This is an updated reissue of a previous column.
Gout is an extremely painful, inflammatory condition that commonly affects the joints of the large toe, but can affect any joint. About two percent of all Americans experience gout. However, approximately twice as many African Americans suffer from gout (three to four percent). Chronic gout can cause joint deformity and joint destruction.
What causes gout?
Gout is caused by the build-up of uric acid crystals that get deposited in joints producing an intensely inflamed and painful joint response. Over time, the crystals can build up to a paste-like material called tophi.
Uric acid comes from the breakdown of certain products in our bodies called purines, and also from foods that are rich in purines (such as high fructose corn syrup, red meats, seafood, alcohol; and certain vegetables such as beans, peas, lentils and spinach). Gout can be caused by either the inability to get rid of purines or an increased production of purines within the human body.
Certain medications can also increase the incidence of gout, such as low-dose aspirin, diuretics for blood pressure, and drugs used for patients with organ transplants. Additional factors that can cause gout include high lipid levels, being overweight, having high blood pressure, and diabetes.
Foods to avoid because they can trigger gout
- All alcoholic beverages including beer, wine, and hard liquor
- Red meats, lamb, pork, and organ meats like liver and kidney and sweetbreads (pancreas and thymus)
- Seafood, including shellfish such as shrimp, lobster, mussels, sardines and anchovies
- High-fructose-containing products such as soda, juices, cereals, ice cream, candy, and fast food that contains high fructose corn syrup.
Foods that do not trigger gout
Low-purine containing foods such as low-fat dairy and non-dairy fat products, including yogurt and skim milk, fresh fruits and vegetables, grains and nuts are healthy and do not trigger gout. Tofu, eggs and peanut butter are good, too.
It is essential to drink plenty of water. Ten glasses of water per day are desirable, and at least half of your fluid intake daily should be from clean, plain water. Fresh fruits are also important. Vitamin C and caffeinated beverages, in moderation, can also lower uric acid levels.
How is gout diagnosed?
The diagnosis of gout is made by examining the fluid of the inflamed joint under a microscope to see the characteristic crystals.
How is gout treated and prevented?
Gout is treated with anti-inflammatory medications such as Indomethacin and Colchicine and several other prescription medications. Additionally, gout can be treated with steroids. These are used for acute attacks.
There are newer prescription medications that can reduce uric acid levels and prevent future gout episodes. Your doctor will review and recommend these newer medications if appropriate. Other things you can do include drinking plenty of water, maintaining an appropriate and healthy weight, and minimizing foods that can cause a gout attack.
By limiting intake of such foods (listed above), taking medications prescribed by your doctor to prevent gout, and by also managing hypertension, high lipid levels, and diabetes, one can go a long way in preventing future gout attacks. Physical fitness and products such as coffee and vitamin C also appear to decrease the risk of developing gout.
If you have a gout attack, contact your physician immediately, especially if you are experiencing fevers or chills, to make sure there is not an accompanying joint infection. Also, talk to your doctor about several medicines used to prevent gout attacks.
If you have gout, make sure you are seeing a doctor on a regular basis and are having your uric acid levels checked. Make sure you take your medications exactly as prescribed by your doctor, maintain a healthy weight, keep diabetes under control, keep blood pressure under control, minimize alcohol consumption and minimize foods that are rich in purines that can cause a gout attack.
Also, any time uric acid levels change, a gout attack can or may occur. If you are treating your gout, don’t give up. You still may have an outbreak or two as your uric acid levels become normalized. Talk to your doctor about a treatment plan to get you through this transition period, and also a long-term plan to minimize or eliminate future attacks of gout.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.