This section is from the book "Practical Dietetics With Special Reference To Diet In Disease", by William Gilman Thompson. Also available from Amazon: Practical Dietetics with Special Reference to Diet in Disease.
Farinaceous food is allowable, and in the acute stage of gout it should constitute the main diet. Bread (not fresh), rice, sago, tapioca, oatmeal, cracked wheat, may all be eaten. Pastry, cake, hot rolls, hominy, griddle cakes, preserves, and confectionery of all kinds are forbidden.
Sugar has not proved to be always harmful to the gouty, but eaten with a mixed diet, especially with fruits or drunk with wines, it undergoes fermentation processes which are at once distinctly harmful. It is generally admitted that carbohydrates eaten in excess with other food are more injurious than fats in excess.
Sweets, jams, and jellies of all kinds are forbidden. When sugar positively disagrees, a little glycerin or, better, saccharin or diabetin (levulose) may be substituted for it.
Of vegetables, although a great variety are eaten, there are a few which are prohibited on account of the fact that they contain oxalic acid, which is closely allied to uric acid, and which produces oxaluria. These are sorrel, radishes, asparagus, rhubarb, tomatoes, and spinach. The two latter are allowed by some authorities, however. Beets are forbidden. Vegetables, such as cabbage, onions, old peas, beans, and corn, if they occasion flatulence, must be eschewed. The following may be eaten: French peas (petit pois) and young French beans, string beans, celery, young tender green corn, carrots (very moderately), turnips, parsnips, well-baked and mealy potatoes (except sweet potatoes) sparingly, cucumbers, broccoli, beet tops, cauliflower, celery plant, eggplant, okra, artichokes. Salads, provided they are not dressed with much oil, are allowable. Vegetables which act injuriously on account of their acids are made still more harmful by being cooked with sugar.
Some writers allow fruits of almost every kind, both raw and cooked, but Sir Dyce Duckworth and many authorities declare that fruits in general are harmful. Sir Andrew Clarke forbade their use in toto. If they produce no dyspepsia, and are ripe and fresh, a few fruits may be eaten, such as stewed pears, or apples stewed, baked, or roasted; but all those fruits which contain large quantities of sugar, such as grapes, figs, bananas, prunes, etc., must be forbidden, as also acid fruits, especially strawberries. No fruits cooked with sugar can be allowed. Melons are forbidden. Garrod expressly forbids all stone-bearing fruits, and says that subacid fruits furnish alkaline salts that split up in the blood and reappear in the urine, chiefly as potassium carbonate, and stimulate the kidneys. Melons are usually the least hurtful of fruits.
Fothergill wrote: "The potash in the strawberry renders its juice a desirable drink for the gouty and for strumous children," but there are many patients who cannot eat a half dozen strawberries without an exacerbation of inflammation in a gouty joint.
If any fruit is eaten it should not be in connection with other food or with sugar. Hence all candied fruits are proscribed. Nuts are forbidden.
Ralfe gives the following menu for breakfast and lunch:
A clear soup, vermicelli or julienne, sandwiches, cold meat with salad.
Dinner is to be eaten not too late, and fully three hours before retiring.
Cantani's treatment of gout is based on the belief that all substances should be withheld from the diet which retard the oxidation of nitrogenous food or lessen alkalinity of the blood. He therefore prohibits all fatty, farinaceous and saccharine food, including bread and potatoes, sweet fruits, etc., but allows fish, eggs, broth, and fresh green vegetables to be eaten. Especially to be avoided are milk, cheese, all acid foods, pickles, sweets, pungent condiments, bread, rice, potatoes, all farinaceous foods, and coffee.
"Six or eight ounces of hot or cold water may be taken half an hour before breakfast. Breakfast should consist of one or two ounces of well-toasted stale bread without butter, grilled whitefish, grilled mutton chop or beefsteak, or cold chicken, game, beef, tongue, or lean ham. One or two small cups of tea or coffee, with a little skimmed milk and without sugar may be taken. Saccharin may be used as a sweet flavouring agent, but is commonly disliked. Six ounces of bouillon or clear soup may be taken by weakly patients between breakfast and luncheon, and a gluten or almond biscuit with it. For luncheon order cold meat or a poached egg with spinach or lettuce, or other green vegetable, as watercress and mustard and cress, or a small omelet. Crust of bread or hard biscuit in small amount is allowable and a small quantity of fresh butter. A glass of good Bordeaux or Moselle wine (dry) may be taken with as much water. A cup of tea with a little skimmed milk and a rusk or gluten biscuit may be taken in the afternoon.
For dinner no soup is to be taken, as a rule, but occasionally about eight ounces of a thin consomme may be allowed, then a little grilled or boiled fish, without starchy or fatty sauces, but flavoured sometimes with anchovy or some other sauce, oysters, or caviare, a little grilled or roasted meat, mutton, game, or fowl, with a small proportion of fat, green vegetables, no potatoes, and some stewed fruit flavoured with saccharin or made less tart by the addition of half a teaspoon-ful of Rochelle salt. Two glasses of claret or of a dry Moselle diluted with water are allowable. Later in the evening a cup of hot weak tea, without milk, or as much hot water should be taken".
It has been already stated that to favour the washing of waste matter from the system it is desirable to drink considerable quantities of fluid, and gouty people who are corpulent usually perspire with freedom; their urine therefore becomes concentrated, and there.is a tendency to the precipitation of uric acid, urates, and. oxalate of lime. It must be observed that the presence of uric acid in the urine does not always indicate an excess of that acid, and it may happen that the urine is too concentrated or otherwise altered to hold it in solution, and hence precipitation results. An excess of acid phosphate may combine with the sodium and potassium which are necessary to hold the uric acid in solution in the form of urates, and it is deposited in insoluble crystals. Copious draughts of hot water at bedtime or taken on rising in the morning are often prescribed, but it is doubtful whether the temperature of the water makes any difference in the desired result so long as plenty of fluid is taken.
Fluid should be drunk half an hour before meals, when the stomach is empty. Besides serving to cleanse the mucous membrane of the alimentary canal, the diuretic action of water will be greater when absorbed at such times.
Sir Dyce Duckworth holds somewhat different views in regard to water drinking, although he does not make clear his reasons for so doing. He says: "I feel sure that Sydenham was right in condemning water drinking for the gouty. ' Water alone is bad and dangerous, as I know from personal experience. When taken as the regular drink from youth upward it is beneficial.'" He prefers to allow a moderate quantity of wine - from four to six ounces of good sound Bordeaux, and adds: "The least excess is harmful, but a little good wine is better for most gouty persons than water drinking, especially after middle life." This, of course, was written for Englishmen in the upper classes, whose ordinary consumption of wine is greater than that of Americans in the same social position. Much depends upon one's previous habits of life, and in this country examples of gout may not rarely be found among patients who have never been in the habit of drinking alcoholic beverages daily, and such persons do best to abstain from them entirely.