The painful world of gout

Friday, 20 April 2012 From Issue Vol. XX No. 16 By  Dr. Iain Corness

A friend of mine rang me the other morning with a tale of woe.  He had woken that morning with excruciating pain in his knee.  He had gone to bed with no problems and was now a cripple when he woke up.  What could it be?  And what could he take for the pain?

There were only a few conditions that could produce this, and gout was one of them.  (I wrote about gout a few months ago, but it is worth another few column centimeters!)

Gout is indicated in around five percent of all cases of arthritis and is present in around three to five percent of the population, with males outnumbering women around nine to one.

Gout is a recurrent form of arthritis, and which generally affects just one joint - most commonly the joint in the big toe, but for my friend it was the knee.  This arthritis, or inflammation, occurs in association with high uric acid levels in the blood, and is described as ‘exquisitely painful’.

The higher the concentration of serum uric acid (SUA), the more likely you are to get an acute attack.  The ‘normal’ range for SUA is taken as being between 3.5-7 mg/dl.  And if you are at the high end of the scale you are five times more likely to get gout.  My friend’s SUA turned out to be 8.1 mg/dl.  Diagnosis confirmed!

Basically what happens is that with high concentrations of uric acid it crystallizes out into the joint, leaving very sharp, needle-like crystals crunching inside the articular surface of the joint.  Very painful!

The typical gout sufferer is male in his 50’s, overweight, with high blood pressure, carnivorous and consumes large quantities of alcohol.  Is that you?

Gout affects almost four million men in the USA.  It has long been thought that purine-rich foods and a high protein intake are risk factors, and sufferers are advised to avoid meats, seafood, purine-rich vegetables, and animal protein.  But this advice was based more on the theory of how excess blood uric acid can occur, rather than actual clinical studies.  When told of the dietary restrictions, my friend complained there was nothing left for him to eat!

However, it was not all bad.  New studies have shown the relative importance of different foods and different lifestyles.  One of the newer studies began on over 50,000 men from health professions in 1986.  Food-frequency questionnaires were sent out at baseline, and in 1990 and 1994.  Weight, medications, and medical conditions were recorded every two years.

The participants were assigned to groups according to the total intake of meat, their consumption of seafood, purine-rich vegetables, dairy products, low-fat dairy products, total protein, and animal protein.

During the study, there were 730 new cases of gout during the 12 years of low-up.

When total meat consumption was analyzed, the risk of acquiring gout was 1.41 times greater in the high meat eaters; in other words, eating more meat was a risk factor for gout.  Similarly, high seafood eaters were 1.51 times as likely to develop gout.  (Grass should be fairly safe!)

In contrast, gout was less common in those taking more dairy products.  Men who drank two glasses a day of skim milk, or ate a serving of low-fat yogurt more than twice a week, halved their risk of developing gout.

This large study confirmed that a diet high in meat and seafood increases the likelihood that a susceptible person will develop gout.  It also showed that milk proteins increase the excretion or uric acid in the urine.

So, to avoid developing gout, try to limit your intake of meat (beef, pork, chicken, lamb, and offal) and seafood, while increasing your intake of low-fat dairy produce (skim milk, yogurt).

Note too, that it is low-fat milk that is being proposed, as high fat milk introduces the cholesterol problems again!  It really is a fine line that we must all tread!  It is the ‘middle way’ again, I am afraid.  And if you are overweight (my friend is), then you are also more likely to have problems.  However, if you stick to a sensible lean diet for your gout, the weight will come down too.

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