Gout is a common issue for many of our patients and is becoming increasingly more prevalent in the population. Gout is one of the oldest disease recorded in medical history, which could be explained by the largely meat based diets of our ancestors. It is characterised by a sudden onset of arthritic like pain, usually beginning in the big toe and continuing up the leg. When we consume foods high in purines (see table below), high uric acid levels (hyperuricemia) occur in the blood. While uric acid is a normal waste product formed in the breakdown of food, high levels of uric acid in the blood can cause crystals to form in the joints. The most common areas affected include; fingers, hands, elbows, feet, heels and helix of the ear.
The disease usually occurs after the age of 35 years and predominately affects men. However there are a number of lifestyle factors that may trigger the onset of gout, such as:
- Being overweight
- Ketosis associated with fasting or low carbohydrate diets
- Having high cholesterol, diabetes or insulin resistance
- Hypertension (high blood pressure) or the use of diuretics
- Consuming a large amount of alcohol
- A diet high in purines
The goals of treatment are to prevent future gout attacks, manage the pain of acute attacks and prevent the formation of tophi (large formation of urate crystals in the form of monosodium urate crystals). Gout is treated by using drugs that prevent uric acid formation such as colchicine, allopurinol or non-steroidal anti-inflammatories (NSAID).
Lifestyle Strategies to reduce gout onset/symptoms:
1. Reduce and maintain weight within healthy ranges
As gout is more common in people who are overweight, losing some weight excess weight can help to reduce the risk of further attacks. However, rapid weight loss can increase uric acid levels and may trigger an attack. One to two kg weight loss per month is recommended.
2. Limit alcohol consumption
Alcohol can increase uric acid in the blood, particularly beer and spirits. If you choose to drink keep alcohol to 1-2 standard drinks per day. However during flare ups it is best to avoid all together.
3. Eat regular meals
Skipping meals or fasting can increases uric acid levels. Eat small, regular meals or snacks throughout the day. Limit your intake of high sugar, high fat foods and drinks.
4. Limit purine containing foods and drinks
Purines in food break down to uric acid, therefore it is wise to limit your meat intake of meat, poultry and fish to 130-160g per day.
5. Drink low fat dairy
Consuming 2-3 serves (1 cup) of low fat milk/yoghurt as a part of a balanced diet is linked with lower uric acid levels and risk of gout.
6. Increase fluid intake
Increase fluid intake to 2- 2 ½ L per day to help dilute the uric acid levels that are removed in urine. Too much uric acid in your urine can cause kidney stones.
7. Enjoy cherries
Recent studies suggest eating 1-2 serves of cherries per day can help to the risk of gout flare ups. 1 serves = ½ cup (10-12 cherries). Stick to 2 serves of fruit including cherry intake per day.
If you would like more information regarding gout or would like a more tailored meal plan to suit your lifestyle, contact us today to arrange an appointment.
References: PEN: the global resource for nutrition practice: Gout, Krause’s Food & the Nutrition Care Process by L. Kathleen Mahan, Janice L Raymond, Sylvia Escott-Stump