Gout

Diet is the most important & effective way to manage the disease

Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat.

An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure.

Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. According to global statistics, one in four people with gout has a family history. Men are more likely to suffer from gout than women, while postmenopausal women are more likely to develop gout. A gout diet may help decrease uric acid levels in the blood.

While a gout diet is not a cure, it may lower the risk of recurring painful gout attacks and slow the progression of joint damage. How does gout develop? Uric acid is normally cleaned out of the blood by the kidneys and passes out of the body along with urine. However, high levels of uric acid can accumulate in the body, either when the kidneys excrete too little uric acid or when the body produces too much uric acid.

This condition is known as hyperuricemia, according to the NIH. The high concentration of uric acid in the blood will eventually convert the acid into urate crystals, which can then accumulate around the joints and soft tissues. Deposits of the needle-like urate crystals are responsible for the inflammation and the painful symptoms of gout.

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout. 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, metabolic syndrome, and heart and kidney diseases. If other members of your family have had gout, you’re more likely to develop the disease.

Gout occurs more often in men, primarily because women tend to have lower uric acid levels.

Symptoms cholecystectomy

The signs and symptoms of gout almost always occur suddenly – often at night – and without warning. They include:

• Intense joint pain: Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands, and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort: After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness: The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion: Decreased joint mobility may occur as gout progresses.

Gout and hypertension

Gout is a very common form of arthritis. It is caused by elevated levels of uric acid in the blood. Uric acid is produced as a byproduct of the body breaking down chemicals called purines which are found in food. It can crystallize and form painful deposits in the joints, usually the big toe. Occasionally, gout is associated with other conditions such as high blood pressure, also called hypertension.

There are two reasons for this:

• Certain medications for high blood pressure are diuretics. Diuretics increase the body’s water and sodium excretion. This allows the blood vessel walls to relax, alleviating high blood pressure. However, this can also cause an increase in the blood uric acid concentration.
• High blood pressure, if left untreated, is a risk factor for developing gout.

Usually, medications for high blood pressure will not cause gout, but they can exacerbate an existing gout condition.

Tips for avoiding gout and alleviating high blood pressure:

• Lose weight: Many studies have shown that being overweight is very detrimental to your health. Excess weight exacerbates gout and high blood pressure. Talk to your health practitioner about designing a safe and effective weight loss program.
• Stop drinking alcohol: Alcohol, especially beer and wine, is high in purines, acts as a diuretic, and interferes with the body’s ability to excrete uric acid.
• Avoid foods high in purines: Red meats, organ meats, legumes, and shellfish are high in purines.
• Talk to your health practitioner about switching your medications for high blood pressure if they might cause gout.
• Stay hydrated: Drink at least 64 ounces of water each day. Dehydration allows a higher blood uric acid concentration.
• Follow a low-sodium diet: High levels of sodium contribute to high blood pressure.
• Quit smoking: Smoking also contributes to high blood pressure.
• Eat a healthy diet: Avoid purine rich foods, and make sure to get plenty of fruits and vegetables. Avoid foods high in fat, saturated fat, and cholesterol.
• Take a multivitamin: Research shows that certain nutrients like potassium can help reduce blood pressure, and a restricted diet can leave out certain nutrients.
• Be sure to talk to your health practitioner to design a program for managing your hypertension and preventing gout. Do not stop taking any prescription medications without first consulting your health practitioner.

High uric acid level

A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Normal uric acid levels are less than 6.0 mg/dL (female) and less than 7.0 mg/dL (male). The patient’s lifelong nutrition contributes significantly to high uric acid levels in the blood; hence, the diet is the most important way to reduce the severe pain episodes that occur to patients with gout.

Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol.

Other less common causes are a diet high in purine-containing items or your body producing too much uric acid.

Factors that may cause a high uric acid level in your blood include:

1. Diuretic medications (water pills)
2. Drinking too much alcohol
3. Genetics (inherited tendencies)
4. Hypothyroidism (underactive thyroid)
5. Immune-suppressing drugs
6. Obesity
7. Psoriasis
8. Purine-rich diet — liver, game meat, anchovies, sardines, gravy, dried beans and peas, mushrooms, and other foods
9. Renal insufficiency — inability of the kidneys to filter waste
10. Tumor lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers

Also, you may be monitored for high uric acid levels when undergoing chemotherapy or radiation treatment for cancer.

Tips and instructions

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

• Keep your fluid intake high: Stay well-hydrated, including plenty of water. Limit or avoid alcohol: Talk with your doctor about whether any amount or type of alcohol is safe for you.
• Get your protein from low-fat dairy products: Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
• Limit your intake of meat, fish, and poultry: A small amount may be tolerable, but pay close attention to what types – and how much – seem to cause problems for you.
• Maintain a desirable body weight: Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

A patient with gout should avoid the following foods:

• Fatty foods and fats
• Lentils and legumes during severe attacks
• Meat, fish, and chicken during severe attacks
• Liver, kidney, brain, salmon, sardines, and oysters
• Meat and fish soups
• Eggplant, cauliflower, peas, and spinach during severe attacks
• Jam containing seeds
• Berries, strawberries, and figs
• Spices and pickles during severe attacks

The patient with gout is allowed to eat:

• Bread, toast, and rice.
• Legumes such as lentils and others, while abstaining from gout attacks.
• Meat, fish, chicken, and rabbits about 100 g of each.
• Eggs and milk products.
• Vegetable Soup.
• Vegetable salad.
• Cooked vegetables.
• Potatoes.
• Butter, oil and fat equivalent to two tablespoons per day.
• Sugars, jam, honey (avoiding jam containing seeds).
• Fresh fruits except for berries, strawberries, and figs.
• Dried fruits and nuts.
• Spices in small quantities, while abstaining from gout attacks.
• Pickles while abstaining during gout attacks.
• Drinks such as tea and coffee with two or three glasses a day.
• Unlimited quantity of fluids.

There are some foods that help in treating patients with gout:

• Lemon juice is effective in the treatment of gout, as it dissolves the salts deposited in the joints.
• Pineapple is very useful in cases of obesity and arthritis.
• Grape juice works to reduce the uric acid levels in the blood.