Take the "Ow" Out of Gout
Created on 6/27/2008
C was recently diagnosed with gout, probably after she sought medical care for an acutely painful, swollen joint. Dietary factors play a role in gouty flares, and C is concerned over the limited food options she has been presented with.
Gout is an inflammatory condition that tends to run in families. Inflammation with gout occurs in response to the accumulation of crystals in a joint (specifically monosodium urate crystals). Most often a single joint is involved, and frequently the great toe is affected. The joint becomes swollen, very painful, and may be reddened and warm to the touch. It's important not to make a diagnosis of gout on your own, as many other conditions can mimic the findings of gout, including infection and even a condition called pseudogout.
Conventional medical approaches are very effective at managing the disease, but the frequency of flare-ups, as well as your need for medication, can often be lessened simply by making prudent dietary choices. One's diet takes on added importance in the setting of gout now that an association has been recognized between gout and the metabolic syndrome (a constellation of findings that includes high blood pressure, elevated triglyceride and LDL ("bad") cholesterol levels with low HDL ("good") cholesterol, and central abdominal weight gain), as well as other conditions.
Dietary recommendations for the person with gout take into account that the metabolism of certain foods increases uric acid levels in the body, and thus the potential for uric acid crystals to find their way into the joints. While such recommendations used to be far-reaching and somewhat difficult to adhere to, guidelines are becoming more specific and easier to follow.
Most experts would agree that limiting intake of red and organ meats, as well as alcohol (especially beer), can help. Interestingly, even though fish oils are typically considered anti-inflammatory, recent data suggest that the protein from fish can also worsen gout. Low-moderate intakes of red and organ meats, and fish are acceptable for most people (1-2 times per week). A diet rich in fruits and vegetables seems the best option. In the past certain vegetables were considered taboo, as their metabolism was thought to contribute to high uric acid levels, but more recent data suggest that is not the case. Of note, eating cherries and enjoying cherry juice have been touted as potentially effective interventions to help relieve an acute flare of gout. Sugary drinks (including those containing fructose) do seem to worsen gouty symptoms - just another reason to limit intake of soda and some fruity drinks. Coffee has long been considered another "no-no" for people with gout, but research has called this caution into question (data suggest that coffee drinking is associated with lower uric acid levels; the findings did not hold true for tea, however). People who exercise regularly also seem to do better with gout, perhaps in part because it helps them maintain a healthy body weight.
Diets of health promotion work far better than diets of disallowance. Yes, there are some foods that when eaten may increase your risk for a flare-up of gout, but that does not mean you have to avoid those foods at all cost. You may even find that you are able to enjoy some of your favorite meals that include red meat or fish without fear of worsening gout. Remember, everyone is unique and different, so the approach needs to be individualized.
I hope this is of help to you, C, and that the discomfort of gout is something
you experience rarely, if ever.
Be well.
Dr. Russ
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