PROTECTION AGAINST PURINES
If you’re reading this, you likely either have gout, suspect that you might have it, or know someone who does. And you’re probably not too happy about it. Gout is a big fraternity that nobody wants to be in.
Gout is a form of arthritis in which glasslike shards of built-up uric acid jab into joints, causing searing pain. For some, the pain is so severe that the mere weight of a blanket on an inflamed toe is too much to bear. Fever and chills can be part of the gout package, too, as the immune system attempts to fight off the assault.
About 2.1 million Americans know the pain of gout, and doctors say that it’s on the rise as the population ages. Gout can occur in both men and women at any age, but most of the people with gout are overweight men over 40.
The uric acid that causes gout is a normal part of our metabolisms. Our bodies make uric acid when they break down protein by-products called purines.
Normally, uric acid dissolves in the blood, is filtered out by the kidneys, and takes a ride out of the body in the urine. Not so in those with gout, however. Gout sufferers, perhaps through some metabolic glitch, either produce an overabundance of uric acid or have trouble getting rid of it. Over time, the excess acid condenses into sharp little crystals that lodge in joints and the connective tissues around them, resulting in inflammation and pain, says Doyt Conn, MD, professor of medicine and director of the division of rheumatology at Emory University in Atlanta. The big toe is a favorite first target of gout attacks, but gout has also been known to make its first appearance in the ankles, knees, hands, and shoulders.
Gout can be deceiving because attacks are sometimes separated by long periods with no apparent symptoms. When it does strike, it usually hits at night. Without medication, the pain of gout can persist for days or even weeks. If you get gout, you can count on getting it again. Half of those with a first attack have a second one within a year; 75 percent within 5 years.
Pain isn’t the only thing you have to worry about with gout. Without treatment, gout attacks often grow more frequent and more severe. After about 10 years, lumps of uric acid crystals, called tophi, may begin to build up around joints and in cartilage elsewhere in the body. Tophi are sometimes visible under the skin, particularly when they park themselves in the outer ear. Left untreated, these deposits gradually grow bigger and can irreversibly cripple a joint. In addition, people with gout are more likely than others to develop uric acid kidney stones.
What was long thought to be a men’s club is now increasingly open to women. But you won’t hear any cheers from the ladies. After all, who wants to join a club that involves painful, red joints?
Gout occurs in men and women at a rate of 2:1, which means that for every two men suffering with the painful condition, there is one uncomfortable woman. And chances are, she is past menopause. Why?
Doctors suspect that estrogen helps prevent a buildup of uric acid in the blood. But this shield slips at menopause, when a woman’s estrogen levels fall. As the vast numbers of women in the baby boom generation age, the incidence of gout is sure to increase.
Unfortunately, there is no cure for gout. Drugs can keep it under control, but people with the condition have other weapons at their disposal, too. Slimming down, eating right, cutting back on alcohol, and drinking plenty of water all help lower uric acid levels and decrease the risk of gout attacks, says Dr. Conn.
Obesity has been linked to high levels of uric acid in the blood, so weight control is especially important for people with gout. Crash diets and fasts aren’t the answer, however, since these extreme weight loss measures can actually raise uric acid levels. Slow and steady weight loss is not only better for your general health, but also more likely to keep gout under control, says Dr. Conn.
A study conducted at Massachusetts General Hospital followed 47,150 men with no history of gout for 12 years and studied the relationship between weight change and gout flare-ups. They found that the men who gained the most weight had the highest risk of gout. Weight loss, on the other hand, was protective against gout.
As you know, it’s a lot easier to keep weight off than to take it off later once you’ve packed on the pounds. Keeping your weight under control now will go a long way toward preventing gout in the future.
The same New England Journal of Medicine study that pointed the finger at meat and seafood (at right) also showed that the physicians who ate the most dairy products—particularly, low-fat dairy products—had a reduced incidence of gout, says Donna Weihofen, RD, of the University of Wisconsin Hospital and Clinics in Madison. “So now there is some good news, too—eat some low-fat dairy, which is a good source of protein, and you can lower your risk of gout,” she says. Specifically, the physicians who ate 2 cups or more of fat-free milk, low-fat milk, or low-fat yogurt had half the rate of gout than those who ate hardly any dairy. “So to prevent gout, aim for the same amount,” Weihofen says.
In the past, the only thing to do for gout was to cut purines from the diet. And although there are a few foods you should cut down on to help improve gout, there are also some things you can add to your diet to improve the condition, says Donna L. Weihofen, RD, a senior clinical nutritionist at the University of Wisconsin Hospital and Clinics in Madison.
As far as elimination, Weihofen points to a study published in the New England Journal of Medicine that looked at the diets of male physicians and their rates of gout. “They found that the only foods associated with the gout were meats and seafood—the purine-rich vegetables weren’t related,” Weihofen says. “So the recommendation is now simpler: If you want to cut down your risk of gout, cut down on your intake of meat and seafood,” she says. (And watch out for cauliflower; see opposite page.)
While you’re cutting back on these foods, it’s also a good idea to make sure that if you drink, you do so only in moderation, and that you drink wine instead of beer or liquor. A study published in the Lancet looked at the alcohol consumption of more than 47,000 men with no history of gout and measured the number who developed the condition over 12 years. They found that beer and liquor—but not wine—consumption was associated with an increased risk of gout. It seems that beer and other alcoholic beverages increase the risk for gout attacks in two ways: They increase the body’s production of uric acid, and they impair the kidneys’ ability to get rid of it.
Getting more water into your system will dilute the uric acid in the bloodstream and help prevent crystals from forming, Weihofen says. Both soda and fruit juices can help, but water is really the best choice, because it passes through the body quickly without adding unnecessary sugars. She recommends drinking at least 10 to 12 glasses of water a day.
Weihofen also recommends eating foods high in vitamin C. An article in Arthritis and Rheumatism showed that vitamin C appears to help prevent gout by lowering blood levels of uric acid. The study participants included 184 nonsmokers, half of whom took 500 milligrams of vitamin C, and half who took a placebo (dummy pill). After 2 months, the uric acid levels of the vitamin C group were lower than in the placebo group, indicating that vitamin C was effective in lowering uric acid levels. “The study results suggest that 500 milligrams of vitamin C per day can help reduce gout risk,” Weihofen says. Foods high in vitamin C include strawberries, kiwifruit, oranges, and other citrus fruits, and vegetables such as peppers, broccoli, and Brussels sprouts. One vegetable high in C that should be avoided, however, is cauliflower. See “Food Alert” on page 150 to discover why this vegetable can be problematic.
The recorded use of cherries to treat gout dates at least to the 1950s, to a Texan named Ludwig W. Blau, PhD, who was crippled by a gouty big toe and forced to use a wheelchair. Dr. Blau reported in a Texas medical journal that a diet including six cherries a day soon had him up and walking. Further, he noted that his physician tried the cherry diet on 12 patients and had equally good results.
Do cherries work? A small study showed that they very well might.
In the study, after fasting overnight, 10 women ate two servings of Bing cherries. Researchers collected urine and blood samples before and after the women ate the cherries and measured antioxidant levels, urate (which contains uric acid—the substance that builds up and causes kidney stones), and the inflammatory markers C-reactive protein and nitric oxide. After the cherries were eaten, the women’s plasma levels of urate fell significantly for a 5-hour period, which confirms the antigout properties of the fruit. In addition, levels of the anti-inflammatories dropped as well, suggesting that cherries help decrease inflammation.