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Diet, Lifestyle and Gout

Gout is on the Rise; Diet & Lifestyle Can Help

Gout, one of the oldest known forms of arthritis, has been become more widespread over the past 2 decades according to research presented at a recent American College of Rheumatology Annual Meeting.

During gout attacks, crystals of a naturally occurring chemical called uric acid (urate) accumulate in joints – commonly in the toes – causing swelling, pain and inflammation. Urate in blood serves as the source of these uric acid crystals: some people make too much urate, while others have a hard time getting rid of it. But whatever the cause, estimates from the National Health and Nutrition Examination Survey (NHANES) are that 32 million US adults have high blood levels of uric acid, a stepping-stone to gout.

Compared with women, men have a greater risk of developing gout. But women can get gout too, often after menopause when estrogen levels decline. Estrogen helps the kidneys excrete uric acid, so uric acid levels can rise in postmenopausal women.

A number of medications can help manage gout, but diet and lifestyle factors play a significant role as well.

Beverages: Some to Curtail, Others OK

Restriction of alcoholic beverages is important in the management of gout. Too much alcohol may reduce excretion of uric acid, and beer in particular contains a high level of purines. Dietary purines are a source of uric acid when they’re metabolized in the body. A glass of wine is usually considered harmless.

A large prospective study found that drinking coffee was associated with a decreased risk of gout, while higher intake of sugar-sweetened soft drinks or fructose was strongly associated with an increased risk. These findings suggest that coffee is probably alright for gout sufferers. But intake of fructose-sweetened drinks should be limited as they appear to reduce uric acid excretion. And everyone – but especially those with a history of kidney stones due to uric acid – should drink an ample amount of water daily to help flush away urate crystals.

Gradual Weight Loss is the Goal

Studies report that gout is often associated with the metabolic syndrome – a condition characterized by abdominal fat, Insulin resistance and high triglyceride levels. Lowering triglycerides with a weight-loss diet has been shown to increase the kidney’s excretion of urate in patients with gout.

Excess weight is a risk factor for gout, and many gout sufferers are, in fact, overweight. But the idea is to shed excess pounds gradually (around 2 ½ lbs monthly) through exercise and calorie cutting. Crash dieting with rapid weight loss could lead to ketoacidosis (a build-up of ketones) and provoke gout attacks.

Watching Purine Intake: Meat and Seafood

Many physicians advise gout patients to reduce their intake of animal-source purines like meats and seafood, which can lower blood urate levels modestly. Some doctors also suggest avoiding other purine-rich foods such as peas and cauliflower. Getting individualized dietary advice is the best bet for those with gout.

What about prevention? One research team followed 47,000+ men with no prior history of gout over a 12-year period. Participants who ate the highest amount of meat were 40% more likely to develop gout than those who ate the least. And those eating the most seafood were 50% more likely to develop it. In this study, though, not all purine-rich foods were associated with an increased risk of gout. Consuming peas, beans, spinach, mush-rooms and cauliflower did not raise gout risk.

Bring on the Bing

Lastly, a pilot study in healthy women found that eating sweet Bing cherries lowered blood urate levels. In a second study, consuming 2 servings of the cherries for a month had anti-inflammatory effects in women. Both findings suggest that this fruit could have beneficial effects for those with high urate levels or gout.

Resources:

1. Tausche AK et al. Gout—current diagnosis and treatment. Dtsch Arztebl int 106:549-55, 2009.
2. Choi HK et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM 350:1093-103, 2004.
3. Schumacher HR Jr, Chen LX. The practical management of gout. Cleve Clin J Med 75 Suppl 5:S22-5, 2008.    
4. Keith MP, Gilliland WR. Updates in the management of gout. Am J Med 120:221-24, 2007.
5. Jacob RA et al. Consumption133(6):1826-9 of cherries lowers plasma urate in healthy women. J Nutr 133:1826-9, 2003.