Thirty-eight-year old Ram Bahadur woke to find his big toe red, tender, swollen and excruciatingly painful. Even the weight of the sheet covering his foot seemed intolerable. Thinking he might have stubbed it somewhere, he tried to ignore it and left for the hotel where he worked. As the day progressed, so did the throbbing pain in his foot, so much so that by lunchtime he was hobbling in agony and had to go see a doctor. The doctor examined his foot, ordered some blood tests and declared that Ram Bahadur in all likelihood had gout.

This vignette happens all too regularly here. Gout (sometimes non-specifically called 'baath' in Nepali) is a very painful type of arthritis which often starts at night, probably due to a lower body temperature, and is caused by high levels of uric acid in the blood that crystallise and are deposited in the joints, tendons, and surrounding tissues. Although not always a reliable test, uric acid in the blood is often checked to diagnose gout. Certain foods such as red and organ meat, fish, 'geda gudis', alcohol and sugary soft drinks increase the risk of gout and eliminating most high-protein food from the diet usually helps. But this is not always practical. Many gout sufferers also avoid tomatoes and spinach, but science has dismissed this belief as baseless.

Some medicines like diuretics, commonly used to treat hypertension, and even low-dose aspirin, can increase uric acid levels so avoidance of these medicines can help. Certain diseases and conditions make it more likely that you'll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood, and kidney problems.

Although the exact number of gout sufferers in Nepal is not known, gout attacks are common and seem to afflict us at a younger age (less than 40 years) than what is usually noted in Western medical textbooks (over 60 years). The reason for this predisposition is not known.

Just avoiding certain types of food and alcohol may not be enough to avoid the type of acute gout attacks that Ram Bahadur suffers from. If you get more than two or three such painful attacks a year, it may be prudent to consider taking medicines long term to prevent gout and other related complications such as kidney stones. Effective drugs like Allopurinol that have been tried and tested over many decades are available, but they need to be used under the proper supervision of a competent doctor.