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Therefore, nutritional management should be carried out in three ways (Figure 6)

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Table 4: Reasons to use medication to lower uric acid Gout with more than two flares a year, whether due to overproduction of uric acid or difficulty excreting it Chronic visible collections of uric acid (tophi) High uric acid in the urine (over 800mg per 24 hours), especially if history of kidney stone Failure of other options to control the arthritis of gout (for example, failure of probenecid) When a person is receiving chemotherapy for a leukemia or a lymphoma and it is expected that many tumor cells will be killed (since one of the breakdown products of cells is purine which gets broken down to uric acid) iii