Gout

(Berkeley Wellness)
A Pain in the Toe
More than 5 million Americans have gout, most of them are men. Its incidence has doubled in the last 20 years. That’s not surprising, since gout is linked to obesity and hypertension, which are on the rise as well.

A common form of inflammatory arthritis, gout was once considered a “rich man’s disease” because it was associated with overindulgence in food and drink (think of corpulent Henry VIII of England) and because more men than women get it. Gout commonly results from an excess of uric acid, a waste product formed from the breakdown of nitrogen compounds called purines, which are found naturally in the body and in certain foods. As uric acid builds up in the blood, it can form crystals that get deposited in joints. The body sees these crystals as foreign invaders and releases inflammatory substances that make the joint hot, red, swollen, and extremely tender.

Gout can affect any joint—notably the ankles, knees, wrists, elbows, and hands—but most first attacks occur in the big toe. Sometimes there is fever. Inflammation often subsides in a few days, but a severe attack can last a few weeks.

Gout seems to run in families, and recurrences are common. Certain medications (aspirin, for example), alcohol, surgery, trauma, and perhaps even hot weather (because of dehydration) may increase uric acid levels and trigger gout. Studies have linked gout to high intake of meat and seafood, which are rich in purines, but not to purine-rich vegetables (such as peas, beans, lentils, spinach, mushrooms, and cauliflower) or total protein intake. Dairy, on the other hand, may protect against gout.

Pre-emptive action

Gout can’t be prevented, but recurrences can be minimized, as follows:

• Lose weight if you are overweight. But don’t go on crash diets or fast, since that may increase uric acid levels.

• Treat high blood pressure.

• Limit alcohol, especially beer. Moderate wine drinking does not appear to increase risk.

• Avoid medications that can increase uric acid levels.

• Go easy on meat (particularly organ meats) and seafood (particularly herring, sardines, anchovies, and scallops). Be careful of high-protein diets, such as Atkins, that allow large amounts of red meat and are high in saturated fat.

• Eat plenty of fruits and vegetables rich in vitamin C, such as oranges, strawberries, bell peppers, and broccoli. Large amounts of C may reduce uric acid levels.

• Drink sufficient fluids to avoid dehydration.

• If you have frequent gout attacks, your doctor may prescribe medications that lower production of uric acid or increase its excretion.