Gout- A Metabolic Problem? PDF Print E-mail
Friday, 20 November 2009 13:54

What is gout?

what_is_gout_signs1Once called the “disease of kings,” gout has long been associated with portly men – especially those who could afford to overindulge in rich foods and alcohol. But, in truth, gout can be a royal pain for both men and women, regardless of wealth or body size.

Gout occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic. In its chronic stage, gout can affect many joints, including those of the hands. Other problems related to gout can include the formation of tophi, or lumps of crystals under the skin, in the joints and in bone; kidney stones; and impaired kidney function.

Who gets gout?

Gout affects men in their 40s and 50s are most likely to develop gout. But by age 60, gout affects men and women roughly equally. After age 80 more women than men have gout.

High uric acid levels (hyperuricemia), which can lead to gout, occur for one of two reasons: the body produces too much uric acid or the body is not efficient at excreting uric acid in the urine. For more than 90 percent of people with gout, the cause is the latter. There are certain inborn errors of metabolism that can cause hyperuricemia, but these genetic disorders account for a very small fraction of people with gout.

How is gout diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

How is it treated?

To stop a gout attack, your doctor can give you a shot of corticosteroids, or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.

To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Avoid regular daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids.

Gout - Prevention

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissue. You probably won't know that you have an elevated uric acid level in your blood until you have had your first gout attack. But you can help prevent or reduce the severity of future gout attacks.

  • If you have been prescribed medicines for gout, it is important that you take those medicines as instructed to prevent future attacks
  • If you are overweight, take steps to lose weight.
  • You probably will be advised to reduce or stop your alcohol intake or to adjust your diet.
  • Making changes in your diet may help with your gout. If you want to try an eating plan for gout.

Changing your diet

Gout is caused by too much uric acid in the blood. This used to be treated with a strict diet, but now there are medicines that can control it. These medicines have largely replaced the need to restrict what you eat. But making changes in your diet may still help with your gout.

Key points

To help control your gout:

  • Limit foods that are high in purines, especially meat, seafood, and beer.
  • Eat a healthy diet that provides the nutrients you need and helps you control your weight.
  • Eat low-fat dairy products. This may lower your risk of gout.
  • Drink plenty of water and other fluids. This can help your body get rid of uric acid.

Talk with your doctor about the changes to your diet. He or she may have more suggestions and tips on how to avoid high-purine foods. You may also want to meet with a registered dietitian for more ideas about a healthful diet for you.

 

What are purines?

Purines are chemical compounds that are broken down into uric acid. High levels of uric acid can cause gout attacks. Most purines are made by the body, but some come from foods. Eating foods that have a lot of purines can raise uric acid levels in the body, which may make your gout worse.

Foods that are high in purines include:

  • Organ meats, such as liver, kidneys, sweetbreads, and brains.
  • Meats, including bacon, beef, pork, and lamb.
  • Game meats.
  • Any other meats in large amounts.
  • Anchovies, sardines, herring, mackerel, and scallops.
  • Gravy.
  • Beer.

Why might you want to follow an eating plan for gout?

Changing what you eat may help control your gout. Eating foods with a lot of fat, such as organ meats, broths, and gravy, can raise uric acid levels. High uric acid levels can cause attacks. You may be able to help control the amount of uric acid in your body by limiting high-purine foods in your diet.

Lowering your uric acid levels may also lower your chances of getting kidney stones.

Eating a healthy diet will help you stay at a healthy weight, which may help lower your risk of having future attacks of gout.

How to eat to help control your gout

There are several things you can do as part of an eating plan for gout.

  1. Avoid or limit foods that are high in purines, especially during a gout attack. These foods include:
    • Organ meats, such as liver, kidneys, sweetbreads, and brains.
    • Meats, including bacon, beef, pork, and lamb.
    • Game meats.
    • Any other meats in large amounts.
    • Anchovies, sardines, herring, mackerel, and scallops.
    • Gravy.
    • Beer.
  2. Eat foods that may lower your risk of gout. These include:
    • Low-fat or skim milk.
    • Low-fat yogurt.
  3. Choose healthy foods. These foods include:
    • A wide range of fruits and vegetables.
    • Eggs, nuts, and seeds for protein.
    • Small amounts of meat. Limit your serving size to 2 to 3 ounces a day .
  4. Drink plenty of water and other fluids. This can help your body get rid of uric acid.
  5. Avoid eating habits that can raise your uric acid levels. For example:
    • Avoid crash diets and low-carbohydrate diets.
    • Do not eat too much food or drink too much alcohol.
    • Do not take large amounts of vitamin C.
    • Avoid alcohol, especially beer and "spirits" such as whiskey and gin.

You can ask a dietician to help you make a healthy eating plan, remember seeking your doctor’s help is very important.

Home Treatment

If you have been diagnosed with gout, take steps to:

  • Decrease the pain of an acute attack.
    • Rest the affected joint until the attack eases and for 24 hours after the attack.
    • Elevate painful joints.
    • Relieve inflammation by taking nonsteroidal anti-inflammatory drugs (NSAIDs). Do not take aspirin, which may abruptly change uric acid levels and may make symptoms worse.
  • Prevent recurrences.
    • Control your weight. Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. But avoid fasting or very low-calorie diets. Very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack.
    • Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.
    • Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels.
    • Talk to your doctor about medicines you take. Certain medicines that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin may raise the uric acid level. Since low-dose aspirin may be important for the prevention of a stroke or heart attack, your doctor may want you to continue to take low-doses of aspirin.
  • Modify your risk factors.
    • Keep your weight within the normal range for your height.
    • Follow a moderate exercise program.
    • Avoid a diet rich in meat and seafood. Making changes in your diet may help with your gout. If you want to try an eating plan for gout.
    • Have an evaluation for lead poisoning if you have been exposed to lead in your job or through hobbies.
  • Continue to take the medicines prescribed to you for gout. But if you have not been taking medicines that lower uric prior to the attack, do not begin taking it when the attack begins. These medicines will not help relieve acute pain and may actually make it worse.

In the past, gout was thought to be due to drinking too much alcohol and eating too many rich foods. Although eating certain foods and drinking alcohol may trigger a rise in the level of uric acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an overproduction of uric acid (due to metabolism problems) or decreased elimination of uric acid by the kidneys.

 

Sources: WebMD, Healthwise, Arthritis Today and the Arthritis Foundation

 


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