Gout is an inflammatory joint disease that is caused by crystals (of monosodium urate) that settle into the joints. The formation of the crystals happens when patients have high amounts of uric acid in their blood. Once these crystals have settled into the joint(s) they become painful, swollen and red. This is an acute gout attack.
Gout affects men more often than women but can affect either gender. The most common age range for gout to appear is between 30-60 years old and African Americans are affected more often than other races.
There are several risk factors that increase the likelihood of having a gout attack. This includes having a specific medical condition or taking certain medication that decreases how quickly your body gets rid of uric acid. These include kidney disease and diabetes (when in ketoacidosis) and taking medications such as aspirin and diuretics (ex. Furosemide and thiazides). A person can also have increased uric acid due to its increased production (not decreased excretion) which can be caused by states of quick cell breakdown seen in certain cancers, treatment of cancers (tumor lysis syndrome) and certain enzyme deficiencies (Lesch-Nyhan syndrome, von Gierke disease). Aside from medical conditions and medications there are also some lifestyle factors like high protein diet and obesity that can increase the risk of having a gout attack.
It takes a long time to develop gout, patients usually have high levels of uric acid in their blood for 20 years or more before they develop symptoms. When an attack of gout does occur, the patient has severe pain in the joint(s) (usually the big toe) that comes on very suddenly. The joint(s) will be red, swollen, hot, painful to touch and can have decreased range of motion. The pain and other symptoms will slowly go away over the next few days to weeks if left untreated but can resolve much faster if treated with prescription medication.
Some patients begin to have gout attacks on a regular basis, if this happens the Doctor may prescribe medications to help prevent them.
There are also changes that can be made to diet and lifestyle that will help decrease uric acid levels and further reduce the risk of flare ups.
Diet
- Avoid or limit high purine foods (purines get broken down in the body to uric acid)
- Beer and alcohol – daily consumption recommendations are no more than 2 alcoholic beverages per day for men or no more than 1 per day for women and seniors. Beer and alcohol should be avoided entirely during a gout flare.
- Seafood and shellfish – these foods should be limited even when not having a flare. They can still be consumed occasionally but certainly not every day.
- Organ meats – like tongue, brain, liver, sweet breads and kidney meats.
- Turkey – other poultry sources like duck and chicken are better options to help keep uric acid levels under control
- Red meat – beef, pork and lamb.
- High sugar beverages – this includes soda, juices, sweetened iced tea and lemonade, energy drinks and sweetened coffee drinks.
- High purine vegetables – these aren’t the biggest source of dietary purines but if you are experiencing a flare you may choose to avoid them because even moderate uric acid level elevations from your diet can make you feel worse. These include peapods, bean sprouts, artichokes, and brussels sprouts.
- Increase foods that have been shown to reduce the severity or frequency of gout flares
- Cherries – one serving of cherries is 10-12, some research shows that 3 servings of cherries over a 2-day period decreases gout flare risk. Try incorporating cherries into your diet on a regular basis and during acute flares.
- Vitamin C – has mild urate lowering effects. Ensure there are many vitamin C rich foods in your diet. Some good sources are citrus fruits, bell peppers, tomatoes, broccoli, strawberries and brussels sprouts.
- Coffee – may also have mild urate lowering effects but it is not recommended to consume high amounts of caffeine. For this reason, keep coffee consumption to 1-2 servings per day.
Weight loss
It is important to lower your body weight if you are overweight or obese. Research shows that patients with excess body fat suffer from gout attacks more frequently that healthy weighted patients. Try increasing exercise to 30 minutes, 5 times per week as well as following the recommended dietary guidelines for general health and body mass goals. There are many online resources available to help you find the diet and exercise approach that is best for you. Alternatively speak to your primary care provider or nutritionist if you are having a hard time and they can help direct you to an appropriate resource for more information.
Manage medications that could be making your gout worse
It is possible that you are taking a medication that is making your gout worse. Talk to your doctor about your current medications to see if any of them are contributing to your gout flares. If they are, there may be medicine alternatives that your doctor can discuss with you.
Never discontinue or adjust your prescription medications without consulting your doctor first.
The lifestyle management techniques listed here can be helpful in reducing the frequency and severity of gout flare ups however they probably won’t make a big enough difference to eliminate the need for medication. Always follow the advice of your doctor as far as medication and treatment for any condition and then use these lifestyle strategies to supplement your treatment plan.
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