The Doctor's Consultation: by Dr. Iain Corness
The diet for gout sufferers
A few months ago I covered a diet for dentures. This week
it is a diet for those with gout, and there are far more of you than you
might imagine. If you are a sufferer, then you join with Henry VIII,
Benjamin Franklin and Thomas Jefferson.
It is indicated in around five percent of all cases of arthritis and is
present in around three to five percent of the population, with males
outnumbering women around nine to one. Afro-Americans and many Asian races
also have higher incidence than Caucasians.
Gout is, in its simplest fashion, a recurrent form of arthritis, and which
generally affects just one joint - most commonly the joint in the big toe.
This arthritis, or inflammation, occurs in association with high uric acid
levels in the blood, and is described as ‘exquisitely painful’.
It is a condition that is still being researched, and there is still no
complete agreement on the preventive treatment for this condition.
The higher the concentration of serum uric acid (SUA), the more likely you
are to get an acute attack. The ‘normal’ range for SUA is taken as less than
0.42 mmol/L (called ‘milli moles’ per liter), but if your concentration is
0.54 mmol/L then you are five times more likely to get gout.
Basically what happens is that with high concentrations of uric acid it
crystallizes out into the joint, leaving very sharp, needle-like crystals
crunching inside the articular surface of the joint. Very painful!
The typical gout sufferer is male in his 50’s, overweight, with high blood
pressure, carnivorous and consumes large quantities of alcohol. Is that you?
Gout affects almost four million men in the USA. It has long been thought
that purine-rich foods and a high protein intake are risk factors, and
sufferers are advised to avoid meats, seafood, purine-rich vegetables, and
animal protein. But this advice was based more on the theory of how excess
blood uric acid can occur, rather than actual clinical studies.
One of the newer studies began on over 50,000 men from health professions in
1986. Food-frequency questionnaires were sent out at baseline, and in 1990
and 1994. Weight, medications, and medical conditions were recorded every
The participants were assigned to groups according to the total intake of
meat, their consumption of seafood, purine-rich vegetables, dairy products,
low-fat dairy products, total protein, and animal protein.
During the study, there were 730 new cases of gout during the 12 years of
low-up. Most of them were aged 55 to 64.
When total meat consumption was analyzed, the risk of acquiring gout was
1.41 times greater in the high meat eaters; in other words, eating more meat
was a risk factor for gout. Similarly, high seafood eaters were 1.51 times
as likely to develop gout. (Grass should be fairly safe to eat!)
In contrast, gout was less common in those taking more dairy products. Men
who drank two glasses a day of skim milk, or ate a serving of low-fat yogurt
more than twice a week, halved their risk of developing gout.
In this study at least, purine-rich vegetables, and total protein had no
influence on the chances of getting gout.
This large study confirmed that a diet high in meat and seafood increases
the likelihood that a susceptible person will develop gout. It also showed
that milk proteins increase the excretion or uric acid in the urine.
So, to avoid developing gout, try to limit your intake of meat (beef, pork,
lamb, and offal) and seafood, while increasing your intake of low-fat dairy
produce (skim milk, yogurt).
This is all very important, as the long term outlook is not good for the
unrepentant gout sufferer. Constant high levels can lead to uric acid
‘stones’ being deposited in the kidneys (producing renal problems) and even
discharging lumps (called ‘tophi’) around joints, on the forearms and even
on the outer ears. Really a most bleak and depressing future, and not one
I’d like to have.
Note too, that it is low-fat milk that is being proposed, as high fat milk
introduces the cholesterol problems again! It really is a fine line that we
must all tread!
Susy is special
Susy is blind. She comes under the category ‘Dogs with Special
Needs’ but really she just needs a warm bed in cold weather, a shady
spot in the hot months, fresh water close by, some nice food, and
someone who cares enough to give her all these. Contact the shelter
English (08 47 52 52 55) or Thai language (08 69 13 87 01) to make
an appointment to meet her.
Heart to Heart
I met my Thai wife in a bar in 2004. We are married and living in the
USA. We will move back to Thailand soon. She speaks very good English
now, and I speak better and better Thai. She works here in the US as do
I. We are, and have been very happy. She has become an expert skier as
we live in the mountains. Wonderful girl! She is 31 and I am 68!
R & N
Dear R & N,
Well thank you, Petals. It is good to get the other side of the coin
flipped, even if it is generally in the minority. I am glad to see that
your Thai wife has also used the six years to learn some new skills,
such as English and skiing. However, I hope that you just watch, I think
you’re just a little over the limit for snow skiing, even though you are
not too old for some of the other exercises! And think of this as an
advantage, when she turns 60 and gets the pension, you will only be 97.
I have been married to my Thai wife for eight years and together for 10
years. We don’t live in UK but KSA, in fact my wife loves the Middle
East, as I do, and we have worked very well together here. We go on hols
to Thailand three times a year and occasionally visit UK and other
countries. I am a very happy man and I know I have a diamond.
Yours was the second email on this subject to come in on the same day,
dealing with the same situation, and at first I wondered if you were the
same person as the letter above yours. However, living in KSA you are
not likely to do much skiing, other than sand slides. I am pleased to
hear that your marriage has been made in heaven, but you did not say how
you met your little diamond, who is not a cubic zirconia. Knowing that
might be an example for all the love-sick swains who write to me. All
My Thai GF no sooner finishes eating than she’s ready to go again. She’s
as thin as a rake, but eats all the time. Her mates are all just the
same, finish one round and they’re ready for the next. It gets me, I go
out after the third course. What’s the secret, Hillary?
Is that “wondering” or “wandering” I wonder? What do you do between
courses four and five? No, Petal, eating is more than just a meal for
your Thai GF, it is a very social time when friends can get together and
share the food. That can occur at any time of day or night, but the food
they eat, such as the favorite som tam is not high in sugar and
calories, so that’s why your GF remains thin. The chili also hurries the
food through the system. As the TV program warns, “Don’t try this at
home!” The real som tam can be far too spicy for foreigners.
Everybody must know by now if they read you column that there is a
difference between the girls who work in the bar and the girls who work
in regular jobs. What you say is for us to look for female company from
the regular job girls. What you don’t say is that the regular jobby ones
can’t speak English, are difficult to meet or get to know, while the
ones who work from the bars can speak English and are easy to meet and
are easy to get to know. For my money, give me the bar girl every time.
How astute of you, my Petal! Yes, there are great differences, and even
more than the ones you mention, even such things as educational level.
If all you are looking for is some female company, then the bar is the
right place, but the problem comes when the customer (guys like you)
then falls in love with their English speaking, easy to meet and know
girl, and forget the fact that they are customers, not boyfriends. Thai
girls do not choose to work out of a bar unless they are looking for
quick money, without having any necessary qualifications to put them in
high salary jobs. They are using their looks, their (presumed) sexuality
and their ability to get money from their customers. You are paying for
a commodity by meeting the fees demanded. When you fall in love with
someone who is used to being fully paid for, the relationship is not
really on the emotional plane, but in the financial one. And like all
business deals, you can get burned. And many like you do. As you wrote,
“For my money, give me the bar girl every time.” And that’s what it is,
Petal, your money and you are entitled to spend it any way you please,
but don’t complain if you find it has all gone, and the girl’s
“affections” with it. There is a phrase in business called ‘due
diligence’. Apply it, Petal.
by Harry Flashman
How to get ‘professional’ pictures
all things in this life, practice makes perfect. It is the same
for photography - the more photos you take, the better you
become as a photographer.
Sometimes I find some old photographs that I took as an
enthusiastic amateur, and I am sorry to say that there are very
few that I am proud of. The concepts I explored were good. The
delivery of those concepts was not.
I have written before about how a friend delivered a very
expensive camera outfit to me on his return from an overseas
trip. I had asked him to enquire how much the Hasselblad cameras
were in the duty free stores, but he decided that I had
empowered him to buy one on my behalf. In the long run that was
a good decision, but in the short term it was a huge financial
drain, just when I didn’t need it. It was at that moment I
decided that the Hasselblad was going to have to pay for itself.
And if it were to bring in money, it meant I was going to have
to become good enough to charge for my photographs.
The next step in my photographic career was to go to all the
bookstores and purchase books on photography. Initially I was
selecting ‘how to’ books, especially those which gave examples
of photo projects. These I devoured until I could reproduce the
results that professional photographers like Michael Freeman
explained in his instruction books.
After that I began to give myself my own project subjects,
imagining, for example, that I had been hired to do the
photography for a catalogue of artificial flowers. I had a
friend who did import these, so it was not too difficult to
borrow some for my own photo shoot.
In this way I learned to shoot to a layout and was able to size
the photo illustrations to fit. I also, from the books, learned
how to set up a small studio at home in the spare bedroom. Rolls
of background papers were found and the catalogue items
photographed against them. I had no expensive flash heads, but
used internal reflector tungsten lights. I very quickly learned
how this changes the overall color of the shot, and how by using
blue gels I could correct for the overly warm tones of the
tungsten lighting. I also learned to be critical of my own
By this stage, I began to give myself projects to be
photographed outside. These were mainly “advertising” style of
shots with models in some physical setting, looking like a
fashion style of layout. Fortunately there were enough amateur
would-be models wanting to parade in front of the would-be
photographer’s lens in return for a few prints. We all learned
I also began to learn to use shadow, instead of bathing the
models in floodlight (or the sun). All of a sudden, my shots
began to have an air of mystery and were starting to look
professional, as well as now having a 3D look to them. Shadow is
the photographer’s friend!
Eventually I was ready to present my work as a professional, and
to do this you place your best shots together, which is called
your ‘book’. This is not a real book, but should show your work
in the best possible way. The local photographic equipment store
showed me some ‘books’ belonging to semi-pro shooters and I made
the decision to present only transparencies (slides), but a
minimum of 6x6 cm (the Hasselblad size, otherwise known as two
and quarter inch square), with the rest 5x4 inch. This made it
look as if I had a 5x4 camera, which I didn’t, but the
Hasselblad transparencies were sharp enough to be duplicated and
enlarged (known as ‘dupes’ in the trade).
I bought a portable light box, mounted all the transparencies on
heavy dark card so that they could be thrown on the light box
for viewing, and I was ready to meet the art directors - the
people from the ad agencies who dole out the work to the
photographers. Eventually one gave me an assignment, and I went
on from there. Get one and the rest are easy.
Money Matters: Paul Gambles
MBMG International Ltd.
The New World Order, part 1
In times gone by, investors always believed that it the only
way to run a portfolio was to have a 70:30 ratio of equities and bonds - in that
order. This method of investing should now have gone the way of the dinosaurs.
There is a simple but effective way of investing these days and that is going
with multi-asset, multi-manager funds. However, what the canny investor needs to
also do is see how the manager of these funds decides which funds to use.
Up until recently, the average investor always assumed that the Emerging Markets
were very much a large rick area and so only a small weighting of a portfolio
should be dedicated to them. However, over time it is these Emerging Markets
that have saved portfolios on many an occasion although I am the first to admit
the ride could well have been more than a tad bumpy.
It is because of these potential returns that more and more people are now
looking at the Emerging Markets with more interest. Up until now, as stated
before, these were only a small part of anyone’s investment. However, the
problems of the old traditional western markets that have shaken the more
established markets to the core have persuaded people to look elsewhere for
their returns. As one fund manager at Miton recently said, “Many investors (are
looking) to reassess both the absolute risk associated with emerging market
investments, as well as the risk relative to other asset classes, especially
previously perceived safer developed market assets.” He also went on to state
that, “We have been gradually increasing our exposure to emerging markets … over
the last 12 months.”
The other piece of good news for new investors is that it is becoming much
easier to actually invest in this particular asset class. Also, liquidity is
getting better as many funds are no longer asking people to tie their money up
for a certain length of time. One caveat to this though is that it is difficult
to discern if these Emerging Markets are getting more attention because of the
fact they are more accessible or if it is just they are receiving more interest
because of more investor demand.
These days there are loads of investment trusts, open-ended funds and Exchange
Traded Funds (ETF), etc., which are available to investors. These offer the
possibility of investing in index trackers, equities, bonds, commodities,
property and currencies which are either hedged or not as the case may be. Also,
potential investors can also dip their toes into the Emerging Market scene by
putting their money into companies which are in major indices such as the Dow
Jones or FTSE. This indirect approach by the more cautious investor will allow
them to access what is developing in the world of Emerging Markets whilst at the
same time allowing them to deal with companies that use well known, transparent
and accepted western business practices.
Why is there this new interest in Emerging Markets as an attractive asset class?
Simple. The economic outlook for these places seems to be a lot more favourable
than the actual developed markets and good looking economic fundamentals show a
healthy state of affairs for risk assets.
Naturally, there have to be some concerns. The politicians and economists in
charge of the Emerging Markets must be careful and they have to ensure their
countries respective economies do not overheat as this could create pressure on
local interest rates. This may create a dilemma for the potential investor as
he/she knows the returns could be a lot more than the older markets but then so
is the risk. However, there has been a great improvement over the last ten or so
years with excellent Finance Ministers like Korn Chatikavanij, who won "Global
Finance Minister of the Year" from The Financial Times' Banker magazine last
year, leading the way.
So, why are things looking so rosy for the Emerging Markets and developing
countries? Two very important factors are population growth and productivity.
Much of the developing world is benefitting from the former and good demographic
trends - an expanding working age population which has come from urbanization
and natural evolution. This means more and more young people are starting to
join the workforce. Goldman Sachs have recently calculated that in India, the
demographic trends will contribute four percent of annual Gross Domestic Product
To be continued…
The above data and research was
compiled from sources believed to be reliable. However, neither MBMG
International Ltd nor its officers can accept any liability for any
errors or omissions in the above article nor bear any responsibility for
any losses achieved as a result of any actions taken or not taken as a
consequence of reading the above article. For more information please
contact Paul Gambles on [email protected]
How does your garden grow?:
By Eric Danell,Dokmai Garden
The hog plum (Spondias pinnata, ’makok’) is a tree native to the dry
savanah-like forests surrounding Chiang Mai. It is sometimes called ’Thai
olive’, but that is a confusing name. The fruits of the hog plum resemble
quail eggs, greenish with dark blotches. They can be seen in the Chiang Mai
markets from December-February. The fragrance is quite appealing, fruity,
but when you bite a fruit you will have an astringent sensation, not very
pleasant, at first. One or two seconds later, the initial flavours degrade,
resulting in new flavours, which in turn degrade, resulting in another wave
of flavours. There is also a peculiar oscillation between swetness and
acidity. The Thai family Seehamongkol like to stock this fruit in the
freezer when available, so they can use it in their Esan-style papaya salad
all year round. The flowers and the young leaves are edible too. The wood is
soft and not termite resistant.
The tree itself is a member of the mango family (Anacardiaceae). It grows
quickly, and does not need any special attention, being well adapted to our
climate. The bark of young trees is quite lovely, silvery and wrinkled, like
the skin of an elephant. The leaves are compund leaves with many leaflets.
Without water the tree sheds the leaves like so many other local monsoon
The other member of the Spondias genus native to Chiang Mai is Spondias
lakonensis (’maho’ in northern Thai). It has a coppery bark. An American
forester visiting Dokmai Garden remarked that of all our trees, this was his
favourite, due to the lovely bark. I was happy somebody noticed this tree,
because sometimes I fear I dispaly plants without any audience. The fruits
of this tree are edible too. www.dokmaigarden.co.th.