Indulgence in rich food and plenty of alcohol can leave many poople with painful joints.
What is gout?
Gout is a type of arthritis which usually affects only one or two joints in the body. The most characteristic joint in which gout develops is the big toe. Usually gouty inflammation of the joints only last for a few days, but it can be so excruciatingly painful that sufferers never forget an episode. Unfortunately gout attacks have a habit of recurring.
What causes gout?
Gout is caused by deposits of urate crystals in the joints. Urate is one of the breakdown products of compounds called purines. Ideally the human body should break urates and uric acid down completely to form a substance called allantoin which can be excreted by the kidneys. Sadly humans and primates have lost the enzyme which breaks down urates and uric acid to allantoin. People who suffer from gout tend to either produce more urate than normal or to excrete less in the form of uric acid. Gout is usually accompanied by a condition called hyperuricaemia (raised blood urate levels).
Purines which are broken down to urate and uric acid originate from two sources, dietary protein and body synthesis.
Who is susceptible?
Men are much more prone to develop gout than women, although post-menopausal women also run an increased risk. Gout tends to be inherited and 25% of the relatives of gout patients develop this condition and/or raised blood urate levels. Older people tend to be more susceptible to gout than younger men and women.
Factors that can precipitate a gout attack, include:
overweight - many patients who suffer from gout are overweight or obese
alcohol - acute attacks of gout are often precipitated by overindulgence in alcohol
dietary purines - eating foods rich in purines (meat, fish, fish roes) can cause an attack
starvation or very-low-energy diets - blood urate levels rise dramatically when body proteins are broken down due to starvation or very low energy intake
kidney disease - any disease, such as chronic renal failure, which prevents the kidneys from functioning properly and excreting sufficient urate can cause gout
other diseases - diseases such as leukemia or psoriasis can cause increases in urate production
drugs - chemical compounds which decrease the excretion of urates, such as the so-called thiazide diuretics, can cause a gout attack
a) Anti-gout drugs
Nowadays there are drugs available which can successfully lower blood urate levels and increase excretion by the kidneys. These medicines need to be taken for months or years at a time. If your doctor has prescribed drugs to treat your gout, please use the medicine as instructed.
b) Dietary treatment
Patients who are overweight should try to reduce their weight gradually and steadily, using a low-fat diet and exercise. Remember that fasting, starvation diets, and drastic energy restriction, are dangerous because they are likely to cause an acute attack. People with gout should, therefore, also not use detoxification or purification diets as these may also precipitate a flare-up.
Cut down on alcohol intake drastically. If necessary avoid all alcohol or restrict drinking to less than two drinks a day. A harsh, but effective way of preventing gout.
Avoid rich, heavy meals which contain lots of fat and purines - i.e. the typical Christmas dinner is an excellent example of a meal laden with fat and purines.
Avoid high-purine foods like liver, kidneys, sweetbreads, sardines, anchovies, fish roes (eggs and caviar) and meat extracts.
Drink six or more glasses of water throughout the day and a glass at night before going to bed to help the kidneys excrete urates.
Go easy on caffeinated drinks:
Don't overdo tea and coffee drinking and switch to rooibos tea if you find your joints start aching after a coffee/tea binge.
Moderation and abstinence from alcohol - those are the solutions to gout.
Dr I.V. van Heerden, registered dietician
Eating on the run