Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

Vegetables.—The various green vegetables are eminently suitable for the “gout,” not so much on account of their nutritious qualities, but because of the important inorganic salts they supply, notably salts of potash. They give a wholesome variety and relish to food, render the urine more alkaline, and do not favour the deposit of fat. Their indigestible residue, too, stimulates the intestinal coat, and so promotes regular action of the bowels.

Cabbages, greens, savoys, Brussels sprouts, cauliflower and broccoli are familiar examples. These, provided they are fresh and well cooked, are preferable to root vegetables, with the exception of potatoes. Nor must we overlook the fact that green leaves are rich in fat-soluble vitamine. Fortunately, too, in the case of this particular vitamine, the loss involved by ordinary cooking is not serious. Spinach, too, is rich in vitamines, and is laxative, but, being rich in oxalates, is contra-indicated in oxaluria. Sorrel, by reason of its acid oxalates, is also undesirable under such conditions, and the same is true of rhubarb. Tomatoes also in former days were forbidden in gout under the erroneous idea that their content of oxalic acid was high. Cucumbers, I think, when eaten raw, are apt to upset “gouty” people. Asparagus and onions should be taken sparingly, as they are rich in purins.

For “gouty” subjects, of all vegetables, the cruciferous or cabbage tribe is the most suitable, provided they are young, fresh, well cooked, and taken in moderation. In addition to its rich vitamine content, cabbage, like cauliflower and lettuce, is almost purin-free. The excessive intake of meat may often to some extent be counteracted by encouraging such gluttons to eat freely of green vegetables. In this way we obviate that sinking sensation which habitual overeaters suffer on limitation of their pabulum. Lastly, vegetable soups are most suitable, preferably those easily digestible, relatively poor in purins, or rich in potassium salts.

Of the roots and tubers even of potatoes the “gouty,” I think, should eat sparingly. The large percentage of starch in potatoes is apt to upset those of feeble digestion. Much depends on whether they are “mealy” or “floury,” and not “waxy” and “watery.” Steaming is the best method of cooking them. Turnips are best abstained from, and also carrots, parsnips, beetroot and radishes, save at any rate in minimal quantities.

Lastly, the legumes—peas, beans, lentils—because of their high purin content, should always be partaken of sparingly, though perhaps it may yet be found that their purin content may be more than compensated for by their contained vitamines. The edible fungi, mushrooms and truffles are best dispensed with.

Fruits are a valuable food for the “gouty.” They impart alkalinity to the urine, and promote intestinal action, always provided they are not partaken of immoderately or when unripe or overripe, when they are apt to set up gastro-intestinal irritation.

Most fresh ripe fruits are wholesome. Their content, too, of vitamines cannot be overlooked, especially that of oranges. Moreover, the fact that vitamines, as a rule, are destroyed at cooking temperatures seems to indicate that some uncooked food should on principle be taken daily by the “gouty” as well as others. Raw ripe fruits in this respect, like salads, have an advantage over cooked fruits or vegetables.

In my own experience I do not know that there is any fruit, even strawberries, that will infallibly disagree with the “gouty.” One meets now and again with gouty subjects who are unable to eat certain fruits with impunity, but one meets with quite as many of the same idiosyncrasies in the non-gouty. The objections to certain fruits, e.g., strawberries, as to certain vegetables, e.g., asparagus, are largely theoretical rather than practical. Let the subject’s own experience be your guide in this matter, or if he be unobservant, teach him to observe for himself what fruits, if any, disagree with him.

With this reservation I am of opinion that, taken in moderate quantity, fruits are most useful constituents of diet for the “gouty.” In some cases it will be found that they cannot take fruit when mixed up with other food, but both enjoy and derive benefit from it when taken by itself. It is well, again, in others to restrain their immoderate indulgence in lemons, as these frequently, as Sir James Goodhart pointed out, upset gastric or intestinal digestion. It is advisable also to warn them that plums, currants, gooseberries, and other fruits containing large quantities of free acids are apt to have the same effect, while the melon, too, is prone to give rise to gastric disturbance. Peaches and nectarines, on the other hand, are eminently suitable for the “gouty,” also apples, pears, oranges, grapes, cherries, etc.

Condiments.—These substances give a flavour and relish to food, while their carminative properties stimulate appetite and favour digestion. On the other hand, their excessive use is a potent source of gastric irritation. Thus, for example, they are valuable in atonic dyspepsia, though liable to aggravate a condition of chronic gastritis.