Chicken stock - purine content and gout
I'm very proud of my chicken stock. I mostly follow the instructions from Edna Lewis in The Gift of Southern Cooking. I hack the birds with a cleaver until my work area looks like a crime scene, add plenty of carrots and onion, but I cook it much longer than Miss Lewis does, and my stock is rich and flavorful and sets up like Jell-O in the fridge.
But I'm getting over a gout attack stupidly brought on by a week of cooking and eating (1) red kidney beans cooked in that stock with ham & sausage, (2) lentil & sweet potato dal, and (3) shrimp creole. I'm studying up on gout and purine content of foods and see what bad choices I bundled together.
I don't know whether my chicken stock rates as medium or high concentration of purine. I'm afraid that the richness of it caused by chopping the meat & bone into smaller pieces with larger surface area and long extraction times means a higher purine content. What do you think?
Gouty Boy here: I've been taking a daily dose of colchicine for a few years - except now it's Colchrys and expensive, but that's a different topic - and unless I get silly I don't get any flare-ups. "Silly" includes a lot of my favorite things, especially broths made with lots of bone and connective tissue, so I keep consumption of any meat soup down to a minimum. Sadly, this precludes my checking out all the great ramen places that are popping up around L.A., since that glorious broth they rave about is made from VERY long-cooked pork bones.
My worst attack, though, was after making and eating a mostly-vegetarian dish: it was my tofu curry thing, usually made with onion, tomatoes and zucchini, the Thai green curry sauce from Trader Joe's mixed 50-50 with coconut milk, and tofu cubes marinated in fish sauce and Sriracha. This time I used cubed eggplant and green beans as the vegetables and added the marinade to the sauce … so that was three no-nos right there. Eggplant and green beans are both on the AVOID list, and fish sauce is made by fermenting anchovies, also to be avoided. Deciding to have a beer with it was another very bad idea …
re: Will Owen
For me any connection of foods versus gout attacks is tenuous to unstable. If I banned everything that shows up on any avoid list, I would have practically nothing to eat. Drinking plenty of water is important, though.
One problem is that high uric acids levels may come from the body's production of uric acid, efficiency of excreting uric acid or both. I suspect that this variability is why studies of diet versus uric acid may be so indeterminate. My internist said that the only way to tell for sure between production and excretion is a 24-hour urine collection and analysis study, which is probably a waste of effort as the treatment is likely to be the same anyway.
Aspirin tends to inhibit excretion. Thiazide diuretics tend to increase blood uric acid levels, but I do not know the mechanism. Colchicine is notorious for causing diarrhea. I can handle two pills the first day of an attack but no more than one pill at least 24 hours apart after that.
re: Eldon Kreider
I was told by my doctor that if your problem is excessive production the medicine indicated is allopurinol, and if it's lack of excretion then colchicine is called for. At the urging of a gouty friend, a pharmacy assistant who despises colchicine, I asked for an experimental prescription for allopurinol. About three hours after my first dose I had an attack, and that was the end of that.
I have a much better tolerance than you for colchicine - hardly anything in the way of stomach upset, and when I get that light touch of diarrhea the flare-up goes away almost immediately.
re: Will Owen
My doctor said that you need to take colchicine daily for three weeks before you start allopurinal and three weeks after or there is a risk of a gout attack in all joints. I did not get to that point because changing my blood pressure medication mix and reducing the dose of aspirin for heart attack prevention dropped my uric acid level far enough that allopurinal was not needed.
Alcohol in the form of wine with dinner does not seem to be a problem, but I have not been willing to risk full bodied craft beer or ale.
People's responses to foods do seem to be quite ideosyncratic.
I found the solution to curing my gout. I swear I am not trying to sell anyone on anything. I am just trying to be helpful. I was suffering horribly from gout for years and tried everything including medicine, cherry juice, and pineapple. But it all came down to one thing I finally discovered. One thing that has allowed me to eat whatever I want including broth, lobster, steak and so on. The answer is water. I was obviously not drinking enough water and I suspect most people who suffer from gout are too lazy to drink enough. They keep drinking soda and juice and think that makes up for the water. Part of the problem for me was I didn't like the taste of my water at home so that caused me to skip the water. Then I went to Target one day and bought this thing called a ZeroWater and I instantly fell in love with the taste and started to drink much much more water. I then began to notice when I started having gout flare ups I could curtail and stop the effects by just drinking more water. Now I don't know if it is because the water is more akaline or if the water just taste so much better that I am finally drinking enough water to flush out the purines from my system. If you are suffering from gout I highly suggest cut out the disgusting soda and just drink water every chance you can, like 8 to 10 glasses a day.
I've also been dealing with gout and have been taking a hit-or-miss approach with recipes. So far:
1. I've used stock concentrates with no ill effects.
2. I can eat ONE shrimp with no ill effects; two and I get a twinge in my foot; three and it swells up. Same for mushrooms.
3. As far as legumes are concerned, I've eaten red beans and rice with no ill effects. However, a bowl of lentil soup will practically put me in the hospital. Same with black eyed peas. Oddly enough, using Hambeens 15 Bean Soup, I can eat a bowl with no side effects.
4. I have at least one beer/wine/hard liquor drink a day, sometimes two. No ill effects. Yet.
5. Dark meat chicken has no effect; half a chicken breast, and I get a gout attack. In lieu of stocks and reductions, I tend to just drizzle some of the pan juices over the meat with no ill effect.
6. Organ meats (gizzards, livers, kidneys, sweetbreads) are a no no. I will however, once a year, indulge in sweetbreads since, for me, it's worth the temporary discomfort.
Keep in mind, one person can eat a particular purine rich food and have no reaction, while another can eat the same stuff and their foot blows up. Caveat emptor. When I do get an attack, I consume lots of dried and fresh cherries and plenty of water, and the swelling goes down in a few days. I've tried one of the remedies (lemon juice and warm water in the morning) but can't say it's had much effect. I've got a prescription for indomethacin and it works within 72 hours, but the side effects (dizziness, nausea) make that a last resort. If you check online, pretty much EVERYTHING has some level of purine, so unless you want to subsist off celery and water, it's all a matter of moderation and experimentation.
oh monkeyerotica, can we limp together from the kitchen to the table and back?
I grew up on the Mississippi Gulf Coast between Biloxi and Mobile, my red beans are from Camellia, and the last batch had a pound of sausage, at least a pound of ham, about a quart of that Jell-O thick chicken stock, and plenty of sauteed onion and garlic. T'weren't just beans in my bowl.
Shrimp? Don't break my heart! My parents still buy brown gulf shrimp on the docks for the whole family, and nobody can eat just one or two!
Thanks monkey, "Keep in mind, one person can eat a particular purine rich food and have no reaction, while another can eat the same stuff and their foot blows up. Caveat emptor." YES, it's very much individualized, and I very much appreciate everyone's help.
This is what wikipedia had to say:
Dietary causes account for about 12% of gout, and include a strong association with the consumption of alcohol, fructose-sweetened drinks, meat, and seafood. Other triggers include physical trauma and surgery. Recent studies have found dietary factors once believed to be associated are, in fact, not; including the intake of purine-rich vegetables (e.g., beans, peas, lentils, and spinach) and total protein. The consumption of coffee, vitamin C and dairy products as well as physical fitness appear to decrease the risk. This is believed to be partly due to their effect in reducing insulin resistance.
Your gout flare-up could well have been caused by the shrimp. Consider ruling that out before ruling out the chicken broth. Here are a couple of links, googling will turn up more:
I've had gout about 12 years now and through trial and error I've discovered a few factors that set off an attack for me personally...
1) Dehydration. This is the absolute 100% biggest factor by far. If I get dehydrated over a length of time like a long weekend etc. where I just don't pay enough attention to drinking water it will lead to an attack every time. The science is simple in that it concentrates the uric acid in your blood to a much higher level than normal. At the same time when you get dehydrated over a period of time you often aren't eating correctly and tend to lose some weight. Which leads to...
2) Losing weight. If exercising or dieting you need to be careful because when you burn fat uric acid which was stored in the fat cells are released into your blood stream.
3) This one is just though personal experience, but I find eating pork or shellfish raises the chances of an attack noticeably compared to other proteins. I have no idea why, but am positive about it for me personally anyways. I find vegetable proteins like beans and legumes have almost no effect on my gout at all and I can eat as much as I like. But Ièm a die hard carnivore and have been eating more duck, lamb and game as well as chicken and fish and havenèt had any problems in years.
I've found some herbal supplements (http://www.goutcure.com/) that work far better for me personally than any prescriptions or other drugs Ive tried.
I'm no gout expert but a quick web search suggest that in the future you stick with a vegetable stock:
"Why are gravy, meat extracts and broth so high on the list of don't eat?The reason is because the purine is leached out in the cooking process so when you make gravy from the drippings of a roasted chicken the drippings have concentrated amounts of purine leached from the chicken, It is the same for meat extracts and broth. Most people would agree that the gravy is the most yummy part of the roasted turkey or chicken. A pot roast of beef is delicious because of the gravy. Just keep in mind that gravy, broth and meat extract are concentrated purine. Check cans for concentrated meat extract."