A friend has told me that cherries are one of the more effective natural remedies for gout as they help in the excretion of uric acid. How can I test that idea?

This is a new one to us! It may be a variation on the uricosuric effect of high doses of vitamin C, We wouldn’t recommend that you give up your prescription and rely entirely on cherries but you could test their effect if you sometimes get gouty arthritis. Without altering other aspects of your diet or drug regimen, see if the attacks are less frequent or less painful when you eat cherries regularly (two or three times per week?) over a period of a few weeks or months. The season for fresh cherries is very short, so you’ll have to find a source for tinned, frozen or dried cherries or the juice.

A medical website on the internet says that people with gout should cut down on the amount of protein in their diet. Does this help to stop the uric acid crystals from forming?

Protein is the third major component of our diet, along with carbohydrate and fat. It is essential to eat some protein every day, though perhaps not as much as Westerners often do. Proteins are biochemically completely distinct from the nucleic acids that release purines when they are digested. Nevertheless, some foods that are rich in protein are also rich in purines – organ meat (e.g. kidney, liver), shellfish, beans – so the website advice is broadly correct, with some important exceptions. For example, cheese and yoghurt are rich in protein but low in purines, while some vegetables are high in purines without being a particularly good source of protein. Eliminating meat (especially game and»organ meats) from your diet will reduce both purines and protein but you must include other proteins in your diet.

Dr Patrick Dessein, at the Baragwanath Hospital in Soweto, South Africa, has devised an eating plan that helped to reduce the frequency and severity of gouty attacks in men who were over-weight or obese but not heavy drinkers. His research suggests that it is more important to reduce the overall amount of food – to about 1,600 calories per day for a man – rather than cutting the proportion of protein. Ideally, each meal consists of protein + carbohydrate + fats, with an overall calorie distribution of 30 per cent, 40 per cent, 30 per cent respectively.

Bear in mind that each gram of fat contains about twice as many calories as a gram of carbohydrate. His regimen did not eliminate foods from group B, but group C foods were not eaten. This diet therefore combines restriction of calories and purines. The men in the study were not treated with urate-lowering drugs at the time, so they did continue to have gouty attacks, although less severely than before.