Gout - The disease of Kings or more like the Prince and the Pauper?
Gout is a disease that’s been documented in history going back as far as Egypt 2,600BC but seemingly we know as much, or possibly as little, about gout as we do about the mysterious pyramids!
Historically known as the disease of kings, gout was often thought to be due to an overconsumption of rich foods and wines which could only be afforded by royalty, however, this is something of an oversimplification.
During a gout attack, uric acid crystals build up in joints causing them to become red, hot, swollen and very very painful! It’s actually one of the most common conditions we get called out to see as sufferers are often in so much pain, they simply get out of bed to make their way down to their regular clinic.
They commonly affect the inner, medial base of the big toe but can actually affect any joint. Remember, gout affects joints, the space between bones, so if your pain affects your entire foot, then even if you have all the described hallmarks of a gout attack, it might not be!
In the olden days, doctors would stab a needle into your affected joint to draw out some fluid to make a diagnosis. Thankfully, we are a little more considerate now so most of the time we can make the diagnosis just from examining the joint in question, or via a blood test to check your uric acid level, though this needs to be done about two weeks after the onset of your symptoms to avoid getting a false negative result.
So what actually causes Gout?
Unfortunately, the answer is not so simple and there’s still a lot we don’t know about the exact mechanism!
Our bodies contain chemical compounds called purines. They occur naturally in the body and some if it is there from our diets. As the body breaks down purines, uric acid is formed and when blood uric acid levels become too high, uric acid crystals can build up in our joints and tissues, causing inflammation and severe pain.
We know that it predominantly affects men over the age of 30, though worryingly we are seeing it in younger and younger patients. Women are less likely to develop gout until they reach menopause when their uric acid levels become similar to men.
There appears to be a genetic component, so it can run in families and it also appears to be linked to various conditions such as obesity, diabetes, high blood pressure, kidney disease and heart disease, so if you have any of these, you might get gout too!
So why is it possible for some people to have all of these diseases and still never get gout? For that matter, why do some individuals have high blood uric acid levels but they never feel any pain and never get gout?
Well, therein lies the mystery as we don’t really have the answers!
One area currently being investigated is how uric acid is excreted from the body via the kidneys and gastrointestinal system. It appears that some individuals have problems affecting their kidney transport systems, resulting in ineffective uric acid excretion allowing it to build up in the blood.
This still doesn’t explain why some individuals can have high uric acid levels but never develop gout though my suspicions point towards chronic inflammation being the key.
Acute inflammation is the body’s normal response to injury on a cellular level. When this is prolonged, or chronic, the inflammatory cells themselves can result in tissue destruction and this process has been implicated in numerous diseases including heart disease, kidney disease, diabetes, dementia, rheumatoid arthritis, autoimmune diseases, cancers and so much more.
Chronic inflammation can be as a result of a disease, or more commonly, due to a crappy lifestyle exposing our bodies to certain toxins such as too much sugar, poor quality pro-inflammatory foods, alcohol, smoking, stress and other less than ideal diet and lifestyle traits.
By placing our bodies in a pro-inflammatory state, you might be paving the way to developing gout and all the other diseases mentioned above.
So what can you do?
Conventional wisdom has always advised reducing your dietary intake of purine containing foods to try and lower blood uric acid, foods such as:
· Asparagus, cauliflower, mushroom
· Oatmeal, wheat bran and wheat germ
· Red meat
· Broths, meat stocks and gravies
· Chicken essence
· Bak kut teh
· Salmon, herring, mackerel, prawn
· Anchovies (ikan bilis), sardines, fish roe
· Cockles, mussels, scallops
· Spinach, peas
· Strawberries and strawberry jam
· Peanuts, bean cake, moon cake
· Organ meat, liver, kidney, brain
You should also avoid alcohol as they can interfere with uric acid excretion and sweet drinks / fruit juices which are known to trigger gout attacks.
Unfortunately, in practice, simply reducing the intake of high purine foods does not always work, so try your best to also reduce ‘inflammation’ as much as possible via a clean, unprocessed diet, exercising and sleeping well, drinking plenty of water, avoiding smoking and excess sugar.
This, of course, is not an exhaustive list of methods to reduce inflammation.
Going on a low carb or ketogenic diet is another way to reduce inflammation but if you do a dirty keto diet, eating just the dishes from your local food court without rice, or eating fried low quality meats and fish, using low quality oils, you will likely increase inflammation!
If things take a turn for the worst and you end up having a gout attack, there are medicines which can help such as:
· Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Diclofenac (not suitable for certain patients, including those with asthma, weak kidneys, heart disease and certain gastric problems)
· Corticosteroids such as Prednisolone
Patients with very poorly controlled gout may have attacks every few weeks and this can actually result in permanent joint swelling and destruction (gouty tophi).
Thankfully, there are special medicines (Allopurinol, Probenecid, Fuboxostat) that can be used to prevent gout attacks in these severe cases.
These medicines need to be taken daily (even when you don’t have an attack) and can have side effects, so we usually only use them when conventional methods have failed.
So there you go folks, as is often the case, gout appears to be a multi-factorial disease. Everyone in your family might have it but that doesn’t mean you have to!
Take care of yourself and stay healthy but if worse really comes to worst and you have a gout attack, give us a call and we’ll pop by and give you a jab!
Dr. Bobby Stryker