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All about Gout!

Gout is a common condition that is increasing in prevalence in Australia, however, with the right care, it can be effectively treated and prevented. Gout comes from gutta, which means a drop in Latin. It is a reference to the belief that it was caused by a drop-by-drop accumulation of fluid in the joints.


What is Gout?

Gout is a common form of inflammatory arthritis that affects the joints. It is characterized by extreme joint pain, swelling and redness. While other types of arthritis develop slowly, a gout attack usually happens suddenly, often overnight. The big toe is the most affected joint, but gout can also strike joints in the hands, wrists, knees, ankles, elbows or any other joint. People with osteoarthritis in their fingers may experience their first gout attack in their finger joints.


All about Gout - nutrition and more from a Dietitian

How does gout happen? what is the cause?

Gout attacks usually peak after 12 to 24 hours, then slowly disappear on their own, whether they are treated or not. The recurrence of gout attacks varies among people. You may have only one in your lifetime or one every few years. Having gout multiple times can lead to gouty arthritis, a form of arthritis which gets progressively worse. Gouty arthritis involves more joints, lasts longer, and increases in severity over time.


Gout happens when there are high levels of a waste product called uric acid building up in the body. The body makes uric acid from the breakdown of purines, which are natural chemicals found in human cells and many foods, especially red meat, organ meats and some seafoods, sugary sodas, and beer. Normally, the body excretes extra uric acid through the kidneys into the urine. However, this does not happen efficiently in people with gout, either naturally because the kidneys don’t excrete uric acid the way they should, or from consuming a high-purine diet. When uric acid builds up, uric acid crystals can form around the joints, causing sudden, severe pain and swelling.


What are the symptoms?

Gout is not gout until symptoms occur! During a gout attack, symptoms in affected joints may include:

  • Intense joint pain

  • Joint swelling

  • Red and shiny skin over the joint

  • Affected joint may be hot to touch.


There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission.


What are the risk factors?

While studies continue to investigate how genes and environmental factors contribute to a buildup of uric in your blood, there is evidence that certain factors may increase your chances of developing gout, including:

  • High uric acid. However, not everyone with elevated uric acid levels develops gout.

  • Family history of gout.

  • Age.

  • Alcohol.

  • High purine diet

  • Drinks containing high-fructose corn syrup, such as soda.


Some health conditions may also increase your risk of developing gout, such as:

  • Overweight or obesity.

  • Metabolic syndrome, a name for a group of conditions including high blood pressure, high blood sugar, abnormal cholesterol levels, and excess body fat around the waist.

  • Chronic kidney disease, a condition that develops when kidneys’ functions are altered, and they cannot filter blood the way they should.

  • High blood pressure.

  • Conditions that cause your cells to turn over rapidly, such as psoriasis, haemolytic anaemia, or some cancers.

  • Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two rare conditions in which your body either does not have the enzyme that regulates uric acid levels or does not have enough of that enzyme.


Some medications can increase your risk of developing gout, such as:

  • Diuretics, which help the body to eliminate excess fluid.

  • Low-dose aspirin.

  • Niacin, a vitamin, when taken in large amounts.

  • Cyclosporine, which is an immunosuppressant for people who have organ transplants or treat some autoimmune diseases.


Gout questions answered by a dietitian

Who gets Gout?

Men are three times more likely than women to develop gout. Almost 9 in 10 (87%) people with gout are males in Australia. Gout usually develops in middle age. Gout tends to affect women after menopause when they lose the protective effects of estrogen. Younger people rarely develop this disease; however, if they do, it tends to be more severe.


What are the complications of Gout?

Over time, recurrent attacks of gout can cause irreversible damage to the joint and the nearby bones. They can also cause kidney stones, kidney damage and ‘tophi’, solid lumps of uric acid crystals often found in the ears, fingers, hands, forearms, knees, and elbows.


How is Gout treated?

The treatment of gout may include pain-relieving medicines, usually non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen, anti-inflammatory drug colchicine, and corticosteroids injections or tablets. Medications to lower levels of uric acid include febuxostat, allopurinol, and probenecid.


How can I manage a Gout attack?

In addition to medical treatment, you can also provide relief from gout symptoms at home.

  • Applying ice and elevating the joint help to reduce swelling and pain.

  • Resting the joint and protecting the joint area to prevent further damage.

  • Prompt treatment is important not only to provide relief for symptoms of acute gout but also to prevent complications.


Without treatment, symptoms of gout will usually last for about a week. You may not have another attack for months or years.


Can Gout be cured?

Unfortunately, there is no cure for gout. However, with the help of healthcare providers, you would be able to manage your symptoms and lower your uric acid levels.


The relationship between Gout and your diet

What is the relationship between Gout and the diet?

People who have gout are more likely to eat foods rich in purines, which convert into uric acid within the body.


Foods with high levels of purines include:

  • Red meat and offal such as liver, kidneys, and heart.

  • Fish and Seafood, especially shellfish, scallops, mussels, herring, mackerel, sardines, and anchovies.

  • Foods containing yeast such as Vegemite and beer.


Dietitian tips for someone with gout

Diet and lifestyle can help manage gout and prevent complications related to the disease.

Lifestyle strategies:

  1. Maintain a healthy body weight. Gout is more common in people who are overweight. Losing weight can assist in gout management. However rapid weight loss from very low-calorie diets, may increase your uric acid level, so it is important that you aim for gradual weight loss of 0.5-1kg per week. See a Dietitian for advice.

  2. If you drink alcohol, drink alcohol in moderation and avoid binge drinking.  Alcohol can greatly increase your uric acid levels. Limiting the amount of alcohol you drink, especially beer and spirits, may reduce your risk of gout. Speak to your doctor about whether it is ok for you to drink alcohol in the first place. Know that during a gout attack, it is best to avoid alcohol completely.

  3. Stay hydrated. Drinking plenty of water helps to dilute the uric acid levels in your body. It is important to drink 8-10 glasses of water or fluid per day.

  4. Avoid drinks high in sugar or fructose, like juices or sodas. There is research that suggests sugary drinks such as fruit juices or soft drinks may increase your risk of gout. As these drinks also contribute to weight gain it is recommended to limit their consumption. Choose lower kilojoule alternatives such as diet drinks or better still, choose water.

  5. Exercise regularly – aim to complete at least 150 minutes of physical activity per week.


What should I eat?

There are some foods that appear to trigger a Gout attack. These foods contain a high level of purines, which form uric acid in the body. Avoiding, or eating in moderation, foods that are high in purines can help lessen uric acid levels in the body and limit gout flares. Purine-rich vegetables like spinach or mushrooms are usually safe to eat. Talk with a dietitian for tips and advice.


Eating a healthy diet rich in vegetables, whole grains, proteins from plant products such as beans, lentils, peas, healthy fats such as nuts and extra virgin olive oil and minimally processed foods may reduce your risk of a gout attack.


Mediterranean diet or DASH (Dietary Approaches to Stop Hypertension) diet may help prevent gout attacks. The DASH eating plan can help improve high blood pressure and may help lower blood uric levels. One study including 45,000 men found that those who follow a typical American diet with high consumption of red meat, French fries, sweets, and alcohol, had a 42% greater chance of developing gout compared to those eating a DASH diet.


Following the DASH eating plan, reduced uric acid levels and gout risk significantly. The DASH eating plan includes:

  • Increasing the intake of fruits, vegetables, nuts, and whole grains products and reduce the intake of processed food.

  • Eating low-fat or fat-free dairy products, poultry, and oils.

  • Limiting foods high in saturated fats such as fatty cuts of meat, animal fats, fried food, etc.

  • Limiting sugar-sweetened foods and drinks.

Mediterranean diet may help prevent gout attacks
Mediterranean diet or DASH (Dietary Approaches to Stop Hypertension) diet may help prevent gout attacks.

Seeking help with Gout

Each person with gout requires an individualised treatment plan. Work closely with your GP to prevent further attacks and actively manage your condition. Together, you and your doctor, can develop an ongoing treatment plan to manage uric acid levels and fight inflammation. Kidney function and uric acid levels may affect the choice of treatment.  The main goals of gout treatment are to prevent uric acid build up ad ease acute gout flares.


Gout and mental health

The fear of another painful flare can increase stress and contribute to more inflammation in the body. Like other forms of arthritis, inflammation in gout is associated with an increased chance of depression, especially in people who have frequent gout attacks. If you feel down, talk with your friends and family. Or reach out for professional health support.


Remember, regular exercise, good sleep, and healthy eating improve your mood. The better your mood, the more you will be able to manage gout. Read more about mental health and your diet here.


In summary

Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals that collect in your joints, causing pain, swelling and other symptoms. Healthy lifestyle choices and a medical treatment plan are effective for the prevention and management of gout.  Most people with gout find that though following a healthy, balanced diet, along with medicine, they were able to reduce their uric acid levels. It is best to seek the advice of your dietitian before making any changes to your diet. Dietitians can teach you how to follow a healthy diet to improve your health.


At OSCAR Care Group, we have a team of expert Dietitians who can assist you with dietary advice and personalised dietary plans that suit your lifestyle. Book your one-on-one consultation with a Dietitian on our website now!

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