One of the curses of American life has been the abundance and variety of food. Curses, you say? While humans through the ages consumed whatever the good Lord made available, today we have almost unlimited choices. One negative result: an increase in diet-related gout.
Gout was once known as the rich’s man disease, or disease of kings. Once upon a time, only kings could have meat, seafood and beer with every meal.
Now, however, we have a secret weapon: Knowledge! Since we know what causes this painful disease and how to prevent and treat it, we are much better off than the kings of olden days.
Gout most often attacks the big toe— actually, the metatarsal-phalangeal joint— and it occurs with no warning. It’s caused by a build-up of uric acid, which in itself is a symptom of arthritis. Uric acid, which is normally flushed out in the urine, calcifies. Then the urate crystals accumulate in the joints. The result is acute pain that renders the toe or other joints so sensitive that even the weight of a sheet in bed is unbearable.
Now the good news. We know that uric acid is a byproduct of the body’s breakdown of purines, chemicals that are formed naturally in our bodies and in certain foods. Besides managing the symptoms and adjusting our intake of water and medications, we can avoid certain foods such as shellfish, red wine, beer and red meat. (The old canard about beans and lentils causing gout has been disproved.) The reason that gout attacks the big toe is because the extremities are most often exposed to cold, and uric acid cystalizes at lower temperatures. But gout can attack any part of the body— and it may attack other joints after the first episode.
We have successfully treated patients with gout in our clinics in Dallas, DeSoto and Sunnyvale, and the disease is very manageable, though not curable.
It Hurts But Is It Gout?
Men are more prone to gout, perhaps because of hormonal reasons. Post-menopausal women start to appear at the clinic in almost the same numbers as men.
Other factors that might predispose you to gout:
- obesity, as your body produces more uric acid and your kidneys become overworked;
- diet that is high in meat and seafood, as well as beverages sweetened with fructose, or beer;
- no adverse effects such as are reported with oral treatment
- greater convenience for the patient, who is not required to apply a topical solution twice a day
- medical conditions such as untreated high blood pressure, diabetes, metabolic syndrome, heart or kidney disease;
- certain medications such as diuretics or aspirin, or anti-rejection drugs for patients who have had an organ transplant;
- recent surgery or trauma such as a car accident.
The doctor will perform a physical examination, and check for certain signs such as swelling, redness, tenderness, and restricted range of motion.
There is also a test that allows the doctor to see urate crystals in the joint fluid— another tool unknown to the ancient kings!
Gout Treatment Begins With Prevention
If left untreated, gout can worsen and destroy the joint. While some people have only one attack, others find that gout attacks reoccur regularly. Untreated gout is apt to cause deposits of urate crystals under the skin, in nodules called tophi. While these are normally not painful, tophi can become swollen and tender during a gout attack. Kidney stones are another consequence of gout, as urate crystals collect in the urinary tract.
We have had success in preventing subsequent attacks by analyzing the patient’s lifestyle, diet and medications. One of our first recommendations is to drink more water, or non-alcoholic, non-sweetened beverages. The kidneys have an easier time flushing the system of uric acid if they are well-hydrated.
We also advise our patients to avoid certain foods containing purines. Seafood is a menu favorite near our clinics in Sunnyvale, Dallas and DeSoto, and while we appreciate the value of this food we would advise you to limit your intake to one serving per week.
There are medications and injections we may prescribe to reduce the swelling and inflammation, as well as relieve pain.
Some patients find that elevating the foot several times a day (to a level even with the heart) helps reduce swelling.
The main message is that the underlying condition should be addressed, and such management will relieve symptoms.
Now even a king can’t get better advice than that!