Because most members of MAG are approaching the twilight years, we are interested in those aspects of medicine, including diet and alternative therapies, which can enable us to maintain our health and fitness. Also, being gay men, we are interested in the medical aspects of the prevention of HIV-AIDS in our day to day lives and prevention of the spread of HIV-AIDS throughout the community. We are particularly interested in current treatments for persons with HIV-AIDS.
complied by Peter Smith
What is gout?
Gout is one of the most painful rheumatic diseases accounting for around 5% of all cases of arthritis. Arthritis refers to more than 120 different rheumatic disease that affect joints, muscles and bones. For many people, gout initially affects the joints in the big toe. It can also affect the instep, ankles, heels, knees, writs, fingers and elbows.
Hyperuricemia [raised blood uric acid] has caused the deposit of uric acid crystals in the joint spaces, which leads to a sudden onset of intense pain and swelling in the joints, which also may be warm and very tender. An acute attack commonly occurs at night and can be triggered by stressful events, alcohol, drugs, or the presence of another illness.
Where high uric acid has been present for a long time and acute goat has been frequent and severe, deposits of uric acid salts may appear around the affected joint and even in tissues elsewhere such as the ears. High uric acid levels and recurrence gout are often associated with high blood pressure.
What increases the risk of Gout?
Being overweight increases the risk of developing gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.
Genetics may play a role in determining a person's risk, since up to 18% of people with gout have a family history of the disease. There is a very strong link between gout and insulin resistance (up to 96% of gout sufferers are thought to be insulin resistant) that some experts have recommended that all people with gout should be screened for this condition. Beer drinkers are more at risk than spirit drinkers, although moderate wine drinkers are not at increased risk at all. Drinking too much alcohol can lead to hyperuricemia because it interferes with the removal of uric acid from the body.
High intake of foods containing purines: Eating too many foods rich in purines can cause or aggravate gout.
Certain medicines can lead to hyperuricemia because they reduce the body's ability to remove uric acid: these include diuretics, salicylates, the vitamin niacin, cyclosporine and levodopa. In any member who suffers gout and takes these medications please check with your doctor for a second opinion.
How to treat gout:
The 1st step is to correct those factors which give rise to high uric acid levels.
Alcohol intake should be reduced, especially beer. During an acute attack of gout it is best to avoid alcohol altogether. Weight loss may be very important.
Eat small to moderate sized meal or snacks regularly through the day. Skipping meals or fasting can increase blood levels of uric acid. When they are in season ,as a snack, eat cherries; it has been proven in studies that cherries lower utate levels, the same for any other red/blue coloured berries and strawberries.
Include at least 2 cups of low fat milk (or other low fat dairy foods such as yoghurt) every day.
Recent studies indicate that intake of low fat dairy products strongly reduces the risk of gout.
Drink plenty of fluids especially water - at least 2-3 litres per day. This helps your body dilute the uric acid it excretes through your urine and reduce the risk of developing kidney stones. Some kidney stones are formed of uric acid: others may have an uric acid core. Reduce or avoid high purine foods. It is found that people benefit from limiting foods which are very rich in purines. Purines are broken down into uric acid by your body's metabolism. The following food is high in purines and should be avoided. Sardines, anchovies, fish roe [caviar], shrimp/prawns, mackerel and herring. Yeast and yeast extracts eg. Brewer's yeast, Vegemite and Promite. Liver, kidney and pate. Meat extract eg. Bonox and Bovril. Dried beans, lentils and wild game meat. Limit meat and poultry and fish to 1 moderate serve per day. The following have purines in them, but it is suggested that you can only eat one serve of the next mentioned and not to serve more than one in a meal at one time. Moderate purine foods are: Meat, chicken, fish and shellfish, oats, asparagus, cauliflower, mushrooms and silver beet.
Please note that tomatoes are not included in the list of purine foods. However, having said that, tomatoes are most likely to trigger allergic migraine reactions in some people, they have a high content of glutamic acid, amines and salicylates, especially in concentrated products. As you would have noticed I have already mentioned salicylates in 'certain medicines' this is the reason tomatoes are one of the culprits in gout flare ups.
Several herbs have been used in the management of gout. Propolis is a sticky resin that seeps from buds or bark of trees especially conifers. Bees gather propolis and carry it home in their pollen sacs for use in the hive. A recent Japanese study showed that a propolis preparation decreased the uric acid levels. Celery and juniper is a traditional remedy for gout. Juniper berries reduce the uric levels and ease gout symptom. Celery seeds increase renal urate excretion. Herbs such as garlic, milk thistle, yucca and globe artichoke have been used to relieve systems of acute gout. Devil's claw and bromelains have been used to reduce inflammation of gout.
The use of herbal remedies is well and good; however some herbal products can interfere with other drugs/medications that you may be taking.
It is always best to check with your doctor to see if it is safe to