Wishing you a gout-free festive season

‘Tis the season to be jolly … but not so easy if you are one of the one in 40 people in the UK suffering from gout.

Gout is a form of arthritis and a disorder of purine metabolism, primarily effecting adult men (95% of cases are men aged over 30). Purines are a type of protein found in animal and plant products. As the body breaks down purines, a waste product called uric acid is formed. Too much uric acid in the body (hyperuricaemia) that can’t be excreted fast enough will be stored as crystals in the body, typically around joints, tendons and even in the kidneys, causing intense inflammation and pain. In severe and recurrent cases, joints may become debilitated and kidneys may be damaged. For many, the first signs of gout is swelling, redness and intense pain in the first joint of the big toe, although other joints may well be affected, with attacks commonly occurring at night and lasting up to 10 days.

What causes gout? 

We generally associate gout with rich foods, alcohol and general over indulgence. And this is pretty much spot on as diet plays a key role in preventing and minimising gout. Foods containing high levels of purine are a common trigger – see box below. In a study published in the Annals of the Rheumatic Diseases in 2012, 633 participants who had a history of gout showed a nearly five-fold increase in recurrent attacks when consuming a high purine diet. Previous studies have also shown an increased risk of developing gout with a purine-rich diet.

Purine content of foods

High (avoid)	Medium (eat in moderation)	Low
Offal Game Oily fish Seafood Meat and yeast extracts	Meat Poultry Dried peas/legumes Mushrooms Some vegetables – asparagus, cauliflower, spinach Wholegrains	Dairy Eggs Bread and cereals Pasta and noodles Most fruit and vegetables

Note – many of these foods should form part of a healthy, balanced diet, but consume with caution during attacks of gout

How to prevent it? 

Look at making dietary and lifestyle changes

• Make sure you are eating at least your 5-a-day, and preferably more. A diet rich in fruit and vegetables provides the necessary vitamins and minerals for good health. Diets rich in vitamin C have also been shown to reduce uric acid levels.
• Aim to ‘eat the rainbow’ the ensure you are getting the maximum range of nutrients in your diet
• Montmorency (sour) cherries contain antioxidants that can help reduce uric acid and inflammation. They are available from health food stores and can either be taken in tablet or liquid form
• Maintain a healthy weight. This is the single, most effective thing you can do to prevent attacks of gout. Excess weight slows down the removal of uric acid by the kidneys. Abdominal fat is a risk factor for many health conditions, including gout
• Avoid purine-rich foods
• Avoid sugary drinks and added sugars
• Drink plenty of water – this will help to minimise the risk of crystals forming in your joints by helping the kidneys to flush out excess uric acid
• Reduce alcohol consumption as alcohol both increases uric acid and slows down its excretion. Beer contains higher levels of purines and gout is more common in beer drinkers than in those drinking wine. Binge drinking may trigger attacks of gout
• Stop smoking
• Where possible, minimise stress.  Stress is known to deplete the body of certain vitamins, particularly the B vitamins.  Pantothenic acid (vitamin B5) helps the body excrete uric acid and it is no coincidence that attacks of gout are often associated with stress
• Maintain a healthy weight.  Being overweight increases your body’s uric acid levels
• Exercise regularly – if you are suffering with gout then choose low-impact activity that won’t place a strain on joints (swimming, gentle walking)

How to deal with an attack

Resting and elevating the affected limb and keeping it cool with an ice pack are helpful strategies for dealing with an attack. Reducing inflammation in the joint is also key and implementing the above lifestyle and dietary strategies is important.  Bromelain, an enzyme found in pineapples (make sure you eat the tough inner core where concentrations are highest) is believed the help reduce inflammation associated with gout.  And of course, check with your doctor to make sure there are no other underlying causes.