Tuesday, November 29, 2011

“Gout” You by the Toe? Kick It with Good Nutrition

Lifestyle contributes to gout 
Gout has long been viewed as a malady suffered by the wealthy, those with means to afford rich foods and wine. Today, gout is the most common form of inflammatory arthritis suffered in men, effecting 3.4 million adult men and an increasing number of postmenopausal women. The incidence of gout is on the rise and lifestyle factors play a significant role in its occurrence.

Gout is characterized by on overproduction of uric acid or a decreased excretion of urate in the kidney. Uric acid is the end product of purine metabolism. Most purines are contained in the human body as DNA. Cells of the body are constantly turning over with the release of genetic material and their consequent breakdown to uric acid. Foods and beverages that we consume can also contribute to the overall uric acid load in the body. When the uric acid level of the body is elevated, crystals can form in the joints. These crystals activate an inflammatory response, which brings on the pain and swelling of gout. The big toe and ankles are common joints affected.

Gout has been shown to be related to the metabolic syndrome, which includes features that increase the risk of heart disease and diabetes such as obesity, elevated cholesterol, high blood pressure, and insulin resistance. Overweight and obesity seem to play a role in both gout and metabolic syndrome. Maintaining a healthy body weight is import in the control of gouty inflammation, however, sensible eating is important. Following a low carbohydrate, high protein diet for weight loss can exacerbate gout.

High protein foods tend to contain more purines with the potential to raise uric acid level, though not all high purine foods have the same ability to cause an attack of gout. Beef, lamb, pork and fish are primary offenders and should be eaten less often and in smaller amounts. A small portion is considered three ounces and is the size of a deck of cards. Most restaurants serve meat in portions of six ounces or greater. Plant foods higher in purines do not seem to bring on gout and do not need to be limited. These include whole grain breads and cereals, oatmeal, wheat germ, wheat bran, mushrooms, green peas, spinach, asparagus and cauliflower. These foods have other health properties that may protect against gout. Low fat dairy products seem to protect against gout and it is recommended to eat at least two servings a day. Dairy products are low in purines and increase the excretion of urate. Vitamin D may also play a role in gout. Many people who have gout are deficient in vitamin D. Urate may prevent the activation of vitamin D, which is believed to have anti-inflammatory properties.

Alcohol has long been known to be a risk factor for gout. Beer is high in purines but alcohol in general may also be implicated. Alcohol is dehydrating and poor hydration increases the risk of gout. Alcohol intake should be controlled; especially beer and special attention should be paid to drinking enough water. This is particularly true when traveling. Many people experience gouty attacks while on vacation. They are dehydrated from their travels and imbibe more than they would at home.

Other diet and lifestyle factors important in the management of gout are:

• Reduced fructose consumption. Fructose is the only sugar that increases urate. Fructose is found most in soft drinks, sweetened juices, apples and oranges.

• Increased fruit and vegetable consumption (except apples and oranges). These foods are known to decrease inflammation with the potential to lower urate.

• Increased vitamin C intake. Vitamin C found in many fruits and vegetables decreases urate. Supplementation of 1500 mg vitamin C daily may be helpful. Vitamin C supplementation should be split throughout the day (500 mg with meals three times a day is suggested).

• Cherries are known for their anti-inflammatory ability. Consumption of cherries and cherry juice decrease gouty attacks.

• Increased physical activity is associated with decreased risk of gout.

As with all diet and lifestyle recommendations, do not undertake dramatic changes in your habits without supervision and advisement from your physician.