DOES EXCESS MEAT INTAKE CAUSE GOUT?

“Gout? Isn't that the old, rich, fat man's disease?” This was someone's response in an attempt to describe gout. Far from being charitable, this statement is wrong on pretty much all counts. In the past the disease tended to affected mostly kings and noblemen because they had the means to live a lifestyle that made gout more prevalent - peasants rarely developed gout.

Gout or gouty arthritis is defined as the inflammation, pain, and swelling as a result of excessive uric acid levels. Uric acid is formed in the bloodstream when the body breaks down waste products, mainly those containing purines. Purines can be produced naturally by the body, and they can be ingested from such high-purine foods as meat. Normally, the kidneys filter uric acid particles out of the blood and excrete it into the urine. If the body produces too much uric acid or the kidneys aren't able to filter enough of it out, there is a buildup of uric acid in the bloodstream. In gout the body makes excess uric acid or the kidneys fail to function properly, failing to rid the body of the uric acid and it begins to build up in the joints in the form of uric acid crystals. White blood cells then respond to attack the crystals and release chemicals of inflammation, causing intense pain, often accompanied by heat and redness of joint tissues.

A common site for gout is the big toe joint. But gout can occur in an ankle, knee, elbow, wrist or finger. Acute symptoms of gout usually resolve in about a week, and then disappear altogether for months or years at a time. Eventually, however, the attacks may occur more frequently, last longer, and do more damage. The uric acid crystals may eventually settle into hard lumps under the skin around the joints, leading to joint deformity and decreased range of motion. These hard lumps, called tophi, may also develop in the kidneys and other internal organs, under the skin of the ears, or at the elbow.

People with gout also face a heightened risk of kidney disease, and almost 20% of people with gout develop kidney stones. One out of every five people who suffer with gout has a family history of gout. Gout attacks are more prevalent in men. Men don't commonly develop gout until reaching their late 30s or early 40s and women become susceptible to gout usually after menopause.

Gout is diagnosed based on family history, specific symptoms, and laboratory tests. Medications are usually prescribed to reduce the risk or lessen the severity of future episodes. These drugs speed the elimination of uric acid from the body, and they also slow down the rate at which it is produced. Along with specifically prescribed medications, patients are advised to avoid purine-rich foods, soft drinks, alcoholic beverages. Patients are also encouraged to drink plenty of water and maintain a healthy weight.

Purine-laden foods
Purines cannot be avoided entirely because they are released in the body as the result of recycling dead cells (basic structural units of our body organs). In addition the nutrients in meat- major source of purine - is also vital for normal body functions.The recommended daily intake for meat, poultry, fish and alternatives should be 3-4 servings, which is equivalent to 6-7 match box (small) sizes of fish or meat or poultry or combined proportions of these a day and about three whole eggs a week. It is advisable to limit intake of fatty portions of meats and if possible trim off visible fat before or after cooking. You can roast, broil, grill, steam or boil these foods instead of frying. Even healthy people who usually exceed the recommended intake of meat and its alternatives increase their risk of gout attack.

However gout sufferers are required to take less than the recommended intake. A diet high in fiber and low in fat (like whole grain) is also recommended. Gout is a condition that responds favourably to improvements in diet and nutrition. Since purines are broken down into urates by the body, consumption of foods high in purine should be limited. Foods that are especially high in purines are red meat, organ meats (liver, kidneys and heart - commonly used in sausages), meat gravies, shellfish, sardines and anchovies. The yolk of an egg contains purine, but the egg white is purine free. Milk contains no purines but fermented milk products, such as yogurt and aged cheeses, have purines as a result of bacterial cells that proliferate during fermentation.

Studies on link between gout and vegetarian diet is not conclusive but vegetarians should be wary of excessive intake of purine-rich foods like mushrooms, cooked spinach, rhubarb, and asparagus

Obesity and weight-loss diets
Gout is more common in overweight people and the risk of gout attacks increases with higher body weights. Crash diets for extremely obese patients are inappropriate because the use of fats and proteins for energy by the body instead of carbohydrates raises uric acid concentration and can cause an acute attack. So, a gradual loss of weight may be beneficial for overweight people who have high levels of uric acid. During a gout attack, it is prudent to avoid excessive exercise and long periods of starvation or limited food intake that would accelerate the breakdown of body tissues which can result in increased uric acid levels.

Alcoholic beverages and sugary soft drinks
Alcoholic beverages trigger episodes of gout because uric acid is insoluble in alcohol. As the alcohol content of blood increases, the blood is not able to dissolve as much uric acid, and the excess crystallizes. In addition gout problems can be worsened because of acute and chronic alcohol consumption which impairs the function of the kidneys resulting in minimal excretion of uric acid.

Daily consumption of alcohol is never encouraged nevertheless the recommended alcohol intake is no more than two drinks a day for men and only one drink a day for women. One drink is equivalent to 30ml or one tot of liquor (whisky, brandy etc.) or one glass of wine (120ml) or 250 ml of beer (about one mini beer). Alcohol should ideally be completely eliminated from a gout sufferer's diet. Beer also has purines in it.

Fructose (sugar in soft drinks) for instance, accelerates the breakdown of a molecule known as ATP, which is the primary source of energy for humans and is loaded with purines. And so this in turn increases formation of uric acid. Studies on people with no history of gout found out that some subjects eventually developed gout in direct proportion to the consumption of sugar-sweetened soft drinks. The risk of gout was related to the amount of fructose consumed. People who consumed two or more servings of sugary drinks per day had an 85% greater risk of developing gout. Fruit juices rich in fructose such as apple juice or orange juice were also associated with a higher risk of gout.

Drinking plenty of water helps keep the kidneys filtrating properly.Increased intake of fluids will dilute the urine and encourage excretion of uric acid. Therefore, six to eight glasses of water (3-4 sachets of locally packed water) should be consumed daily.

Gout cannot be cured, but it can be managed successfully. Purines, in themselves, are not the problem. It's the excessive amount as a result of too many purines in the body and purines from foods. You certainly control much of the power to live without gout. Prompt attention to diet and reducing uric acid levels will rectify many of the problems associated with gout. You can consult experts for individualized management because these guidelines provided here are at best generalized.

The writer is a dietician, [email protected]