I’m always being asked questions about gout. About a month ago, there was an interesting phone-in programme on a UK radio and it was amazing how many people phoned in, of all ages, lifestyles and classes. I say classes because gout used to be known as a condition in people who led a high lifestyle, eating rich foods and drinking heavily.
That may have been the case in previous centuries, but due to the change in food and alcohol consumption, this has changed dramatically. So what is gout?
Gout is a type of arthritis in which crystals of sodium urate produced by the body can form inside joints.
The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is usually affected, but it can develop in any joint. The callers who phoned in to contribute to the radio show expressed the intensity of pain felt by the joints affected by gout.
Obviously, those of us who have never suffered this cannot understand. However, caller after caller described an unbelievable pain which takes hold when an attack starts. It was heartbreaking to hear of such pain.
Symptoms can develop rapidly to their worst point in six to 24 hours and usually last from three to 10 days (a gout attack). After this time, the joint will start to feel normal again and any pain or discomfort would eventually disappear. However, these attacks will continue.
Gout is caused by a build-up of uric acid in the blood. Uric acid is a waste product created in the body everyday and excreted mainly via the kidneys. It forms when the body breaks down chemicals into cells known as purines.
Gout used to be known as a condition in people who led a high lifestyle, eating rich foods and drinking heavily
If you produce too much uric acid, or excrete too little, when you urinate the uric acid builds up and may cause tiny crystals to form in and around joints.
These hard, needle-shaped crystals build up slowly over several years. You may not even know this is happening. The crystals may cause two problems:
Some may spill over into the soft lining of the joint, which causes the pain and inflammation associated with gout.
Some pack together to form hard, slowly expanding lumps of crystals which can cause progressive damage to the joint and nearby bone; this eventually leads to irreversible joint damage which causes pain and stiffness when the joint is being used.
Some of the factors which increase the risk of gout are:
• Age and gender: gout is more common when you get older and is three to four times more likely in men (however, depending on your life and genetics, it could affect men in their 30s or 40s);
• Being overweight or obese;
• Having diabetes or high blood pressure;
• Having close relatives with gout (gout often runs in families);
• Having long-term kidney problems that reduce the elimination of uric acid;
• A diet rich in purines, such as frequently eating sardines and liver;
• Drinking too much beer or spirits – these drinks contain relatively high levels of purines.
So, the big toe is the most common site, but gout can also affect the ankles, knees, wrists and hands. Classic signs are redness, swelling and attacks of severe pain.
Certain foods are known to play a role because they are high in purines include organ meats, shellfish, peas, beans, anchovies, sardines, asparagus and mushrooms. A diet heavy in any, or all, of these foods can lead to uric acid build-up in the blood.
Together with the illnesses described before, people who suffer from lupus are more vulnerable and those who regularly take diuretics, low-dose aspirin and drugs commonly prescribed to organ transplant recipients (Arthritis Res. Ther., 2006). Another overlooked cause is lead poisoning; the kidneys may be failing to effectively excrete excess lead (Toxicology, 1992).
Beer appears to raise the risk. In addition, sugary soft drinks and even some fruit juices can be associated with gout. Follow a low-acid diet, avoiding foods that are rich in purines.
In one study, men who switched to a purine-free diet significantly reduced their blood uric acid levels after just a few days. Also drinking six to eight glasses of water a day may help dilute the uric acid levels in the blood.
A traditional remedy for gout is munching on cherries. US researchers found that patients with gout who ate cherries over a two-day period had a 35 per cent lower risk of an attack compared with those who didn’t (Arthritis Rheum., 2012). If you don’t like cherries, try a cherry extract supplement. Also, celery juice is a remedy said to help and is widely used in Australia.
Other ways of helping are a daily dose of vitamin C, recommended by a study. Acupuncture, when combined with a nutritional approach, has proved successful. Homeopathy can offer a range of remedies, so speak to your practitioner for more advice. Quercetin, a flavonoid found in onions, capers, watercress, kale and dill, is sometimes recommended for gout.
Finally, there are herbs that can help with pain relief. However, looking at the successes from studies, changing your diet and munching cherries seems to be a proven help.
kathryn@maltanet.net