Gout: Not for gluttons only

It was long thought that gout was a disease of gluttons – wealthy, overweight men who ate too much food and drank too much wine. Although there’s a kernel of truth to it – organ meats and alcohol can induce a gout attack – it is by no means the whole story.

Shout For Gout

One of humankind’s oldest known diseases, gout has been recognized for more than 2,000 years. It’s caused by too much uric acid, a substance that normally forms in your body from waste products called purines. When you have gout, your body either produces too much uric acid or excretes too little. Not everyone with too much uric acid though develops gout.

Uric acid is typically dissolved in your blood and passes through your kidneys into your urine. But in people with gout, the excess uric acid can build up and form sharp crystals, which deposit in a joint and surrounding tissue. Gout typically affects the joint of the big toe, but it can strike joints in the hands, arms, legs, ankles, and feet, as well. The affected joint feels like someone set it on fire. It’s hot, swollen, and so tender that even the weight of your blanket on it may be intolerable.

Gout Bout

Gout is more likely to affect men more than women, especially men between the ages of 40 and 50. Women become more susceptible to gout after menopause. Gout appears to run in some families.

A number of factors may cause the body to produce too much uric acid or deter the kidneys from eliminating enough of it. Known risk factors of gout include:

• Excess weight

• Certain medical conditions, including high blood pressure (hypertension), diabetes, and elevated blood fat levels (hyperlipidemia)

• Excessive alcohol intake

• Excessive intake of foods high in purines

• Certain medications, including some diuretics, low-dose aspirin, niacin, and the organ transplant antirejection drug cyclosporine

• Surgery

• Severe illness or injury

No Doubt About Gout

Gout attacks are usually relatively short-lived. Pain and swelling in the affected joints usually go away over several days but may be stopped sooner with medications.

In some people, the crystals can form kidney stones (calculi). In others, the urate crystals may build up over several years and form large deposits called tophi in joints and nearby tissues. Deposits may also develop on the outer edge of the ear.

If you experience sudden pain in a joint, contact your doctor. Gout that’s left untreated may result in increased pain and even joint damage. People who have gout should be assessed for other risks. Gout is considered a risk factor for cardiovascular disease.

To determine whether you have gout, your doctor may remove some synovial fluid from the affected joint to view it under the microscope. The presence of urate crystals in the sample can confirm a diagnosis of gout. It cannot be diagnosed by a blood test. Having hyperuricemia is not equivalent to having gout. Most patients with gout do have hyperuricemia, but not necessarily at the time of attack.

Gout Out

The earlier an acute gout attack is treated, the faster the pain may clear up. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed. Typically, an NSAID is taken until the pain subsides, usually in five days or so. If the patient cannot take NSAIDs, a short course of glucocorticoid medications such as prednisone, may be prescribed. Another drug, colchicine, may be used to treat acute gout. However, nausea, vomiting, and diarrhea are common with this medication.

Preventive medications are generally recommended if you have frequent gout attacks – more than one attack a month or three over six months – or if you have tophi. Allopurinol (Zyloprim) may help reduce the level of uric acid in your blood by slowing the rate at which it’s produced. Allopurinol can decrease the frequency of gout attacks and prevent long-term complications, especially if you have deposits of crystals in your joints, soft tissues or kidneys.

Medications such as probenecid (Benemid) or sulfinpyrazone (Anturane, in the US) may be prescribed to increase the amount of uric acid you excrete in your urine. These drugs also help dissolve tophi deposits and prevent the deposits of uric acid in joints. However, they are not generally prescribed for people with kidney disease or people with a history of kidney stones.

Attacks of gout often seem to hit at the least convenient times; for example, on business trips and vacations, prompted perhaps by indulging in rich foods or alcohol. Be prepared: If you’ve had a previous attack, carry your prescription pills with you so you can take immediate action if necessary.

Lifestyle changes that may help prevent repeat gout attacks include:

• Maintaining a healthy weight. Gradual weight loss reduces joint strain and may decrease uric acid.

• Avoiding foods high in purines(see table). These include organ meats, sardines, anchovies, and some broths and gravies.

• Limiting or avoiding alcohol. Alcohol inhibits excretion of uric acid, increasing risk of a buildup.

• Increasing fluids. At least 10 to 12 glasses of fluid each day may help flush excess uric acid from your body.

An attack of gout is no picnic, but with proper treatment, it can be short-lived, complications can be avoided, and it will leave no permanent damage.

Low Purine Diet (For gout patients)

Group I

Select from these foods:

Fruits

Gelatin (gulaman)

Milk, breads, sugar & syrups

Tea & coffee

Eggs

Vegetables (except those under Group II)

Cereal & cereal products

Cheese

Group II

Use foods in moderation:

Poultry

Seafoods (crabs, oysters, eels, shrimps)

Vegetables (asparagus, spinach, mushroom & cauliflower)

Beverages

Fats

Fish (except those under Group III)

Legumes (beans, lentils)

Meat

Meat soups & broths

Oatmeal

Butter, margarine

Group III

Avoid these foods:

Mussels (tahong)

Meat extracts

Brains

Gravies (sarsa)

Patis

Sweatbreads (mulyehas)

Yeast

Anchovies (dilis, bagoong)

Internal organs (such as liver, kidney, pancreas)

Sardines

Herring (tamban, tawilis, tunsoy, lapad, silinyasi)

Mackerel (alumahan, hasa-hasa, tanguingi)

– Prepared by the Biomedical Nutrition Division of the Food and Nutrition Insitute of the Department of Science and Technology