Gout is a metabolic disorder that is due to abnormal metabolism of purines, a constituent of many foods. Essentially what happens is that the excretion of uric acid, which is the product of purine metabolism, does not keep pace with uric acid production. As a result there is abnormal accumulation of uric acid.
Gout causes symptoms because crystals of uric acid form and deposit in tissues. Crystal deposits form when serum urate levels are above the saturation point of roughly 7.0 mg/dl. This assumes that other physiologic factors such as temperature are normal. The goal then of gout therapy is to keep the serum uric acid below a level of 6.0 mg/dl. Below this level, deposits of uric acid shrink and attacks of gout diminish in frequency.
The typical early manifestations of gout are acute episodes of painful swollen joints. The usual sites of the first attacks are the big toe, the foot, and the ankle. If gout is not treated, uric acid accumulation worsens and other joints become inflamed and attacks become more frequent and debilitating. Besides being excruciatingly painful, the attacks also cause damage to joints and to internal organs such as the kidneys.
Gout is increasing in incidence and affects approximately four per cent of Americans. This increase in incidence is felt to be due to environmental factors including changes in diet as well as the obvious increase in obesity. Gout is part of the “metabolic syndrome” since it is often accompanied by other medical conditions such as hypertension, diabetes, and hyperlipidemia.
A number of studies have now identified the major contributing factors to gout. These include obesity, alcohol (especially beer), red meat, shellfish, and fructose containing beverages. The latter include both soft drinks as well as processed fruit juices.
Lifestyle changes can also make a difference as far as reducing the likelihood of gout. These include weight loss, as well as increasing intake of foods such as low-fat dairy products, coffee, vitamin C, and cherries. In fact, the latter have been shown to be gout protective in at least two well-controlled studies. Skim milk also seems to be protective against gout.
Of note, there are dietary factors that play little or no role in the development of gout. These include purine-rich vegetables, moderate to large fat dairy materials, tea, and wine.
While there are effective medications for the treatment of gout, it is a safe assumption to suggest that most people would prefer to treat their disease without having to resort to pills. Dietary management and lifestyle adjustments can play a significant role in the early treatment of uncomplicated gout.
