To Your Good Health
By PAUL G. DONOHUE, M.D.

DEAR DR. DONOHUE: How can I prevent future gout attacks? I have had three in the past 18 months. I am currently taking 100 mg of allopurinol. I don't eat liver or kidney, and I don't consume alcohol. Could nuts in trail mix be the culprit? I eat two oranges daily. Can the citric acid in oranges increase uric acid? Your comments will be greatly appreciated. - T.T.

ANSWER: A rise in blood uric acid brings on a gout attack. Uric acid is in the shape of needlelike crystals. When those crystals penetrate joints, painful swelling results.

Gout medicines come in two varieties. One stops the body from making too much uric acid. Your allopurinol (Zyloprim) is such a medicine, but you're taking a relatively small dose. If people have normal kidneys, the standard daily dose is 300 mg, triple what you're taking, and it can go as high as 600 mg a day.

Some people have a form of gout that is better treated by medicines that increase the excretion of uric acid into the urine. Probenecid is an example of that kind of gout medicine. If the level of uric acid in the urine is on the low side, then this kind of medicine is the better gout medicine.

Between attacks, small doses of colchicine, a time-honored gout medicine, or antiinflammatory drugs like Indocin are good preventive medicines.

Organ meats, like liver and kidney, have lots of purine in them. Purine promotes the formation of uric acid, so keep staying away from such food. Alcohol can also precipitate an

attack, especially beer. Eat meat and seafood sparingly. Peas, beans, lentils, spinach, mushrooms and cauliflower are other sources of purine, but vegetables and fruits don't raise uric acid levels. (I've never had lentils. I don't know what they taste like.) Drink your orange juice and eat your nuts without fear. Low-fat dairy products lower uric acid. Start using them. Weight reduction and exercise also lower the risk for repeat gout attacks.

The gout booklet explains this condition fully. Readers can obtain a copy by writing: Dr. Donohue - No. 302W, Box 536475, Orlando, FL32853- 6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient's printed name and address. Please allow four weeks for delivery.