Do you have an inflamed big toe? If so, you may have gout. It is most common in middle age men and is frequently found in combination with obesity, diabetes, hypertension and heart disease.
Gout is a disease caused by having too much uric acid and is the most common medical disorder associated with arthritis. Uric acid is a nitrogen compound formed in the body as a result of the metabolism of protein into purines. Purines in the body are the end product of protein breakdown. They are converted by an enzyme to uric acid and excreted in the urine as urea.
Symptoms of Gout
Increases in serum uric acid leads to the formation of crystals of uric acid in joint tissues. This produces severe inflammatory reaction giving the traditional swollen, throbbing painful joints. Excess uric acid may not cause symptoms for years until, most commonly, the joint between the foot and the big toe becomes red and inflamed. In medieval times it was associated with the large, obese heavy drinking individuals.
What else does gout cause?
Tophi : lumpy deposits under the skin, often not painful but they can limit the movement of joints.
Kidney stones : made from salts of uric acid in people who have a high level of uric acid in the urine and inadequate fluid. Symptoms can be abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine.
What causes too much uric acid in the blood?
- The body may produce too much uric acid due to a genetic defect or certain diseases such as cancer / blood disorders.
- The kidneys do not eliminate enough uric acid.
- Consumption of some medications increase uric acid levels eg diuretics
- Rapid weight loss causing the breakdown of muscle mass and increase in free purines.
- A diet too high in alcohol and protein and purine rich foods.
Who has symptoms?
Only 10% to 20% of people with high levels of uric acid develop the symptoms of gout. This usually occurs before tophi or kidney stones develop. These sudden attacks are sometimes related to physical illness, trauma, or excessive alcohol intake.
How is gout diagnosed?
It is suspected if you have an inflamed toe joint and / or a high blood uric acid (above 0.44 for men and 0.38 mmol/l for women. There are anti-inflammatory drugs that are effective for gouty arthritis that your doctor may prescribe.
Can diet help?
Diet can be of assistance. It still may be necessary to have medication to keep uric acid levels under control. An accredited practising dietitian can help modify and improve your diet.
To reduce the risk of a gout attack:
Control purine foods
Restrict high purine foods such as organ meats, game meats, gravy, fish roe, oily fish, scallops and wheat germ.
Only have small quantities of asparagus, cauliflower, legumes (beans\lentils\ split peas), mushrooms, parsley, green peas, and rhubarb. (These are high in purines.)
Have 1 moderate serve of meat, fish and chicken intake a day. (large quantities of protein will increase purines.)
Eat more low purine foods. Breads and cereals, low fat dairy products, eggs, fruit and juices (except rhubarb) and vegetables such as bean sprouts, broccoli, brussel sprouts, capsicum, carrot, cabbage, celery, Chinese vegetables, cucumber, eggplant, green beans, lettuce, onion, parsnips, potato, pumpkin, radish, sweet corn, tomato turnips and zucchini.
Limit alcohol to 2 standard drinks a day and take with food. Controlling alcohol intake will help prevent the build-up of lactate which will prevent the uric acid excretion. Alcohol is a common precipitatory factor in acute gouty attacks. High levels of lactate prevent urinary excretion of uric acid.
A large intake of fluid (water plus juice) is important to help eliminate uric acid and prevent renal stones, gout and dehydration. It is recommended that 3 litres of fluid should be consumed each day.
Control obesity and exercise
Control obesity as this puts extra stress and strain on the joints. Endeavour to lose weight slowly with moderate exercise so as not to accumulate purines from improper break down of protein or build up of lactic acid in the muscles.