This disease affects approximately 8.3 million people in the United States. Men between 30 and 50 years old are at much higher risk for their first attack. For women, most gout attacks occur after menopause.
Uric acid (or urate) levels are directly related to the risk of gout attacks. As uric acid levels increase, there is a greater chance of urate crystal deposits in the joints, although some patients can still experience gout attacks without high levels of uric acid.
Common potential causes include drugs, such as diuretics; alcohol intake; uncontrolled high blood pressure; obesity; and sweetened beverage and fructose intakes. Though heredity plays a role, these risk factors are modifiable.
The best way to prevent and treat gout is by modifying medications and lifestyle. One simple lifestyle change is to make certain that those susceptible to gout attacks remain hydrated.
With a gout attack, NSAIDs such as indomethacin or steroids such as a Medrol pack help treat the symptoms. In terms of prevention, allopurinol helps to reduce the risk of a gout attack.
Let’s look at gout by using a case study. I had a patient who had started a nutrient-dense, plant-based diet. Within two weeks, she had a gout episode.
Initially, it was thought that her change to a diet with increased plant purines might have been an exacerbating factor. Purines are substances that raise uric acid levels, so it is not surprising that foods containing purines might substantiate a gout attack. However, not all purines increase uric acid equally.
Animal versus plant proteins
A 2012 study published in Annals of the Rheumatic Diseases showed that animal purine sources increase our levels of purines far more than plant sources. The risk of a gout incident was increased approximately 241 percent in those consuming the highest amount of animal products, compared to 39 percent among those consuming plant-rich purine substances.
Plant-rich diets are preferred for patients who suffer gout attacks, especially since nuts and beans are excellent sources of protein and other nutrients.
In another study, published in the New England Journal of Medicine, consuming red meat, pork, lamb and seafood increased the risk of gout. However, purine-rich plant sources did not.
The Mayo Clinic also suggests that plants do not increase gout risk. When considering my patient’s circumstances, it was unlikely that her switch to a plant-rich diet had triggered her gout.
Diuretics (water pills)
My patient was taking a diuretic for high blood pressure. Both diuretics and chronic use of low-dose aspirin are thought to increase gout incidence.
In the ARIC study, patients who used diuretics to control hypertension were at a 48 percent greater risk of developing gout than nonusers, who had a 36 percent decreased risk.
The longer the patient is treated with a diuretic, the higher the probability they will experience gout. It is likely that my patient’s diuretic contributed to her gout episode.
In the CLUE II study, obesity was shown to increase the risk of gout and to accelerate the age of onset. Those who were obese experienced gout three years earlier than those who were not.
Even more striking, those who were obese in early adulthood had an 11-year earlier onset of gout. My patient was obese and had just started to lose weight when the gout occurred.
Patients with gout writhe in pain. Luckily, very modest changes can significantly reduce the risks. They involve avoiding diuretics in patients with a history of gout; losing weight for obese patients; and substituting more plant-rich foods for meats and seafood.
Although the cause of gout may be apparent to you, always check with your doctor before changing your medications or making significant lifestyle modifications, as we have learned from this patient case study.