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Gout – A Lifestyle Disease

Gout is a metabolic disorder caused by abnormal metabolism of purines, a component of many foods. Essentially what happens is that the excretion of uric acid, which is the product of purine metabolism, does not keep up with the production of uric acid. As a result, there is an 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 physiological 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 decrease 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, the accumulation of uric acid increases and other joints become inflamed and attacks become more frequent and debilitating. Besides being extremely painful, the attacks also cause damage to joints and to internal organs such as the kidneys.

Gout is increasing in incidence and affects about four percent 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” because it is often accompanied by other medical conditions such as hypertension, diabetes and hyperlipidemia.

A number of studies have now identified the main contributing factors to gout. These include obesity, alcohol (especially beer), red meat, shellfish, and fructose-containing beverages. The latter include both soft drinks and processed fruit juices.

Lifestyle changes can also make a difference in 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. Colostrum also appears to be protective against gout.

Notably, there are dietary factors that play little or no role in the development of gout. These include purine-rich vegetables, moderate to high 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 prefer to treat their disease without having to take pills. Dietary management and lifestyle modifications can play an important role in the early treatment of uncomplicated gout.

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