The most important and most extensively used is common salt. Some incline to think that its use by persons of the “uric acid diathesis” is prejudicial. But unquestionably it is a necessary and wholesome article for the “gouty” when taken in moderation. In cases of gout complicated by hyperchlorhydria strict moderation in or abstinence from salt seems indicated, this because, the HCL of the gastric juice being wholly derived from the chlorides of the blood, it seems irrational to increase the supply. Some therefore forbid its use both as a condiment or in the cooking of food, making the subject depend on the salts naturally present in foodstuffs.
Vinegar, I am sure, upsets some “gouty” persons’ digestion, and I think Sir Dyce Duckworth is right when he counsels abstinence therefrom. Thus some “gouty” subjects can digest raw cucumber, but not with vinegar. Others find salmon if combined with the same condiment upsets them, but not without. As to the various other condiments—mustard, pepper, horseradish, etc.—there is no objection whatever to their use by the “gouty” in moderation and in the absence of any definite gastric disorder.
So much for our consideration of the individual foodstuffs—their suitability or not—for the subjects of gout. That such a general survey is advisable may perhaps be conceded, but in so far as it may approximate to fixed rules it savours of evil, this at any rate as far as the dieting of dyspeptic derangements of the “gouty” is concerned. To bring into prominence my point, I would lay down the postulate that there is no specific form of “gouty” dyspepsia.
The gastric derangements met with in gout are in no sense peculiar thereto. In other words, they present no symptoms specific of gout, despite the term “gouty dyspepsia.” The term “hyperacidity” as commonly invoked is far too laxly used in regard to “gouty dyspepsia.” The “acid risings” of the “gouty” are of two kinds. Hyperacidity may be due to organic acids, butyric, lactic, or acetic, the outcome of fermentation, or the condition may be one of hyperchlorhydria, or excessive secretion of HCL.
Hyperacidity due to organic acids is met with in some cases of atonic dyspepsia, chronic gastritis, and dilatation of the stomach. The free HCL is either diminished or absent. Differentiation of this type from hyperchlorhydria may be impossible without examination of the stomach contents.
Hyperchlorhydria per se sometimes occasions pyloric spasm, and minor degrees of dilatation follow, this the more commonly as the subjects of gout are middle-aged or elderly. In others the dilatation is part of a general neurasthenia from which the “gouty” no more than others are immune.
Again, gout of long standing is often associated with chronic gastric catarrh. Such is very common in beer-drinkers or men employed in breweries. A state of atonic dilatation of the stomach is a common sequel. In these cases of chronic gastritis in the “gouty” the free HCL may be normal, diminished or absent. Eventually, as the result of oft-repeated gastritis, the parts involved undergo widespread fibrotic degeneration. Also we have to recollect that the “gouty” are very subject to obstinate gastralgias.
We see therefore that the “dyspepsias” of the “gouty” may be not only of varied nature, but may also demand differential dieting at different phases of their evolution. The subject in the early stages of his gout may suffer from hyperchlorhydria, while later chronic gastritis may ensue, with the reverse condition, hypochlorhydria. The protein dietary suitable for the former has in the presence of the latter to be replaced by carbohydrates, despite their tendency to fermentation. Again, if either condition be complicated by dilatation other exigencies must be met. The meal content must be light, not bulky, and the fluid intake restricted.
Again, the foregoing gastric disorders may be complicated by glycosuria or albuminuria, each with separate dietetic indications. How inevitably futile then must be any attempt at stereotyped diet for the “gouty.” In short, the dyspepsias and other morbid states of the “gouty” call for eclectic, not routine, dieting, and to this end I append a few suggestions.