People at risk of gout
- Men, probably because from puberty onwards, their blood uric acid levels are naturally higher than those of women. However, at menopause, women have similar uric acid levels to men, and the gender gap narrows. Before the menopause, the hormones oestrogen activate the elimination of uric acid by the kidneys.
- Individuals with any of the following conditions: kidney disease (kidney stones, kidney failure), high blood pressure, metabolic syndrome, diabetes, obesity, high cholesterol or narrowing of the arteries (atherosclerosis).
- People who take certain medications, such as diuretics and regular low-dose aspirin.
- People with a family history of gout. An inherited metabolic problem could lead to excessive production of uric acid in the body.
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Possible complications of gout
It is rare these days, but if gout is not treated properly, the frequency of attacks and the number of affected joints tend to increase over time. Arthritis can then become chronic in several joints (knees, ankles, wrists, elbows, etc.).
Deposits of crystals may form under the skin: they are called tophi (or tophus, in the singular). They appear on the outer edge of the ear, on the elbows, on the fingers, on the toes and near the Achilles tendon. They can damage tendons.
If treatment is neglected, excess uric acid can also be deposited in the kidneys, blocking its fine channels and causing kidney stones or kidney failure.
Evolution of gout
Since gout is better known today and there are several ways to control it, the quality of life of gout sufferers has improved greatly. With early diagnosis and treatment, the number of attacks can be reduced and permanent damage to the joints can be prevented.
If left untreated, the first attack disappears spontaneously within 1 to 2 weeks. During the first 24 to 36 hours, the pain is intense. The slightest pressure on the joint is unbearable, and it may even be impossible to put on a stocking. However, if the attack is treated quickly, it lasts for 1 to 2 days. Often a new attack occurs 6 months to 2 years later. Only a small proportion of people with gout will have one attack in their lifetime.
Diagnosis of gout
Depending on the case, you can use one of the following types of test:
- Blood sample: measurement of the uric acid level in the blood (uricemia);
- Urine sample: to assess the amount of uric acid excreted by the kidneys;
- Synovial fluid puncture of the affected joint: to look for uric acid crystals, to confirm the diagnosis. Uric acid crystals cannot be detected by X-ray or other tests, but can be seen under a microscope in a sample of synovial fluid.
What Diet to prevent and treat Gout Disease?
In the past, watching your diet was the main way to treat gout. Nowadays, because certain drugs can reduce the concentration of uric acid in the blood, doctors no longer necessarily restrict their patients to a strict diet.Nevertheless, foods rich in purines raise blood levels of uric acid, and some should be avoided during a gout attack.
- Adjust your energy intake to your needs. If weight loss is indicated, make sure it is slow and gradual. Rapid weight loss (or fasting) reduces the excretion of uric acid by the kidneys. You can use our test to calculate your body mass index (BMI) or find out your healthy weight;
- Distribute your protein, fat and carbohydrate intake appropriately;
- Get enough fruits and vegetables, which have a protective effect against gout (8-10 servings per day for men, 7-8 servings per day for women);
- Avoid or limit the intake of alcohol. Drink no more than 1 drink per day, and no more than 3 times per week. Note: recommendations vary from source to source. Some suggest reducing consumption of beer and spirits (e.g. gin and vodka). Drinking wine in moderation (up to 1 or 2 5 oz or 150 ml glasses per day) would not increase the risk of gout;
- The amount of alcohol that is well tolerated by people with gout can vary;
- Drink at least 2 litres of water or drinks (soups, juices, tea, etc.) per day. Water is the preferred choice.
Nutrition during a crisis
Here are some tips:
- Avoid alcohol or limit yourself to 1 drink in a day, and do not exceed 3 drinks per week;
- It is a good idea to restrict the consumption of seafood and fish, which are foods rich in purines, especially if any of these foods have been noticed to trigger the attack;
- Refrain from eating foods that are very high in fat;
- Drink 2 to 3 litres of fluid a day, at least half of which should be water;
Other dietary changes, which vary from person to person depending on the condition, may be beneficial. It is best to consult a nutritionist for individual advice.
What about coffee?
Coffee should not be avoided in cases of gout, as it contains negligible amounts of purines. Epidemiological studies suggest that regular coffee consumption may even have a slight protective effect against the disease. However, this should not be seen as an incentive to drink more coffee.
Does a diet rich in vitamin C help?
The relationship between dietary vitamin C intake and blood uric acid levels was studied in a group of 1387 men in the Health Professional. The higher the vitamin C intake, the lower the uric acid level. However, this finding needs to be verified by further studies.
Caution: Ketogenic diets are not recommended for people with gout. This type of diet is particularly low in carbohydrates and high in fat. Ketogenic diets reduce the excretion of uric acid by the kidneys. This is the case with the Atkins diet, for example.
Is there a real cure for gout?
There is currently no cure for gout. The therapeutic approach acts on 2 levels. It aims to :
- Relieve the symptoms (pain and inflammation) of an acute attack and to interrupt the attack with anti-inflammatory agents;
- Prevent recurrence and long-term complications with drugs that lower blood uric acid levels.