If you have never suffered gout yourself nor witnessed someone writhing in pain with red pulsating joints, then you may dismiss it as a thing of purely historical interest that died out with Henry VIII and his banquets of wild boar and ale.
However, sadly, it lives on. Even amongst tea-totallers and meat-avoiders. And, right now, it may be lurking in the wings, at least in the Northern Hemisphere where things are heating up and it's all too tempting to quench that thirst with a cold beer.
What is this medieval sounding affliction?
Gout occurs when crystals of uric acid build up in the joints causing inflammation. Think ground glass rubbing up against bone. You'd be quite right in thinking that our big toes are common victims but gout isn't that picky and most large joints can be affected.
What are my chances of developing gout?
Excess uric acid is usually excreted from the body in urine but, if the kidneys aren't fully functioning or your body just isn't so good at breaking it down due to your genes, then the crystals which develop look for a cosy joint in which to reside.
Men, I'm afraid, are far more likely to suffer than women. In the under 65 group you're 4 times more likely to have gout. In the over 65's things even up a little but you still have a three-fold greater chance of developing it and women seem to get 10 more years' gout-free life than men. It just turns up later.
What accounts for the difference in risk between the sexes. Well, women have higher oestrogen levels and this seems to encourage uric acid excretion by the kidneys. All is well until our oestrogen levels start to wane with the onset of the menopause, unless of course we take HRT which replaces some oestrogen and our risk of gout drops back down.
Studies also suggest that non-white ethnicities may also have a higher risk. The reason for this is still unclear but may be associated with higher blood pressure levels.
Medications usually involve either pain relief and/or tablets such as Allopurinol which encourage uric acid breakdown. A word of warning: starting Allopurinol during a flare up is not a good idea and can make symptoms worse but, if you already take it regularly, then just continue as usual but add in the pain-killers.
So, 'Yes', if you're a man whose parents or grandparents suffered from gout or if you have kidney problems, then you unfortunately do have a greater chance of getting it. The good news is that you may be able to reduce the odds significantly or, at the very least, avoid so many painful attacks.
Does my body size matter?
I'll come on to what we can do diet-wise in just a moment but, firstly, I must make you aware of yet another reason for not going on a crazy weight loss diet.
Uric acid is also produced when protein from muscles is broken down in our bodies. This is a normal process but, if we're losing weight at a high rate of knots, protein breakdown exceeds storage and our uric acid levels rise steeply. It makes sense also that the bigger our body is, the more protein is turned over daily and the more uric acid re-enters our blood system.
What about pregnant women whose bodies get much bigger?
Fortunately, the higher levels of oestrogen in the body mean that pregnant women are at no greater risk of gout and may, in theory, be protected to some extent. Uric acid levels certainly drop over the first two trimesters, rising again in the third.
So, if you are already a gout sufferer or think that you might fit the profile of someone with a higher risk of suffering, what can you do to reduce the risk or keep the flare ups at bay?
What about the protein we eat? Does it matter what type of protein we choose?
Yes, it does. All high protein foods contain compounds called purines which break down to uric acid. But not all purines have an equal effect. It seems that purines from vegetable sources are less gout-inducing than those from animal sources.
The greatest meat culprits are:
- Offal: liver, kidneys and sweetbreads
- Game: venison, pheasant, wild boar and rabbit
Fortunately, these don't feature very regularly in many people's diets.
As for seafood, you'd be wise to keep the following to a healthy minimum:
- Oily fish: salmon, trout, sardines, mackerel, herrings
- Seafood: lobster, crab, prawns, oyster, mussels, fish roe and the such like
- Yeast and beef extracts: Marmite, Vegemite, Bovril (If you're not a Brit or Australian, you probably stay well clear of these anyway!)
Since oily fish is an excellent source of omega 3 fatty acids, I'd still recommend having those weekly but perhaps keep the others for special occasions.
The following vegetables also contain significant purine levels but, as stated above, appear to be less gout-inducing.
- Beans and legumes: lentils, kidney beans, soya beans, chickpeas etc
- Mushrooms and QuornTM (Quorn is made from a type of mushroom)
- Asparagus, cauliflower, spinach
Dairy protein and eggs, however, are relatively low in purines. So there's no reason for your calcium levels to take a dive.
I'm all for balance, variety and most importantly food enjoyment. So I'd advise a general reduction in meat and the introduction of more white fish and vegetable sources of protein rather than the sudden exclusion of whole food groups, since this can have detrimental effects. For example, meat is an excellent source of easily absorbed iron whereas iron from vegetable sources is less well absorbed. This can be overcome by having a food high in vitamin C alongside the vegetable proteins to aid with iron absorption. Think peppers, green leafy veg, kiwi fruit and a squeeze of lemon or lime here and there. You'll see in a minute that this isn't the only good reason to up the vitamin C if you're a gout suffer.
As for alcoholic drinks, beer has by far the highest purine content, so Henry VIII's jugs of ale probably didn't do him any favours. Frustratingly, all alcohol increases lactic acid levels in the body which, in turn, make our kidneys less effective at getting rid of the uric acid. So, perhaps stick to a couple of glasses of wine or dilute spirits if, like me, a tipple is all part of your healthy balanced diet!
What about other foods and drinks that aren't high in purines? Anything else to be aware of?
Yes, fructose, because it induces uric acid production and may be a trigger for a gout flare up. Fructose is found in high levels in honey, fruit juice and in some fizzy drinks in the form of glucose-fructose syrup. However, whilst glucose-fructose syrup (or high fructose corn syrup) is widely used in the USA, drinks in the EU tend not to contain it. That said, if you're a regular smoothie consumer you might want to rethink the fruit and spinach concoction you down every morning in the name of health. The gains may not outweigh the pain.
So, what else can we do to minimise the risk of developing this potentially agonising condition?
Firstly, and perhaps most importantly, drink plenty! Preferably not alcohol, of course. Staying well hydrated means the uric acid is diluted and crystals are less likely to form. Instead, the kidneys flush them out in our urine.
I can't emphasise this point enough. Dehydration has a nasty habit of creeping up on us. A hot day at the beach or at work followed by a few extra cold beers to cool you down or a hot and sweaty commute home quickly adds up to dehydration. It's often cumulative over a few days. You might think you're drinking regularly but keep an eye on the colour of your urine and how frequently you're passing it. If your urine isn't a pale straw colour and you can't remember when you last pee'd, you need to add in a few more glasses of non-alcoholic liquid a day.
If you're taking a diuretic (a medication to make you urinate more) for other medical reasons, perhaps have a chat with your doctor if you suspect gout is making an appearance.
As I hinted at above, there is evidence that vitamin C may reduce uric acid levels moderately. Try to have this in food or a low dose supplement, if necessary. However, vitamin C in high doses can interact with certain medicines and may increase the risk of developing kidney stones in those who are susceptible. It is vital to speak to your GP before starting a high daily supplement.
Many sufferers swear by sour cherries and sour cherry juice. Studies certainly seem to corroborate this. The polyphenol compounds in sour cherries have an anti-inflammatory effect and, what's more, they are a good source of vitamin C. A daily intake seems to reduce uric acid levels. And, in spite of the unappealing name, sour cherry juice is really quite tasty and usually available in healthfood shops or online.
However, cherries are high in potassium so, if you have been recommended to reduce your potassium intake due to kidney disease, this option isn't open to you sadly. In fact, I would recommend speaking with your dietitian or doctor before making any hasty changes to your diet in this case.
This is by no means an exhaustive list of measures for managing gout, because there may be foods which you swear by as treatment or which you are convinced cause your gout to raise its ugly head. You know your body best.
I would always recommend thinking back over what you've consumed in the previous few days to identify likely culprits. Has asparagus just come into season and you've eaten it everyday for 2 weeks or were prawns on special offer and the freezer is full of them? There might be an easy solution to calming the agony. But, in many cases, it's down to a combination of factors.
If this blog is applicable to you, I hope it helps you make some gradual and tolerable changes to your diet and, most importantly, that you enjoy a wonderful gout-free summer (or winter if you're down south).
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