Gout

Anyone who has ever experienced an attack of this inflammatory arthritis will tell you the pain is excruciating. It appears suddenly, often overnight, and within 12–24 hours of onset the affected joint is hot, red, swollen and immobilised with searing pain. The first joint of the big toe is one of the most commonly affected joints, although gout can affect virtually any joint. This first attack of gout usually subsides in about a week unless it is treated, and it may be many months or years before another attack appears. Without active management attacks become more frequent, and may involve increasing numbers of joints. Eventually chronic gout develops, causing gradual, progressive degeneration of the affected joints. It is not uncommon for gout to affect the kidneys and cause kidney stones. ‘Tophi’ is another complication whereby uric acid crystals are deposited under the skin causing pain and sometimes infection.

What causes gout?

So what causes gout? Uric acid is a chemical which is produced in our body during the normal process of breaking down and building up of food and body tissues. When too much uric acid is present in the bloodstream, the body begins to deposit crystals of uric acid around the joints and tendons, causing inflammation and the symptoms of gout. Uric acid can either build up from an overproduction (most common cause of gout), or an under-excretion, or a combination of the two.

There are many causes of increased uric acid levels, including:

• Genetic inheritance
• Obesity
• Excessive alcohol consumption
• Excessive consumption of high purine foods
• Some high blood pressure medication
• Excessive consumption of refined carbohydrates
• Injury to a joint
• Kidney disease.

1. Eliminate high purine foods

Before the advent of drug therapy, gout was controlled almost exclusively by dietary change. By eliminating high purine foods, uric acid levels in the blood can be lowered. Avoid or reduce organ meats, meats, shellfish, brewers and bakers yeast, herring sardines, mackerel and anchovies. Also consider moderate purine foods including: legumes, spinach, asparagus, fish, poultry and mushrooms.

2. Alcohol and sugar

Alcohol is a double whammy in terms of its effect on uric acid levels. Not only does it increase your body’s production of uric acid by accelerating purine breakdown, it also reduces the ability of the kidneys to excrete uric acid. Many a gout sufferer has noticed that a heavy night on the town is quickly followed by a painful attack of gout. Get your energy from low GI complex carbohydrates such as wholegrains, fruits and vegetables. Saturated (animal) fats slow our ability to excrete uric acid, so keep them to a minimum, focusing instead on healthy fats such as oily fish, nuts and seeds, flax and rice bran oil. Keep your protein intake moderate (fish, chicken, meat, eggs and dairy) as high protein diets tend to increase uric acid synthesis.

3. Drink, drink and drink again… but make it water

Having a high fluid intake, especially water, is an important part of keeping uric acid levels low, by increasing urinary excretion. As an added bonus, a high water intake helps to reduce the risk of kidney stones which sometimes come with gout.

4. Nutritional supplements

Nutritional supplements such as fish oil (omega-3 fatty acids), vitamin E, folic acid and bromelain may help reduce the inflammation associated with gout. However, high doses of the B vitamin niacin is contraindicated as it may keep uric acid levels high.

5. Treatment

Medicines for gout include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – these are highly effective but watch for gastrointestinal upsets, including bleeding
• Colchicine – this is highly effective in short bursts for an acute attack, sometimes used long-term
• Steroids – taken orally or injected into an affected joint, these are usually used when other medicines are contraindicated
• Allopurinol – this is used to reduce recurrences and acts by reducing uric acid production.