Monday, December 10, 2007

Gout: Please be careful during the Festive Period!

It's the end of the year and the time for parties and feasting! I don't think I would be doing my duty as your Family Doctor if I d0 not gently remind our patients who may be suffering from gout to remember to eat in moderation as all that rich food and alcohol may just trigger another gout attack!

What is gout?

Gout is one of the oldest disorders known to humans. Those suffering from gout may console themselves that they are in the same company as some of the greatest men in history, namely Alexander the Great, Kublai Khan, Michelangelo, Martin Luther, Isaac Newton and Henry VIII.

Gout occurs because of the build up of uric acid crystals accumulating in the joints, usually of the big toe, the hands and some other large joints. Uric acid is a by-product of purines (a protein) and it is the kidney's job to get rid of excess uric acid by passing it out through the urine. If you suffer from gout and there is an excessive overload of uric acid in the blood which the kidneys cannot get rid of fast enough, uric acid crystals will start to form which are then deposited in the joints. And that is when you limp into the clinic with excruciating pain.

Who gets gout?

Like many diseases, it is hard to say who will or will not get gout. But there are a few factors which puts you on a higher risk of developing the disease. It seems to run in families and occurs more often in men then women. It is also associated with obesity and high blood pressure. Just because you indulge in rich food and alcohol does NOT necessarily mean that you are going to develop gout. However, if you do suffer from gout, then the rich food and alcohol may trigger another attack.

What are the triggers?

1. Purine rich foods:
  • Red meat and organ meats like liver, kidneys (ie Kway Chap, Pate, Foie Gras)
  • Shellfish eg scallops, cockles, prawns, crabs
  • Tinned Fish eg sardines, ikan bilis, herrings
  • Legumes eg dried beans, peas
  • Meat extracts and gravies eg Bovril
2. Alcohol

3. Medications eg Diuretics

4. Trauma: Injuries, surgery or starvation

What should I do?

During an acute attack, you should rest in bed with a cold compress. Your GP can also prescribe some painkillers or even give you an injection if the pain is severe.

For most people gout occurs occasionally. So aside from eating purine rich food in moderation, there is no need for regular medications. Weight loss and drinking lots of water do help to prevent attacks. However, if you suffer from several attacks every year, you should ask your doctor about preventive medications. Repeated gout attacks can affect the joints in the long term.

A word on Tofu

There is a little bit of confusion over whether people who suffer from gout should take tofu or not. Beans are moderately high in purines but one study has suggested that though tofu does raise the uric acid levels a little, the effects are negligible.(1) Based on the finding, my opinion is that tofu may be a suitable protein alternative between attacks, but is best still avoided during an acute attack.

1. Yamakita J., et al. (1998). Effect of tofu (beancurd) ingestion and on uric acid metabolism in healthy and gouty subjects. Adv Exp Med Biol, 431, 839-42.

Reference:
Murtagh, Patient Education 4th Edition, McGraw Hill Press

6 comments:

Ed said...

Hi Les, Thanks for the added info on the 'gout' issue. Thanks!! :)
What do we do if there are contradicting claims on the kinds of food to avoid?

ieat & itreat said...

If in doubt always err on the safe side and avoid the food especially if you are having an attack.

dorothy said...

Many thanks for the useful information regarding Gout. Want to know that if oat is purine rich food. Where can i find more information related to the purine of each kind of food as I didn't find such information from bookstores or internet?

Anonymous said...

Hi doc,

Im 29, first detected with high uric aci when i was abt 25.

Recently, I had afew attacks continuous since christmas till now. I have controlled my diet already yet it hits so hard on me. Is it due to the cold gusty weather? Im not sure. :(

ieat said...

No, it is usually due to food intake.

Ariel said...

I had my very first gout attack last week. After the attack has completely subsided I took Zyloric to get rid of the excess uric acids. I first took Tramadol to relieve the pain. You can see the complete drug study of these medicines at http://medsheaven.com/index.html

Be sure to drink plenty of water or fluids to flush out the uric acids. Gout really Is a hassle. But if you know how to counter attack it once it appears your in the right track of taking care of yourself.