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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.

     
     

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