Living with gout can be like sitting on a ticking time bomb. An attack can come on unexpectedly and be excruciatingly painful, even crippling.
So what are lifestyle management tips for staving off gout flares?
dailyRx talked with nationally renowned expert, Brian F. Mandell, M.D., Ph.D, MACP, FACR, professor and chairman of the Department of Medicine at Cleveland Clinic Foundation Lerner College of Medicine of Case Western Reserve University.
He started the interview by going over the basics of gout. The condition results from excessive levels of uric acid. Gout develops when levels of uric acid reach and stay at 6.8 or above, Dr. Mandell says.
"Uric acid is a normal chemical that everybody has," Dr. Mandell explained. "Some of it comes from the food we eat, but the overwhelming amount of it comes from our own bodies. And those who have higher levels of uric acid have them because their kidneys don't get rid of the excess uric acid as efficiently as in people who have lower levels," he said.
When this happens, the uric acid spills over into the blood stream and settles primarily in the joints - often in the big toe, ankles, feet and knees.
Dr. Mandell says, "Once the UA has coated the joints like icing on a cake, sometimes that icing breaks loose and the crystals of uric acid accumulate in the joints." And that's when the agony starts.
Food and gout
Dr. Mandell says that avoiding certain foods can make a little bit of a difference, but "not enough to stop flares."
"Uric acid levels below 6 is what we'd like to see. If we can keep it there for months or years, we'll see fewer attacks, but food alone is probably not going to be able to achieve that," Dr. Mandell told dailyRx.
Having said all that, some foods can be helpful and other foods that increase uric acid levels should be avoided.
According to Dr. Mandell, drinking cherry juice and coffee, eating whole cherries and low-fat dairy products and taking vitamin C offer some benefit.
Avoid high-purine foods
Dr. Mandell, who is a board member of the Gout and Uric Acid Education Society, suggests that people living with gout avoid high-purine foods because they can increase uric acid levels.
Foods to avoid or moderate would include:
- Red meat
- Shell fish, such as shrimp and lobster
The New England Journal of Medicine published a 2004 study by Dr. Hyon Choi, a Society board member and chair of rheumatology at the University of British Columbia and colleagues.
The study determined the following:
- Each additional serving of red meat increased the risk of a gout attack by 21 percent in men over age 40.
- Additional weekly servings of seafood increased risk by seven percent.
- Consumption of dairy products, particularly skim milk and low-fat yogurt, decreased risks of gout attacks.
Additionally, the Society recommends that fructose-sweetened soft drinks and processed foods should be avoided or eliminated. A diet that emphasizes fresh fruits and vegetables, whole grains and nuts is best for people living with gout.
High-fructose fruits (apples, dates, peaches, plums, cherries, grapes, pears and prunes) should be limited to 1-2 cups a day.
"Now a key lifestyle change that does make a difference is moderating alcohol intake, particularly beer," according Dr. Mandell, who is also Editor in Chief of the Cleveland Clinic Journal of Medicine.
Beer is the worst, and best eliminated, he says. "Wine seems to be okay - again a modest amount. Liquor is kind of in between, and should be consumed in moderate amounts, if at all."
Binge drinking can definitely bring on attacks, he says.
Achieve and maintain a healthy weight
According to the Gout and Uric Acid Education Society, "An obese person is four times more likely to develop gout than someone with a normal weight."
So people living with gout who are overweight can help themselves immensely by losing weight. However, crash diets are not the answer. Quick or extreme weight loss programs can actually increase uric acid levels.
Regular exercise, to achieve/maintain a healthy weight is recommended for everyone.
Drink plenty of water
Drinking water is critical for ridding the body of waste products, which is what uric acid is. Following the general recommendation of drinking at least eight glasses a day is wise counsel for everyone, including those living with gout.
Drinking water can help remove uric acid from the bloodstream, some experts believe.
Other self-management tips
dailyRx asked Dr. Mandell what else he wanted gout patients to know about taking care of themselves.
He says if gout attacks are frequent, medication and weight loss are the two best remedies.
Dr. Mandell explains that while gout doesn't cause these conditions, it often "travels with type 2 diabetes, high blood pressure and high cholesterol."
So he recommends that people living with gout have their blood pressure, cholesterol and blood sugars checked by their family physician or internist on a regular basis.
Do what you can
When it comes to self-care and lifestyle issues, Dr. Mandell summarizes, "People living with gout want to follow a common sense diet and avoid the excesses of intake."