DEAR DR. ROACH: I have gout in my big toes. Does uric acid cause gout? Also, I read that gout is caused by red meat and seafood. Is only shellfish considered seafood, or any fish, such as haddock and salmon? — D.E.B.

ANSWER: Gout is a disease associated with uric acid crystals (strictly speaking, it’s monosodium urate, the sodium salt of uric acid). They are deposited in soft tissues, joints or bones. It often is seen in its acute phase, commonly in the first joint of the big toe, where it is exquisitely painful, red and swollen. However, some people can have a chronic form of gout, with uric acid crystals visible in the soft tissue, often in cool areas of the body, such as the ears and hands. These depositions are called “tophi,” and the condition is called “tophaceous gout.”

A diet high in purines (a chemical that gets broken down into uric acid) can precipitate a gout attack in people who are genetically predisposed. There are many foods that have high amounts of purines. I recommend the discussion about this from the Mayo Clinic (at https://tinyurl.com/gout-foods). Some meats are much more likely to cause problems, including organ meats, some seafood (scallops and haddock are bad, salmon is not), and alcohol. Too much protein of any kind needs to be avoided. People with recurrent gout (or with very high blood levels) should be on medication to prevent problems.