r overcome this condition should have a prominent place in
the diet. Any accumulation of unabsorbed food in the lower intestines
becomes a breeding ground for putrefactive bacteria, the product of
whose activity imposes a serious tax upon an already overworked organ.

PROBLEMS

(a) Formulate a diet for a patient suffering from gallstones. Outline
method of administration.

(b) List available foods for diets used in disturbances of the liver.
List the foods to be avoided in such cases.

FOOTNOTE:

[155] "Diet in Health and Disease," p. 399, by Friedenwald and Ruhraeh.

CHAPTER XXII

GOUT, OBESITY, EMACIATION

Gout is a constitutional disease characterized by an inflammatory
condition of the joints. It is caused by or associated with a
retention of uric acid in the blood. Gout is also characterized by the
deposit of uric acid or sodium salts which occurs in different parts
of the body, the joints, the lobe of the ear, the knee and the elbow
being common points where the deposit of these salts ordinarily
occurs. The amount of uric acid is lessened in the urine in cases of
true gout, except in acute attacks, and in this way it is
distinguished from the so-called goutiness in which a urinalysis shows
an excess of uric acid. According to Strouse, this excess of uric acid
in the urine "means a physical-chemical change in the urine and is
quite different from the small amount usually excreted."[156]

~Source of Uric Acid.~--In man the uric acid which is eliminated in
the urine is derived from two sources. It may be taken with the body
as purins in food, in which case it is spoken of as being an
"exogenous" product, or it may be formed in the body from the breaking
down of the nucleoproteins (the highly nucleated cells of the
glandular organs particularly). When the uric acid is formed in this
manner as the result of the metabolism of the body tissues, it is
known as "endogenous." In the normal body approximately one-half of
the uric acid formed is oxidized, while the remaining half is
eliminated from the body by way of the urine.

~Elimination of Uric Acid.~--In gout such is not the case, the body
loses to a certain extent the ability to eliminate the uric acid,
hence it is retained within the body, causing an excess in the blood
stream, and it is this excess uric acid in the blood which causes the
acute attacks and general pain and discomfort which inevitably occur
in chronic gout.

~Purin-bearing Fo