Gout
Marked by swelling, inflammation, and excruciating tenderness in the
joints, gout most commonly affects the joints at the base of the big
toe, other foot joints, knees, ankles, wrists, and fingers. The
slightest touch – even that of a bedsheet – may prove to be unbearably
painful during an attack of gout.In North America, gout afflicts
about 21 out of every 1,000 people, about half of whom are overweight.
It is uncommon in women, especially before menopause.
Mistakenly, gout has had a persistent reputation for being the
penalty to be paid for high living and overindulgence. In fact, gout is
actually a type of arthritis that is caused by an inherited defect in
the kidney's ability to excrete uric acid. This waste product of protein
metabolism comes both from the digestive process and from the normal
turnover of cells.
When deposits of uric acid crystals build up in the synovial fluid
that surrounds the joints, the human body's immune system attempts to
eliminate these crystals through the process of inflammation;
unfortunately, this causes attacks of intense pain that can continue for
days or even weeks if the condition is left untreated. Over time, uric
acid crystals accumulate in the form of lumpy deposits under the skin of
the ears, the elbows, and near the affected joints.
Gout attacks usually occur suddenly and unpredictably. The good news
is that there are now several drugs available that will stop the pain
and prevent any future attacks. Colchicine, a drug derived from the
autumn crocus flower, is one of the fastest acting and most effective of
these. Unfortunately, it can also cause severe nausea and diarrhea,
which necessitate stopping the drug immediately. Before these side
effects develop, however, the gout attack has usually abated, and the
gout sufferer no longer needs to continue taking the medication.
Other, less toxic drugs are given on a long-term basis to prevent the
onset of attacks a flare-up is likely if these drugs are stopped,
however. To reinforce the beneficial effect of drug treatment, people
with gout should make dietary changes to help reduce their production of
uric acid.
MANAGING GOUT WITH DIET
Lose weight gradually. Many people who have gout are obese;
losing weight – specially fat around the abdomen – often prevents future
attacks. Weight loss should be gradual, however, because a rapid
reduction can raise blood levels of uric acid and provoke gout. Fasting
increases the blood levels of uric acid, therefore, people with gout
should avoid skipping meals. High-protein, low-carbohydrate diets should
be avoided since these diets encourage he formation of ketones,
metabolic by-products that hamper the body's ability to excrete uric
acid.
You may have to modify your drug therapy. Sometimes gout is
brought on by using aspirin or diuretics for high blood pressure. These
medicines may interfere with normal kidney function and the elimination
of uric acid. Your doctor may change treatment if you experience severe
joint pain while on a drug therapy.
Avoid foods that are high in purines. Foods with a high
content of naturally occurring chemicals called purines promote
overproduction of uric acid in people with a tendency for gout. High-purine
foods include anchovies, sardines, liver, kidney, brains, meat extracts,
herring, mackerel, scallops, game, beer, and red wine; these should be
avoided completely. Moderately high purine content is found in
whole-grain cereals, wheat germ and wheat bran, oatmeal, dried beans and
peas, nuts, asparagus, cauliflower, peas, and mushrooms; eat these in
moderation.
Consume plenty of liquids. Try to drink at least 2 qt (2
liters) a day to dilute urine and prevent kidney stone formation.
Although beer and wine, as products of fermentation, are the only
alcoholic drinks known to be high in purines, any alcohol can interfere
with the elimination of uric acid. Gout sufferers should drink only
distilled alcohols in small amounts. Caffeinated beverages can also
increase the production of uric acid and impair its removal from the
body.
Eat fish rich in omega-3s. The omega-3 fatty acids in fish
have been found to reduce pain and inflammation in people with
rheumatoid arthritis and may have a similar benefit in gout, but this
may be countered by the purine content of the fish.
Gout sufferers also may have hypertension, heart disease, diabetes,
and high blood cholesterol. Counseling by a registered dietitian may
help in designing appetizing, healthful meals that strike a balance
between these health concerns and the enjoyment of food. |
