Prevention of gout – Symptoms, Diagnosis, Treatment

Prevention of gout,  How to prevent the disease of kings
In the past, gout was a “priority” only for the upper classes and it is no coincidence that it was called the disease of the rich and the disease of kings. Today, however, its frequency is constantly increasing and it affects a huge number of people around the world. This article will look at the main reasons for the development of gout, as well as the changes we can make in our eating habits to prevent it.

What is gout

Gout is a disease characterized by high levels of uric acid in the bloodstream (hyperuricemia), which cause the accumulation of urate crystals in the articular cartilage, tendons and surrounding tissues. The deposition of these crystals is most often accompanied by short-term acute attacks of arthritis, which easily subside.

As the disease progresses, however, significant amounts of urate crystals accumulate in the joints, forming the so-called tophi and cause chronic gouty arthritis. Long-term maintenance of hyperuricemia can lead to increased uric acid levels in the urine and cause deposition of kidney stones. Most often, gout develops as a result of long-term maintenance of high serum uric acid levels in combination with complete acidification of the blood. These two factors alone cannot cause gout.

Symptoms

Most often, gout is accompanied by a sudden onset of excruciating burning pain, swelling, redness and stiffness in the affected joint. Usually the first manifestations of the disease are in the joints of the big toe, but it is possible to affect any other joint in the body. In some cases, the gout protrusion is accompanied by a moderate increase in body temperature.

Risk factors for the development of gout

Gout can be divided into two main types: primary and secondary. The primary is most often caused by factors related to lifestyle, hereditary defects in metabolism, medication. Secondary gout occurs as a result of other diseases: obesity, diabetes, high blood pressure, metabolic syndrome, renal failure, leukemia and others. There are several main risk factors that can provoke the development of gout:

• Age – with age, the incidence of gout increases sharply. A probable explanation for this is the connection between some diseases – high blood pressure and metabolic syndrome, for example, and gout. Therefore, increased life expectancy in developed countries may be the reason for the increasing incidence of gout worldwide.

• Gender – Gout is considered a disease typical of men. Although in people over the age of 65 its frequency increases equally between the sexes, among younger people men are affected 4 times more often.

• Serum uric acid levels – this is undoubtedly the most important risk factor for the development of gout. People with uric acid levels ≥ 380 µmol / L are considered to be at higher risk.

• Drugs – The development of gout is associated with the use of a large number of drugs, including diuretics, drugs used in organ transplants, as well as low doses of aspirin. Currently, between 45 and 60% of people suffering from cardiovascular disease take low doses of aspirin daily for prophylactic purposes. Aspirin, taken in low doses, has the ability to increase uric acid levels and thus may increase the risk of developing gout. Concomitant use of diuretics may worsen the situation.

• Organ transplants – Increased uric acid in the blood and the development of gout are some of the most common complications after transplantation of kidneys and other organs. Studies show that about 50% of patients develop hyperuricemia after transplantation, and 13% develop new gout attacks.

• Nutrition – It is widely accepted even in medical circles that the consumption of foods rich in protein is the main reason for increased uric acid levels and, accordingly, for the development of gout. Modern scientific research shows that this statement is only partially true.

In recent years, the link between purine-rich foods, increased uric acid and gout has been unequivocally proven. In fact, uric acid is a product of purine metabolism. Purines are organic compounds that make up the bases abenin and guanine in nucleic acids and are involved in the composition of RNA and DNA. Each cell has its own DNA and accordingly contains a certain amount of purines. However, mitochondrial-rich cells contain significantly higher amounts of purines because mitochondria have their own genetic material.

Red meat, game, offal and seafood are rich in protein and at the same time contain a huge number of mitochondria. Therefore, they supply the human body with a large amount of purines. Hence the misconception that protein-rich foods are necessarily associated with the development of gout.

It is also claimed that dairy products and foods with a high protein content not only do not increase the risk of developing gout, but on the contrary – reduce it by about 50%. Some vegetables such as peas, beans and lentils are also rich sources of purines, but large-scale studies show that their consumption does not increase blood uric acid levels.

• Alcohol intake – Excessive alcohol consumption can also cause gout, especially in systemic abuse. The most unfavorable from this point of view is beer, which contains large amounts of purines. Hard alcoholic beverages have less effect, while the consumption of wine in small quantities is even recommended by experts.
• Obesity – a directly proportional relationship has been established between weight gain and the incidence of gout. People with a BMI ≥ 35 kg / m² are considered to be at 5 times higher risk. The main reason is considered to be the increased production of uric acid in obese people and the inability of the kidneys to excrete it from the body.

What to change in our diet to protect ourselves  – Prevention of gout

If we are unable to change some risk factors such as gender and age, then the most important of them, such as diet and alcohol consumption, are entirely in our hands. In case the first symptoms of gout are already present, it is good to adhere to a few basic rules:

• limiting the consumption of red meat, game, seafood;
• exclusion from the diet of offal – hearts, liver, kidneys, trifles;
• increase the consumption of milk and dairy products – cheese, cottage cheese, fresh and yogurt;
• reducing the overall alcohol intake – limiting the consumption of hard alcohol to 50-70 ml per day, and wine to 150-200 ml per day; cessation of beer consumption;
• minimizing the intake of simple sugars;
• it is good to limit the overall consumption of fat; it is recommended to limit protein intake to a maximum of 120 g per day,
• because in most cases it is mainly at the expense of meat and meat products;
• mandatory increase in water and fluid intake and avoid dehydration;
• weight loss – in most cases, gout develops as a result of metabolic disorders in the body such as obesity, high blood pressure and type 2 diabetes, known collectively as metabolic syndrome. Weight loss would reduce the severity of these diseases and help prevent gout.

However, people aiming to lose weight should not be subjected to extreme diets that severely limit nutrient intake, as well as starvation. It is very often in such cases that gout attacks occur. Therefore, consultation with a nutritionist and building a personal diet tailored to individual needs are extremely important for the prevention of gout.

In conclusion – nowadays gout is far from being a “priority” only for kings and rich people. On the contrary, it is becoming one of the main diseases leading to permanent disability and early disability. To protect ourselves, each of us must realize that the main risk factors responsible for its development are entirely in our hands.

Sources used for Prevention of gout :

1. wikipedia.org
2. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 2006;8 Suppl 1:S2  
3. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004 Mar 11;350(11):1093-103.

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