Diet can help manage a disease that afflicts more than elderly port-drinkers.
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Question: My 45-year-old son is an active surfer, skateboarder and cyclist. During a recent knee operation to remove cartilage, his surgeon also removed crystals from his knee joint and said he had “gout-like symptoms” and must avoid an organic substance called purine. Can this be right – I had always thought gout was an affliction of old port-drinkers?
Answer: You’re not alone in your surprise that someone young, active and seemingly healthy can develop gout. And although gout is often considered a dietary disease, it’s actually far from that. Gout is caused by high urate levels in the blood. Over time this leads to the formation of urate crystals in the joint that cause inflammation and – potentially – joint damage. In more than half of gout cases, the big toe is the first affected joint; other joints typically affected are those of the foot, knee and ankle.
Urate, or uric acid, is the end product of the body’s metabolising of purine-containing compounds sourced from our diet and from old body cells that are broken down. Our diet is a source of purine, but most people with gout have raised urate levels because they don’t excrete enough uric acid in their urine, rather than because of dietary excesses.
Nonetheless, diet does play a role in successfully managing treatment of gout and helping to prevent it, according to rheumatologist Dr Nicola Dalbeth, an associate professor at the University of Auckland. “The vast majority of people with gout aren’t able to reduce their serum urate with dietary management alone,” says Dalbeth. However, in combination with appropriate medication, “dietary management will make management of their gout easier”.
High intakes of meat, seafood, beer, spirits and sugar-sweetened drinks were associated with an increased risk of gout in a US study called the Health Professionals Follow-Up Study. Intake of coffee (caffeinated and decaffeinated) and low-fat milk and yoghurt were associated with a reduced risk. Low dairy intake was also associated with high urate levels in the US National Health and Nutrition Examination Survey (NHANES) III.
Dalbeth and her colleagues investigated the link between dairy intake and gout. They found cow’s milk reduced serum urate concentrations by 10% in healthy adult males, by stimulating the kidneys to remove uric acid. Their findings were published in 2010, in the Annals of Rheumatic Disease, along with those from a subsequent laboratory study that found certain compounds in cow’s milk actually inhibited the inflammatory response to urate crystals. They have since conducted trials of milk products in patients with gout. Dalbeth can’t discuss their findings yet, but does say, “low-fat milk and low-fat dairy clearly have benefits for those wanting to reduce their risk of gout”.
Clinical trials of vitamin C supplements have also produced positive results, although the effects on serum urate aren’t enormous, says Dalbeth. Still, if Dalbeth’s patients want to try a supplement alongside their medication, she recommends 500-1000mg of vitamin C a day. Healthy living is particularly important for gout patients, not only to avoid recurrent attacks but also because people with gout have a greater risk of developing diabetes, hypertension, cardiovascular diseases and chronic kidney disease. A 2008 study published in the New Zealand Medical Journal found nearly two-thirds of gout patients referred to a rheumatology service were at high risk of cardiovascular disease. Hence, Dalbeth makes a point of addressing dietary issues that are risk factors for recurrent gout, obesity and these other health conditions, so that patients’ overall health is optimised.
PREVENTING GOUT
• Maintain a healthy weight
• Opt for no more than two small servings of meat, chicken or seafood each day
• Choose eggs and low-fat cheese as an alternative protein source
• Enjoy low-fat milk and dairy products every day
• Drink plenty of water
• Drink less alcohol, particularly beer
• Avoid sugar-sweetened drinks such as soft-drinks and fruit juices
• Gout sufferers should also aim to avoid high-purine foods such as anchovies, sardines, mackerel, mussels, scallops and offal
• If desired, try a vitamin C supplement of 500-1000mg a day
Email: nutrition@listener.co.nz, or write to “Nutrition”, c/o Listener, PO Box 90783, Victoria St West, Auckland 1142.