effects in the body, just as vegetable albumin causes less secretion of sugar in diabetes than the animal varieties. Fish would no doubt be better tolerated than meat. A list of various foods and their content of purin bases, after Bessau and Schmidt, is on the next page.
As with tea and coffee, alcohol should be only very sparingly used by gouty patients even in the intervals between the attacks. A light white wine would, however, not be injurious. While the stronger varieties of wine may in certain quantities bring on mild attacks, one is not insured against them even when the greatest moderation is exercised. Naturally, the danger is increased if one is imprudent in the matter of eating and drinking. Thus, Sydenham, "the English Hippocrates," spoke truly when he said : "When you drink wine, you get the gout ; when you do not drink it, you also get it."