This week a poor friend of mine reported a recurrence of an inflammation in his feet that has rendered him unable to work, play or walk the dog. Ordinarily for this person you would assume that it was some sort of issue with impact injury from all the activity he does or possibly a wearing of the joints in the feet. So I was most disturbed to read that this was in fact a condition of ‘GOUT’. “How ludicrous” I exclaimed. Isn’t Gout one of those conditions that aristocratic men got in the 1800’s when they had too much wine and patè in their life? It appears not so. I distinctly remember an episode of 'Keeping Up Appearances' where gout seemed to be the ‘illness of choice’ as it had connotations of a regal life well lived in prosperity and with overindulgence in rich food-stuffs! Apparently not!
So how is gout existing in the 21st century and how on earth could my yoga-going, healthy-eating, active vivacious friend have such a condition?
Gout is typically a form of inflammatory arthritis with a chemical cause as opposed to a degeneration of the joints. It is caused from deposits of sodium urate (uric acid) in and around the joints and especially in the feet! Ordinarily uric acid is removed from the blood stream via the kidneys, which filters uric acid out of the blood stream. Any issues that prevent this from occurring creates hyperuricemia which is the primary risk factor for gout. Too much uric acid creates small needle like crystals that tend to collect in the feet and grind and irritate the synovial joints in the metatarsals. The feet tend to be the focus of these collections partly due to gravity and partly due to the slightly decreased temperature found in the extremities that allows the crystallisations to form. This creates inflammation and irritation of the joints and thus pain.
Gout has a sudden onset and usually appears without provocation or slow onset. The pain centres around the big toe and into the arch of the foot and heel. It is acute in nature and is described as ‘exquisitely painful’. The pressure is almost unbearable and weight bearing is acutely painful. Men make up 90% of gout sufferers and are usually over 40. Pain centres around the foot but can often progress to other joints as well. There is a condition called pseudogout (Calcium Pyrophosphate Dihydrate Deposition) which does not involve uric acid levels and presents without any other contributing causes. It also usually attacks the knees or wrists.
There are two main issues that interrupt the normal processing of uric acid in the blood:
1. Improper Kidney function that allows the levels of uric acid to rise.
2. Normal Kidney function but the levels of uric acid are high due to high protein or alcohol intake.
The presenting issue of diet is an element that is mostly in our control and a presenting symptom that has very real connections to the disease. A high protein diet is one element to consider with red, game, organ meats, fowl and a high intake of alcohol being a warning sign. These foodstuffs contain nucleic acids called purines that when broken down create uric acid. So a diet high in these elements is of concern with someone who suffers from gout or has the genetic history. The predisposition to the disease is genetic and so not everyone who has a high meat/alcohol diet will suffer from gout.
The other element of concern for this diet is not just gout but Kidney Stones. Hyperuriceamia can lead to strain on the kidneys and the collection of the uric crystals in the kidneys which leads to the formation of the dreaded kidney stones. If you have ever had the unique pleasure of gut wrenching cramping that are associated with kidney stones it is not a pleasant experience to endure. The other complications that result from this can be high blood pressure. With complicated kidney function, fluid is not processed and this increases blood pressure levels, which leads to further complications of aeschaemic attack and cardiovascular disease.
Acute attacks of gout have varying patterns according to the length. Some people will have a singular attack but more often, people will suffer their first attack and then have a long period (several years) before enduring a second episode. The consequent attacks come in shorter intervals and these can sometimes progress to constant attacks and the onset of rheumatoid arthritis. Acute inflammations often decrease in a matter of days or a week or two. Changes in temperature can often accompany attacks and the extreme inflammation in the joints can create redness and swelling around the affected joint.
Managing gout is a case of looking primarily at limiting the purine food substances and also taking care of kidney function. This requires limiting diuretics such as alcohol and caffeine, ensuring adequate fluid levels in the body and maintaining a healthy weight regime. Medication comes in the form of good ol’ aspirin to help thin blood and prevent crystallization from forming. Other medication involves metabolism and uric acid management techniques. But diet does play a good role in the prevention of the onset of the disease.
So in order to prevent yourself suffering the ‘disease of kings’, put down the red wine and Beef Bourguignon for a time and try to flush your system with lots of water. Maintaining healthy kidneys is primary and to do this one needs a ‘good’ amount of water, not relying on NSAID’s for managing minor complications or even relying too much on supplements and herbal aids for your gut health. All these factors can load up the kidneys and decrease health. And as lovely as it may sound, you don’t want to be hauled up in bed with your feet up and unable to work – it’s nowhere near as glamorous as it sounds.