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GOUT/ HIGH URIC ACID

Introduction: A form of arthritis characterised by severe pain, redness and
tenderness in joints. Pain and inflammation occur when too much uric acid
crystallises and deposits in the joints. Symptoms of gout include severe pain,
redness and swelling in joints, often the big toe. Attacks can come suddenly,
often at night. During an acute attack, anti-inflammatory medication (NSAIDs)
can help to relieve pain and shorten the duration of the attack. Patients with
chronic gout can use behavioural modification such as diet, exercise and
decreased intake of alcohol to help minimise the frequency of attacks.
Additionally, patients with chronic gout are often put on medication to reduce
uric acid levels.

For females, it’s over 6 mg/dL

For males, it’s over 7 mg/dL
High levels could be a sign of many conditions, including gout, kidney disease,
and cancer. But it could be higher than normal because you eat foods with a lot
of purines. That includes dried beans or certain fish such as anchovies,
mackerel, and sardines.
Origin & history:
Science The term "gout" was initially used by Randolphus of Bocking, around
1200 AD. It is derived from the Latin word gutta, meaning "a drop" (of liquid).
According to the Oxford English Dictionary, this is derived from humorism and
"the notion of the 'dropping' of a morbid material from the blood in and around
the joints". Gout has been known since antiquity. Historically, it was referred to
as "the king of diseases and the disease of kings"or "rich man's disease". The
Ebers papyrus and the Edwin Smith papyrus, (circa 1550 BC) each mention
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arthritis of the first metacarpophalangeal joint as a distinct type of arthritis.

These ancient manuscripts cite (now missing) Egyptian texts about gout that are
claimed to have been written 1,000 years earlier by Imhotep.[103] Greek
physician Hippocrates around 400 BC commented on it in his Aphorisms,
noting its absence in eunuchs and premenopausal women.[100][104] Aulus
Cornelius Celsus (30 AD) described the linkage with alcohol, later onset in
women and associated kidney problems: Again thick urine, the sediment from
which is white, indicates that pain and disease are to be apprehended in the
region of joints or viscera... Joint troubles in the hands and feet are very
frequent and persistent, such as occur in cases of podagral and cheiragra. These
seldom attack eunuchs or boys before coition with a woman, or women except
those in whom the menses have become suppressed... some have obtained
lifelong security by refraining from wine, mead and venery.
Signs & symptoms:
The signs and symptoms of gout almost always occur suddenly, and often at
night. They include:

 Intense joint pain. Gout usually affects the big toe, but it can occur in
any joint. Other commonly affected joints include the ankles, knees,
elbows, wrists and fingers. The pain is likely to be most severe within the
first four to 12 hours after it begins.
 Lingering discomfort. After the most severe pain subsides, some joint
discomfort may last from a few days to a few weeks. Later attacks are
likely to last longer and affect more joints.
 Inflammation and redness. The affected joint or joints become swollen,
tender, warm and red.
 Limited range of motion. As gout progresses, you may not be able to
move your joints normally.

Factors responsible for gout:

 Diet: Eating a diet rich in red meat and shellfish and drinking beverages
sweetened with fruit sugar (fructose) increase levels of uric acid, which
increase your risk of gout. Alcohol consumption, especially of beer,
also increases the risk of gout.
 Weight: If you're overweight, your body produces more uric acid and
your kidneys have a more difficult time eliminating uric acid.
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 Medical conditions: Certain diseases and conditions increase your risk

of gout. These include untreated high blood pressure and chronic
conditions such as diabetes, obesity, metabolic syndrome, and heart and
kidney diseases.
 Certain medications: Low-dose aspirin and some medications used to
control hypertension — including thiazide diuretics, angiotensin-
converting enzyme (ACE) inhibitors and beta blockers — also can
increase uric acid levels. So can the use of anti-rejection drugs
prescribed for people who have undergone an organ transplant.
 Family history of gout: If other members of your family have had
gout, you're more likely to develop the disease.
 Age and sex: Gout occurs more often in men, primarily because women
tend to have lower uric acid levels. After menopause, however,
women's uric acid levels approach those of men. Men are also more
likely to develop gout earlier — usually between the ages of 30 and 50
— whereas women generally develop signs and symptoms after
menopause.
 Recent surgery or trauma: Experiencing recent surgery or trauma can
sometimes trigger a gout attack. In some people, receiving a vaccination
can trigger a gout flare.

Causes:
Gout occurs when urate crystals accumulate in your joint, causing the
inflammation and intense pain of a gout attack. Urate crystals can form when
you have high levels of uric acid in your blood. Your body produces uric acid
when it breaks down purines — substances that are found naturally in your
body.

Purines are also found in certain foods, including red meat and organ meats,
such as liver. Purine-rich seafood includes anchovies, sardines, mussels,
scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks
sweetened with fruit sugar (fructose) promote higher levels of uric acid.

Normally, uric acid dissolves in your blood and passes through your kidneys
into your urine. But sometimes either your body produces too much uric acid or
your kidneys excrete too little uric acid. When this happens, uric acid can build
up, forming sharp, needle like urate crystals in a joint or surrounding tissue that
cause pain, inflammation and swelling.
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Types of diagnosis:

 Joint fluid test. Your doctor may use a needle to draw fluid from your
affected joint. Urate crystals may be visible when the fluid is examined
under a microscope.
 Blood test. Your doctor may recommend a blood test to measure the
levels of uric acid in your blood. Blood test results can be misleading,
though. Some people have high uric acid levels, but never experience gout.
And some people have signs and symptoms of gout, but don't have unusual
levels of uric acid in their blood.
 X-ray imaging. Joint X-rays can be helpful to rule out other causes of
joint inflammation.
 Ultrasound. This test uses sound waves to detect urate crystals in joints
or in tophi.
 Dual-energy computerized tomography (DECT). This test combines
X-ray images taken from many different angles to visualize urate crystals
in joints.

Diet strategy:
 Protein: Total protein intake and animal-protein intake are not associated
with the risk of gout. However, the multivariate relative risk of gout
among the men in the highest quintile of vegetable-protein intake, as
compared with those in the lowest quintile, was 0.73 (95 percent
confidence interval, 0.56 to 0.96), and the corresponding relative risk
associated with dairy-protein intake was 0.52 (95 percent confidence
interval, 0.40 to 0.68).

 Carbohydrates: Refined carbohydrates are safe to eat for gout sufferers

because they have a low purine content. But too much consumption of
refined carbohydrates can cause a rapid rise in blood sugar and increase
one's risk of developing metabolic syndrome and diabetes.

 Fat: Both limit red meat, sugar and processed foods and focus on fresh
fruits and vegetables, some whole grains and healthy fats like olive oil.
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Exercise and weight loss also bring down uric acid levels and help
prevent gout flares. In one small trial, patients who lost 16 pounds
dropped their uric acid levels by 3 points.

 Iron: Excess consumption of iron-rich foods such as shellfish could

increase the risk of gout, according to new research. Elevated serum
ferritin levels may increase the risk of gout, according to a new study.

Foods to include:
 Cherries: Cherries have been studied for their role in the prevention and
management of gout. Their deep red color is due to natural compounds
called anthocyanins, which contain antioxidant and anti-inflammatory
properties. Research has shown that cherry consumption may help reduce
uric acid levels, and thus decreasing inflammation and lowering the risk of
future gout attacks.3 The most commonly studied types of cherries for gout
therapy have been tart cherries. More specifically, Montmorency or Balaton
varieties.

 High Vitamin C foods: Vitamin C is a well-known antioxidant, but it is

lesser-known for its potential role in the treatment of gout. The means by
which it may help is by lowering blood uric acid levels. A prospective
study published in 2009 followed nearly 47,000 men for 20 years, and
examined their risk of gout in relation to their vitamin C intake. The
researchers concluded that higher vitamin C intake was associated with a
lower risk of developing gout, with up to a 45% lower risk when
consuming 1,500 milligrams or more of vitamin C per day.

 Coffee: Being one of the most widely consumed beverages in the world,
coffee has been studied for its various effects on health. Early studies
suggest that coffee may decrease the risk of gout. However, research shows
that it may vary based on sex. A 2015 review of studies found that in men
who drank 4 to 5 cups of coffee per day had a 40% decreased risk of gout,
and those who drank 6 cups or more per day had a 59% lower risk, when
compared with no coffee consumption.

 Low-purine foods: One of the most widely accepted and recommended

dietary approaches in managing gout is to reduce purine intake from foods.
By choosing to eat low-purine foods instead of those higher in purines, you
can help prevent your blood uric acid levels from getting too high.
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Additionally, the DASH diet, which encourages many low-purine foods,

has been associated with a lower risk of gout.8 Low-purine foods include
certain fruits, like cherries and citrus fruits, low-fat dairy, plant-based
protein foods such as nuts, seeds and legumes, whole grains, and
vegetables.

 Low-Fat Dairy: Dairy products have been found to decrease the risk of
gout. In particular low-fat or non-fat dairy may be protective against
recurrent gout flares.12 Low-fat dairy may decrease uric acid levels, as well
as contain certain anti-inflammatory properties that decrease the
inflammatory response to monosodium urate crystals within the joint.
Foods to avoid:

 Purines: In 2004, researchers found that some purines, which are present in
animal and plant foods, may worsen the symptoms of gout because the
body converts them into uric acid. The study indicates that consuming
animal based foods that are high in purines might increase the risk of
developing gout. However, eating plant based foods that contain purines
does not appear to have the same effect. The researchers add that
consuming dairy products may reduce the chances of developing gout. The
following foods contain purines. People with gout should significantly limit
or avoid them.

i. Red meat and organ meat, such as liver or kidneys, which are high
in saturated fat

ii. Seafood, such as lobster, shrimp, sardines, anchovies, tuna, trout,

mackerel, and haddock

iii. Sugary drinks and foods that are high in fructose

iv. Processed foods and refined carbohydrates

v. Alcohol, especially beer and hard liquor

 Alcohol: Gout has been associated with alcohol intake for centuries.
Frequent and high alcohol consumption is known to cause chronic
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hyperuricemia, increasing the risk of gout and gout attacks. Because of this,
it is recommended to avoid some alcohol altogether, including beer, hard
liquor and other grain alcohols.
 High-Fructose Foods: Fructose is a naturally occurring form of sugar
found in some foods, such as fruit. Research has shown that fructose,
including high fructose corn syrup added to some foods and beverages, can
increase serum uric acid levels.19 Avoiding or limiting foods high in these
types of sugars may help reduce the symptoms and severity of gout.
 Yeasts: Foods with yeasts and yeast extracts are high in purines and should
not be included in your diet if you have gout. Foods, such as vegemite, as
well as supplements containing yeast should be avoided in order to keep
uric acid levels down.
 Certain fish, seafood and shellfish, including anchovies, trout, sardines,
herring, codfish, mussels, codfish, scallops and haddock.
 Red meat including bacon, turkey, veal and venison
 Organ meats such as liver, kidney, sweetbreads and brain. People with
gout, however, can have a moderate intake of lean meats such as chicken
and turkey.

Superfoods:
1. Bananas: If you have developed gout because of high uric acid,
then having a banana everyday can reduce lower uric acid in your
blood, thereby reducing your risk of gout attacks. Bananas are
naturally very low in purine—a natural compound that breaks down
into uric acid—thus making it a good choice for you.
2. Apples: Apples have a high dietary fibre content, which helps in
lowering uric acid levels. Fibre absorbs uric acid from the bloodstream
and eliminates the excess uric acid from your body. Moreover, apples are
also rich in malic acid which tends to neutralize the effects of uric acid in
the body.
3. Citrus fruits: Fruits like oranges and lemons are a rich source of
vitamin C and citric acid. Including these foods can help you maintain
healthy uric acid levels in the body, since they can efficiently flush out
the excess.
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4. Green tea: Several studies prove that green tea extracts can lower uric
acid production in the body, thus making it a good beverage for those
who suffer from gout or have high levels of uric acid in their blood.

Dietary guidelines:
 Fluid intake Drink a minimum of two quarts of fluids per day, a large
fluid intake is helpful in eliminating uric acid.
 Obesity is often associated with gout. If you are overweight, gradually
reduce your weight, as this may have a beneficial effect. Fasting or
drastic dieting will increase uric acid levels, and thereby be more harmful
than helpful.
 Purine Restriction Eliminate foods high in purines (150 mg or more per ½
cup):
• Anchovies • Organ meats (liver, kidney, brains, or sweetbreads) •
Game meats (rabbit, duck, or venison) • Gravies • Herring • Mackerel •
Sardines • Scallops
 Protein should be restricted to 60 grams per day for people 5’8” or less,
and 80 grams per day for people taller than that.

 Reduce or eliminate alcoholic beverages: Over consumption of alcoholic

beverages may bring about attacks of gout. Taken in moderate amounts
and with food, alcoholic beverages do not appear to affect the symptoms
of gout.

 Consume 3 cups per day of fat-free or low-fat milk or milk products.

Counselling tips:
 Watch your weight. Try to lose weight slowly.

 Eat fresh fruit, vegetables, whole wheat products and some pulses (high
in purine) every day.

 Enjoy low-fat milk and dairy products daily.

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 Keep an eye on the purine content of food. Avoid offal, shellfish and
crustaceans and tinned fish such as sardines in oil.

 Eat no more than 100g of meat, sausages, fish and poultry a day.

 Drink alcohol only occasionally, as it affects the elimination of uric acid.

 Eat low-fat food. The consumption of high-fat foods encourages weight

gain.

 Drink at least two litres of low-calorie fluids a day. Recommended fluids

are water, tea and fruit juice.
Supplements:
1. Vitamin C: Vitamin C is an essential vitamin that helps your body build,
repair, and maintain healthy tissues. Also known as ascorbic acid, vitamin
C is an antioxidant. That is, it helps your body defend itself against free
radical molecules that could cause harm. When it comes to gout,
however, its usefulness seems to depend on whether you already have
gout.
2. Bromelain extract: Bromelain is an extract from the pineapple plant
that’s believed to have anti-inflammatory properties. It’s often used to
treat arthritis, sinusitis, and other types of inflammation. In the future,
more research may uncover the benefit of bromelain for helping people
with inflammation from gout.
3. Fish oil supplements: Experts often recommend omega-3 fatty acids,
which are found in fish oil supplements, to boost heart health. But they
might also be helpful for people with gout because they reduce
inflammation, a key hallmark of this condition. You might wonder, why
not just eat fish? Some types of fish contain higher levels of chemicals
called purines, which could aggravate gout because they tend to raise
your uric acid levels. But fish oil that’s been highly distilled shouldn’t
contain these purines.
4. Ginger: Ginger is often praised for its anti-inflammatory effects. A 2017
study examined the pain-relieving potential of red ginger. The researchers
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found that compresses made with red ginger could alleviate some of the
pain associated with gout.

Justification:
Gout is a complex type of arthritis connecting sudden chronic pain, swelling
and inflammation of the joints. In this article, we discussed the foods that cause
gouts and the best diet habit for preventing gout. Luckily, a gout-friendly diet
can help to reduce pains and other complex symptoms. Organ meats, some
types of fish, fruit juice, sugary sodas and alcohol are the worst food list for
having gout. Some drinks often trigger gout attacks. On the other hand, a fruit
that contains vitamin c, soy products, vegetables, whole grains, and low-fat
dairy products may help prevent gout attacks by lowering uric acid levels.

Multiple choice questions:

1. Gout is caused by the build-up of what substance in the body?
A White blood cells
B Synovial fluid (found in joints)
C Uric acid
D Blood plasma
2. Uric acid is usually eliminated from the body by way of ____________.
A Breathing
B Urine
C Metabolization in the liver
D Sweat
3. People with gout should avoid consuming…
A Alcohol
B Dairy

4. Symptoms of gout may include…

A Warmth, severe pain, and swelling in the joint
B Red or purple skin
C Peeling, itching skin at the site of the gout attack
D All of the above
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5. What is the most common site of a gout attack?

A Big toe
B Foot
C Knee
D Ankle

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209X
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