Overindulgence over the holidays may lead to this painful joint condition
Once known as the disease of the rich, gout can attack all socio-economical groups. While gout is most in men aged 40 to 60, it can occur in younger men as well as in women. In women, gout is found mainly in post-menopausal women. For the 8.3 million Americans suffering from this disorder it is not a trivial matter. There are lifestyle and dietary changes that may help.
Tis’ the season to be jolly, fa la la la la…la la la la…It is also the season to overindulge. Did you find yourself not exercising as much? Perhaps you did not get your usual intake of water. How about drinking too much beer and red wine? Did you eat too much shellfish or red meat? If so you may be experiencing an ugly aftermath called gout.
These behaviors can trigger an extremely painful gout attack, which is a condition when uric acid builds up and crystallizes in and around your joints. It is often noticed first in the big toe of the body because it is sensitive to temperature changes and the big toe is the coolest part of the body. It can however present in the joints of your fingers or in your ears which are also likely to be cooler.
A recent study shows the prevalence of gout in the U.S. has risen steadily over the past two decades and now affects over 8 million Americans. It is no coincidence that obesity and hypertension also jumped during this same time period. This research can be found in the Arthritis & Rheumatism, a journal published on behalf of the American College of Rheumatology (ACR)
What is gout?
Elevated levels of uric acid in the blood cause gout. When you over indulge in foods and drinks rich in purines such as organ meats or yeast (beer/bread), the body breaks down the purines and produces uric acid. Normally the uric acid is flushed out of the body through the kidneys by urinating. However, if the body is producing too much uric acid, the levels of uric acid can rise dramatically. It may be too much for the kidneys to process, especially if you have co-morbidities such as obesity and hypertension which makes the kidneys work harder anyhow. This can cause the fine needle like crystals of uric acid builds up around the joints resulting in severe inflammation and pain.
Gout may be associated with a group of other health conditions under the umbrella of metabolic syndrome. This syndrome is characterized by obesity, insulin resistant diabetes, hypertension and elevated cholesterol which has more than doubled between 1960-1990. Research has now shown that when obesity and hypertension was controlled so was the prevalence of gout.
- It begins without any warning and can last hours to well over a week.
- Pain is in the joints with a warm feeling along with swelling of the area.
- It tends to occur in the night or the early hours of the morning when arising.
- The affected area may become red, maroon or even purple in color.
- As the pain and swelling subsides, you may be left with a reminder with peeling and itchy skin
- Some people may develop a fever during the attack.
- Genetics – It can be inherited (not the inheritance you would like to have for sure). Start preventative measures as soon as you can to reduce your risk.
- Hypertension – An elevation in blood pressure to unhealthy levels can increase your risk for gout as well.
- Diabetes – Insulin resistant diabetes raises your risk of having gout.
- Obesity – The more you weigh the higher your risk of gout.
- Medications - Diuretics – Certain medications could cause a rise in uric acid levels in the body. Studies show that diuretic drugs used to treat high blood pressure, some chemotherapy agents and anti-rejection drugs used after transplant surgery and can increase the level of uric acid in the body. Even too much aspirin or niacin can increase gout symptoms.
- Diet-Consuming foods and beverages that contain high levels of purines, yeast or oxalates can trigger an attack of gout.
Your physician will ask about your family and personal health history. Lab tests and x-rays are often ordered to determine uric acid levels in the blood and to make sure that the swelling in your joints are not from another cause.
Doctors will prescribe medications such as Colchicine, NSAIDS or corticosteroids. Sometimes they may give steroid injections into the area to treat the pain, swelling, and inflammation.
There are other options that can be done instead of or in conjunction with this. It can be managed effectively with natural measures such as diet and lifestyle changes.
Foods and beverages that are high in purines should be avoided. It is the purines that are converted in the body to uric acid that cause your symptoms.
Reduce or avoid all together the following:
- Oxalate containing foods such as spinach, rhubarb, beets,chocolate, strawberries and black tea
- Organ meats such as liver and kidney
- Oily fish and shellfish such as herrings, mackerel, mussels, scallops and shrimp
- Refined sugar and white flour as well as overly processed foods (convenience foods).
- Fried and oily foods high in trans fatty acids.
- Sugary carbonated soft drinks (high in fructose)
- Alcohol especially beer and red wine.
Increase more of the following in your diet:
- Antioxidant foods such as blueberries, tomatoes, squash and bell peppers
- Foods rich in magnesium and low in calcium, such as barley, rye, bran, oats,brown rice, bananas, and potatoes.
- Eat more lean chicken, soy (tofu) and beans to meet your protein requirements.
- Use only healthy cooking oils, such as olive oil.
Cherries (both sweet and sour cherries) are full of healthy antioxidants that can help relieve inflammation and pain. Eat a minimum of 25-30 fresh cherries a day for the best results. Cherry juice (8 - 16 oz. per day) is also helpful. Do this preferably as soon as you get up in the morning.
Cherry juice concentrate is an excellent option. It contains up to 60 tart cherries in every ounce. That way you can get the benefit of 50-60 cherries without all the extra sugar and calories!
Lime is a good source of vitamin C. Better yet it is also a great source of citric acid that helps dissolve uric acid. Drink a glass of water with the juice of half a lime at least twice daily for best results,
Drink 6 - 8 glasses of filtered water daily to help flush uric acid from the body. In addition, dehydration can trigger a gout attack.
Avoid sugary drinks due to insulin challenges in the body.
Red Wine and Beer need to be avoided as well. Beer is a big culprit due to its yeast content.
Also alcohol in general can interfere with the removal of uric acid from the body.
Immobilize and elevate the foot.
Avoid standing and walking. Give that foot a rest. Also elevating the foot to a level above your heart may help reduce swelling.
Take home message:
The symptoms of the inflammatory process of gout usually resolve within a week. If gout symptoms continue or repeated attacks occur, see your healthcare provider. In cases of repeated episodes, the underlying problem must be addressed through diet, supplements or medication. Left untreated the build-up of uric acid over time can cause permanent damage to the joint.
American College of Foot and Ankle Surgeons. Got gout? Holiday season triggers painful toes. Available at https://www.acfas.org/content.aspx?id=4524. Accessed December 27, 2013.
Michael L Snaith, Gout: diet and uric acid revisited, The Lancet, Volume 358, Issue 9281,18 August 2001, Page 525