By Glenn Ellis
Summer is filled with fun outdoor activities, increased exercise, cookouts, and travel making it the favorite season for many, but if you have a history of gout, or are at risk for gout (history of a high uric acid, family history of gout or prior uric acid kidney stones), you may want to pay particular attention to this column.
Anyone who has, or has someone in their life who has gout, knows it is a painful form of arthritis that can seemingly slip into your life like a thief in the night.
Gout is an inflammatory disease that occurs when excess uric acid (a bodily waste product) circulating in the bloodstream is deposited as sodium urate crystals in certain joints. The pain is likely to be most severe within the first four to 12 hours after it begins. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.
Gout happens either when the body produces too much uric acid or when the body does not eliminate enough uric acid through urination or bowel movements. Gout often starts with excruciating pain and swelling in the big toe – and can often follow any type of trauma such as an illness or injury. Uric acid is a normal body waste product. It forms when chemicals called purines break down.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid, or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that causes pain, inflammation and swelling.
After that, future attacks may “flare up” off and on in other joints – primarily those of the foot and knee – before becoming chronic. Once it becomes chronic, gout can affect many joints, including those of the hands. It usually does take a few years for this to happen. In the chronic stage, gout can look a lot like rheumatoid arthritis, causing pain and inflammation in multiple joints. “Pseudogout”, a condition in which calcium – not uric acid – forms crystals that deposit in the joints causing pain and swelling almost identical to gout. This is why it is important to be properly diagnosed by your doctor.
Treating gout requires a two-pronged approach that combines medications and lifestyle changes. Your doctor may prescribe corticosteroid medications, such as the drug prednisone, to control gout inflammation and pain. Medications like allopurinol (the most commonly prescribed drug, that lower uric acid are intended to prevent gout attacks and keep the condition from becoming chronic.
The real “culprit” in gout is a something called purines. Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
As the “disease of kings,” or “a rich man’s disease”, you may be able to associate your advanced risk to a more indulgent lifestyle. If you’re spending time in backyards and parks barbecuing with your friends and family members, there’s a good chance you’re (like most everyone else) also putting healthy-eating on the back burner; no pun intended.
Now, you may be asking yourself, “How am I going to have a picnic without bar-b-que beef, hot dogs, or a few beers?” I feel your pain, but don’t worry you can still enjoy a great summer meal with friends and family, while following a safe, low-purine food that isn’t likely to trigger a gout attack.
If you’ve had a history of gout attacks, avoiding purine-rich foods can help you prevent the next one. However, that’s sometimes easier said than done when it comes to cookout food. How about a few tips for an enjoyable time at a picnic with gout?
The “usual suspects” that you should avoid (or greatly limit) high-purine meats include bacon, beef, pork, and lamb. High-purine seafood includes anchovies, sardines, scallops, mackerel, trout, haddock, tuna, and herring. Even though everyone loves to have a good time at a cookout, beer is a significant gout trigger and should be avoided.
All it takes is just a little pre-planning, focus on food choices, and determination and before you know it, you’ll be having great summer fun with your friends and family.
With appropriate treatment gout can be controlled and future attacks prevented. The biggest obstacles in controlling gout are improper diagnosis and noncompliance. The noncompliance part is totally up to you. Do the right thing, and eat smart at the cookout.
Glenn Ellis is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.