Dietary Management for Uric Acid, Gout, and Food Sensitivities

Uric Acid Stones: Causes, Treatment, and Diet

Uric acid stones are associated with the production of acidic urine.

Treatment for Uric Acid Stones

• Increase fluid intake.
• Increase urine pH to 6.0-6.5.
• Adopt a diet rich in alkaline-forming foods, supplemented with citrate or bicarbonate.

Dietary Considerations for Uric Acid Stones

Acid-Forming Foods (Potentially Acidic Residue)

• Meat: Beef, fish, game, seafood.
• Dairy: Eggs, cheese.
• Fats: Bacon, walnuts, Brazil nuts, hazelnuts.
• Grains & Baked Goods: Flour, bread (especially whole wheat), cereal, biscuits, pasta, rice, cakes.
• Vegetables: Corn, lentils.
• Fruits: Blueberries, plums.

Alkaline-Forming Foods (Potentially Basic Residue)

• Dairy: Milk and milk products, cream, whey.
• Fats: Almonds, chestnuts, coconut.
• Vegetables: All types (except corn and lentils).
• Fruits: All types (except blueberries and plums).
• Sweets: Molasses.

Neutral Foods

• Fats: Butter, margarine, cooking fats, oils.
• Sweets: Simple sugar, syrup, honey.
• Drinks: Coffee, tea.

Hyperuricemia and Gout Management

Traditionally, gout management involves a low-purine diet. Approximately 85% of uric acid formation is endogenous and not significantly influenced by dietary regulation.

Acute Stage Gout Management

• Restrict foods rich in purines, avoiding exogenous purine intake.
• Increase fluid intake (3 liters per day) to aid uric acid excretion and minimize kidney stone formation.
• Maintain a diet relatively high in carbohydrates, moderate in protein, and low in fat (compatible with individual requirements).
• Tofu can aid in the cleansing and excretion of uric acid.

Purine Content in Foods

Group 1: High Purine Content (100 to 1000 mg purine/100 g food)

• Anchovies, herring, broth, bouillon, heart, scallop, meat extracts, goose, fish eggs, brewer's yeast, mussels, partridge, kidney, sardines, brains.

Group 2: Moderate Purine Content (9 to 100 mg purine/100 g food)

• Meat and fish (except those listed in Group 1).
• Mushrooms, asparagus, spinach (in particular).
• Pulses (peas, lentils).

Group 3: Negligible Purine Content

• Carbonated drinks, cereals and cereal products, coffee, tea, spices, chocolate.
• Fats, oil, butter, or margarine (all in moderation).
• Bread, biscuits, cakes, pasta, cheese.
• Vegetables (except Group 2), fruit, milk.

Immunological Components of Breast Milk

Breast milk contains vital immunological components that protect newborns.

Key Immunological Components

• Immune Cells: Various types of immune cells.
• Antibodies: IgA (predominant), IgG, IgM, IgD, IgE.
• Lysozyme: An antimicrobial enzyme.
• Lactoferrin: An antimicrobial and iron-binding protein.
• Interferon: Antiviral proteins.
• Complement Factors: Proteins that aid in the destruction of bacteria.

Undigested Proteins in Newborns

Due to a higher stomach pH (approximately 4.0) and low pepsin activity in newborns (compared to an adult pH of 2.0), proteins can escape complete digestion. This is beneficial as it allows milk antibodies to survive in the stomach and reach the infant's intestines intact.

Colostrum and Milk Composition

Colostrum, the first milk, is rich in antibodies, including IgG, IgA, IgM, IgD, and IgE. These antibodies can bind to bacteria (e.g., E. coli) and aid phagocytosing leukocytes. Mature milk contains approximately 12 grams of protein per liter, of which 1-2 grams are IgA.

Adverse Reactions to Food

Adverse reactions to food can be broadly categorized as toxic or non-toxic.

Types of Adverse Food Reactions

• Toxic Reactions:
  • Poisoning: Natural toxins (e.g., fungal toxins) or contamination (e.g., insecticides).
  • Foodborne Illness: Enterotoxigenic or invasive pathogens (e.g., viral infections).
• Non-Toxic Reactions:
  • Immunological (Food Allergy):
    • IgE-mediated.
    • Non-IgE-mediated.
  • Non-Immunological (Food Intolerance).
  • Psychosomatic Reactions.

What Are Food Allergies?

Food allergies are abnormal body reactions to the ingestion, contact, or inhalation of food, characterized by an immunological response. They are typically characterized by three phases:

1. Initial contact with the allergen.
2. Increased immunoglobulin E (IgE) production.
3. Triggering of allergy symptoms upon subsequent exposure.

Sources of Food Allergens

Proteins are typically the source of allergenicity, with approximately 200 allergens identified to date. Reactions in individuals vary and depend on factors such as: the amount of allergen ingested, food habits, age, and geographical area. Severe allergic reactions can be life-threatening.