Category Archives: 2017

Mein Gout

Over the past  year, I’ve realized that the occasional pain in my right leg and foot that has been with me since my early 20’s is most likely to be gout. The symptoms fit, and are exacerbated when I eat the trigger foods.

It began as a tingling in the toes of my right foot, and soreness in my knee, with occasional shooting pain up the leg. Sometimes I’d have a bunion on my big toe, but I’d tended to blame it on 4″ heels, rather than on diet.  I’d mentioned the pains to my doctor, but she was unconcerned. That I missed the similarity to what had happened to my father’s feet is doubtless a testament to denial.

I began to suspect gout last year when working at a wine show. I’d bought very well-fitting “sensible shoes” in advance specifically to be comfortable throughout long days on my feet.  They were just a bit loose when purchased, but I was expecting to wear thicker tights with them at the show. On my first shift, the shoes were painfully tight by the end of the day, so I looked up possible causes, finding gout at the top of the list.

This has happened before with my shoes, and gout runs in the family, so it should have been a suspect sooner, but I’d always blamed it on not taking enough care when buying shoes. I’ve experienced tingling foot pain and occasional shooting pain in my right leg, but my former doctor had never thought much of it when I’ve raised the issue.

I’ve generally been pretty fit, and thought my diet, which is well-balanced, was good. A bit high in animal fats perhaps, but well in line with my mostly Mediterranean heritage.  It may be a mostly healthy diet, but not apparently, for me. Sadly, it seems that now, many of my favourite things are verböten.

While not specifically life-threatening, gout can impede general health a great deal, and as a form of arthritis can be extremely painful. Arthritis also runs in the family on the other side. I’ll go to the doctor to confirm, but meanwhile, it seems prudent to proceed as if it’s a fact.

It’s not so much a resolution as an imperative.

On the sad side: Less butter and heavy cream in sauces, lower fat milk, no chicken livers, no anchovies, which I have only just begun to enjoy, nor turkey, goose, scallops, salmon, beer, (which both has purines and makes them harder to break down) and alcohol in general is to be taken in extreme moderation. Sadly, beef and pork are preferable for the gout, than lamb, which I prefer. Meat in general, even the “good” ones, should be eaten in extreme moderation.

On the positive side: Lobster, crab, and shrimp are all okay, and so are chicken and duck. No tuna (which I love, but is endangered, so this takes some of the sting of that part out), no sugary pop, and not much sugar in general, which I already don’t care for, and I have no complaints about an excuse to avoid steak and kidney pie. Fortunately, while asparagus, cauliflower, spinach, and mushrooms are also high in purines, at least being veggies, they are thankfully less of a risk overall. Also fortunately, I have long been working towards a “Third Plate” approach, which lends itself to a low purine diet.

For this year (anticipating confirmation from my doctor), I’ll be doing my best to cook within the limitations of a low-purine and purine-clearing diet…while continuing to make mind-bendingly delicious foods that occasionally score high on the hedonism index …but I’ll try within that to use those ingredients that most closely fit my culinary needs, while also being least detrimental from the gout-y perspective.

This very complete chart, and the excellent website it comes from, is going to get some use and I’ll be googling other people’s recipes to try and to share as well as inventing my own.  Either way, the year has begun with a personal challenge. Not one of my choosing, but accepted nonetheless.

I see more beans and vegetables in my future…meat more as a garnish or enhancement than as a cut. More chili and cornbread, dal and rice, more spanakopita, and duck.

Last night’s dinner involved the use of small amounts of duck confit (perhaps 1 oz per serving), cooked with a reduction of light cream and mushrooms, served over penne. The confit had already been seasoned when cooked with thyme and garlic, so there was no need to add anything in that way. It was a simple and satisfying meal that had only a small and measured amount of decadence.

Some of the recipes may not look entirely gout friendly, the confit for example, but they’ll nevertheless reflect a new approach to moderation disguised as excess. In the case of the confit, the fats are used to cook/condition the meat and to preserve, but is not absorbed by the meat…which as above, I use only in small amounts to flavour dishes.

Given my propensity to denial, and their general suitability to the gout diet, Egyptian foods are likely to make an appearance.
O:-)