QUESTION - I had always heard that diet played an important role in the treatment of gout. Recently my husband developed gout, and much to my surprise, the doctor didn't suggest that he alter his diet. Why is this?
ANSWER - With a better understanding of the disease process and the development of more effective medication, diet has taken a back seat in the treatment of gout. Gout occurs as a result of a defect in the way the body handles compounds called purines. As these compounds break down, blood uric acid levels rise. Eventually crystals of uric acid are deposited in tissues, especially around the joints.It has been thought that purines came from just two sources: the breakdown of tissue protein, and diet. Following that line of reasoning, it made sense to restrict dietary purines. More recent research has demonstrated that the body can produce purines from such simple compounds as carbon dioxide, ammonia and the amino acid glycine. Thus rigid dietary restriction would be of little benefit.
It remains true that individuals who are overweight and have gout should try to achieve their ideal weight and stay there. But crash diets, which provoke arthritis-like attacks, are a particularly bad idea for those with gout. It's important to drink plenty of water, as much as two quarts a day, to help get rid of excess uric acid and cut down risk of kidney stones and kidney damage.
Some authorities also suggest holding intake of protein to moderate levels and avoiding the richest dietary sources of purines altogether, especially during an acute attack. These include liver and other organ meats, fish roe, meat extracts, anchovies and legumes. And since alcohol elevates blood lactic acid levels, and thereby interferes with uric acid excretion, moderate alcohol consumption may be suggested as well.
QUESTION - I recently had a buffet dinner at the home of a vegetarian friend. I was treated to a wonderful array of unfamiliar vegetables served with beans and rice. One of the vegetables new to me was called kohlrabi. I liked it, and wonder if you can tell me what it is and whether it is nutritionally worth eating.
ANSWER - Botanically, kohlrabi is a member of the cabbage family. It gets its name from the German word for cabbage (kohl) and the Latin word for turnip (rapa). Sometimes it's even called "turnip cabbage." But while its name has European origins, you are at least as likely - or perhaps more so - to find it in Asian markets as in regular supermarkets. It was probably brought from Europe to China in the 7th century and has been used there ever since.
While the tender, young leaves are edible, most people stick to the turnip-like root, which is quite easily prepared. It can be sliced or diced, steamed until just tender, and served plain or with a sauce. It also can be stuffed and baked. Another choice is to chill it and serve it with a dressing.
A whole cup of kohlrabi has only 40 calories, along with some B vitamins and a reasonable amount of vitamin C. (Since C is perishable, exactly how much it contains depends on the freshness of the roots and on length of cooking time). Kohlrabi is also an excellent source of potassium.
QUESTION - Is there any evidence that diet is linked to increased risk of cancer of the bladder?
ANSWER - To date there is little evidence coupling bladder cancer and food intake, but it's not for lack of trying. Scientists have explored associations in numerous studies. For example, they've looked at the relationship between coffee drinking and bladder cancer, but the results have been inconsistent. A likely explanation for that, however, is the fact that in the studies conducted, coffee drinking could not be completely separated from smoking, which has been clearly shown to put people at increased risk.
Investigations of relationships with artificial sweeteners also produced conflicting results, but it's now believed that they don't play a role. More limited population studies have looked for links with consumption of fats and oils, as well as with vitamin A and beta carotene. Again, no consistent picture emerges.
Therefore the word so far is that what we eat or drink hasn't been shown to affect the likelihood of getting bladder cancer.
1991, Washington Post Writers Group