Why you should not stop eating chana dal (or other lentils) or other proteins in gout and arthritis ?

Gout is an arthritis which occurs due to deposition of increased uric acid into joints. If not treated well, uric acid can deposit into other organs and cause damage to other organs too. 

One of the biggest problem in gout treatment is misconceptions about gout. 

The biggest misconception for Indian population is to avoid dals, especially chana dal (split and skinned bengal gram). The Indian rheumatologists always have patients in clinics, who stop taking all dals, nuts, milk & dairy products including curd, vegetables like spinach, tomato, cauliflower, refined flour (maida), spicy food etc. These patients virtually just survive on daliya (wheat porridge), moong dal (split green gram) or boiled vegetables. They lose weight, but despite so much sacrifice on eating, they continue to have gout attacks and damage to other organs.

Let’s evaluate why this concept is wrong and can be harmful.

1. The purines in chana dals (or other legumes) and vegetables doesn’t get converted to uric acid easily

Uric acid is formed by breaking down of purines. Purines are building blocks of our DNA or genes. Purines are required for many important functions in body. Waste or excess purines may be converted to uric acid in humans. 

Dals like chana dal and vegetables like spinach & cauliflower have slightly higher purine content. So it was thought that they can increase uric acid significantly.  Now, it is well known that purines from plant sources do not increase uric acid that much. It is the purines from animal sources like red meat and sea food which has 50% more chance of increasing uric acid. Hence, you should decrease red meat and seafood, not legumes and vegetables.

• Uric acid is much more increased by unhealthy food

It is well known that red meat and alcohol can lead to excess uric acid and cause attacks. I have told you the reason above. But, junk food, like burgers, pizzas, sugary colas (like pepsi, coke, mirinda) etc, sugary juices, any food with excess sugars, fried foods, foods with refined flour (maida) etc are a much bigger reason for increased uric acid in gout patients. They also make one fat, unhealthy and put at increased risk of heart disease. We should control this things in diet rather than dals and vegetables, which are healthy. 

• Vegetables and pulses like chana dal have got protein and fibre which is good for gout patients

Gout patients are more likely to be fat, have diabetes and more likely to have heart disease. The fibre and vitamins in vegetables and dals are very healthy for the body and beneficial to avoid heart disease in gout patients.

A large study published in one of the most reputed medical journal (NEJM) studied dietary habits of more than forty thousand people. They clearly showed that vegetable food sources and dairy products do not increase risk of gout or gout attacks. Many other studies have confirmed it. The big American and European Rheumatology organisations now recommend low fat dairy products and plant food sources for gout patients. 

• Why most Indian doctors and even Ayurveda asks us to avoid spicy foods, dals, many vegetables and dairy products in gout ?

It’s mostly because they are unaware of new evidence and research. They are probably still following old concepts. Ayurvedic doctors still believe that milk and cold foods cause arthritis. This has been proven totally wrong with research of more than 100 years now.

• For Indians, pulses (dals) are major source of protein – stopping it in gout patients can be harmful

Indian diet is predominantly vegetarian. Even an average lower and middle economic class non-vegetarian person in India, mostly eats vegetarian food. They at any given time do not consume more than 30-50 grams of dals per day. This quantity is too low for causing any significant increase in uric acid. Dals or legumes become more important source of protein in  gout patients as they have to decrease non-veg in their diet. Stopping dals and vegetables does more harm than good. 

• Gout is genetic disease. Most patients will have to take medicines anyways.

In gout, increase in uric acid and its deposition is caused by genetic causes along with unhealthy diet. Thus, even if you stop eating all foods with purines, then also your uric acid might keep on increasing and causing gout attacks. 

6) Why did I have relief in gout attack when I stopped dals ? 

The initial few gout attacks are very painful, but they last for very short period. So, even if you stop something or don’t stop something, the attack will go away. It won’t come back for many months. 

But the uric acid is depositing in your body due to genetic tendency. Later, even if you stop all the dals, meat, alcohol and dairy products you will still have gout attacks if you are not taking proper treatment. 

• High uric acid doesn’t mean you have gout. You need to make lifestyle changes for same.

High uric acid doesn’t mean you have gout. Gout is only said to occur when you have arthritis due to uric acid deposition. Uric acid doesn’t cause minor aches and pains. It’s again a misconception. 

But higher uric acid can mean you are having poor life style with unhealthy diet and not much physical activity. You need to have a general healthy diet without much junk food and do some form of exercise. 

• What do I have in gout then ?

First confirm if you have gout. Take help of a rheumatologist if required. Most doctors in give medicines for uric acid without one having gout, which is incorrect. You don’t need to take medicines just for increased uric acid. Uric acid itself does not cause harm without have genetic tendency for gout.

If you have gout or very high uric acid, then limit red meat and alcohol in diet. Avoid junk food as above in diet. Avoid sugar in form of colas, sweets or juices. Eat more vegetables,  nuts, whole fruits, legumes (pulses/dals, beans etc) whole grain cereals (wheat, oat, barley etc, not refined flour like maida). Drink lot of water as it washes uric acid. Low fat milk and yoghurt is also very good for gout patients.

Do some form of exercise, simplest form is walking.

Take your medicines properly if you have gout. Remember gout has genetic component. 

‘Reach for six’ in gout : You have to keep uric acid below 6 to stop gout attacks. Uric acid deposits into organs above 6mg/dl. Note that normal person can have uric acid 7mg/dl. Only gout patients need to keep it below 6. One might require a medicine like Zyloric (allopurinol) or febuxostat lifelong for that. If you take your medicine properly, you can have limited quantity of meat and alcohol too.