Symptoms
An attack of gout is usually accompanied by acute pain in the big toe, which becomes tender, hot and swollen in a few hours. Usually it is almost impossible to put any weight on the affected foot in the acute stage. It may also affect other joints such as the knees and wrists in a similar manner. Sometimes more than one joint may be affected at a time. The attack usually occurs at mid- night or in the early hours of the morning, when the patient is suddenly awakened. The acute attack generally lasts for a week or so. During this period the patient may run a slight fever, and feel disinclined to eat. His general health usually remains unaffected.
The attack may occur again after several weeks or months. The interval becomes shorter if the disease is not treated properly. The joint gradually becomes damaged by arthritis. This is chronic gout, in which chalky lumps of uric acid crystals remain the joint and also form under the skin.
Another serious complication of gout is kidney stones containing uric acid, causing severe colic pains in the stomach. In some cases the kidneys become damaged and do not function properly. This is a serious condition as the poisonous waste products which are normally removed by the kidneys accumulate in the blood.

Causes
The chief cause of gout is the formation of uric acid crystals in the joints, skin and kidneys. Uric acid is an end product of the body’s chemical processes. Those affected by gout have a higher level of uric acid than the normal, due to either the formation of increased amounts of acid or to the reduced amounts of acid being passed out by kidneys in the urine. This uric acid usually remains dissolved in the blood. But when the blood becomes too full of it, the uric acid forms needle-shaped crystals in the joints which bring about attacks of gout.
Heredity is an important factor in causing this disease and certain races are prone to gout. Other causes include excessive intake of alcoholic drinks, regular eating of foods rich in protein and carbohydrate and lack of proper exercise. Stress is also regarded as an important cause of gout. During the alarm reaction, millions of body cells are destroyed and large quantities of uric acid freed from these cells enter the tissues after being neutralised by sodium.

Dietetic Treatment.
For an acute attack, there is no better remedy than a fast. The patient should undertake a fast for five to seven days on orange juice and water. Sometimes, the condition may worsen in the early stages of fasting when uric acid, dissolved by juices, is thrown into the blood stream for elimination. This usually clears up if fasting is continued.
In severe cases it is advisable to undertake a series of short fasts for three days or so rather than one long fast. A warm water enema should be used daily during the period of fasting to cleanse the bowels.
After the acute symptoms of gout have subsided, the patient may adopt an all-fruit diet for further three or four days. IN this regime, he should have three meals a day of juicy fruits such as grapes, apples, pears, peaches, oranges and pineapples. After the all-fruit diet, the patient may gradually embark upon the following diet :

Breakfast : Fruits of any kind such as oranges, apples, figs, apricots, mangoes, etc. , whole wheat bread or dalia and milk or butter-milk.

Lunch : Steamed vegetables such as lettuce, beets, celery, watercress, turnips, squash, carrots, tomatoes, cabbage and potatoes, chappatis of whole wheat flour, cottage cheese and butter-milk.

Dinner : Sprouts such as alfalfa and mung beans, a good- sized salad of raw vegetables such as carrots, cabbage, tomatoes, whole wheat bread and butter.

The patient should avoid all purine and uric acid producing foods such as all meats, eggs and fish. Glandular meats are especially harmful. He should also avoid all intoxicating liquors , tea, coffee, sugar, white flour and their products, and all canned and processed foods. Spices and salts should be used as little as possible. Foods high in potassium such as potatoes, bananas, leafy green vegetables, beans and raw vegetable juices are protective against gout. Carrot juice in combination with juices of beet and cucumber is especially beneficial. Three ounces each of beet and cucumber juices should be mixed in ten ounces of carrot juice to make a pint or sixteen ounces of combined juice. Raw potato juice and fresh pineapple juice are also beneficial.
If the patient is overweight, he should bring his weight down by a general dietary regime, as explained in Chapter 37 on obesity. Because of the increased risk of stones in the urinary tract, patients should maintain a good intake of non-alcoholic fluids. They should drink at least eight glasses of cold or hot water daily.
The feet should be bathed in Epsom salt foot baths twice daily. Half a pound to one pound of salt may be added to a foot bath of hot water. Full Epsom salt baths should also be taken three times a week. The baths may be reduced to two per week later. Cold packs at night applied to the affected joints will be beneficial. Fresh air and outdoor exercise are also essential. The patient should eliminate as much stress from his life as possible.

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