A gouty attack during the holidays can cancel your plans and ruin all your fun. Changes in your diet, including overindulging in certain foods and beverages, can trigger more gouty attacks this time of year.
Gout attacks are extremely painful and come on suddenly, mostly at night. A recent study has proven the long-held belief that a gout attack is more likely to occur at night. Dr. Hyon Choi from Boston University School of Medicine published the article in “Arthritis & Rheumatism” that shows people have a 2.36 greater chance of having a gout attack at night than in the daytime. It is believed that the lowered body temperature and dehydration during sleep may be contributing factors as well as a change in hormone levels.
Gout is caused when uric acid builds up in the tissues or a joint and crystallizes (turns hard like crystals). Uric acid is the result of the breakdown of purines, (chemicals) that are found naturally in our bodies and in foods, especially proteins. Some people develop gout because their kidneys have difficulty getting rid of excess uric acid, while others just produce too much uric acid. Eating too many foods high in purines also contributes to this uric acid build-up and can trigger a gout attack. Uric acid is normally in the blood and is passed out in the urine but, in people who have gout, the uric acid is not passed out and the levels increase. Gout occurs most commonly in the big toe because of the small size as well as the cooler temperatures there causing the uric acid to turn into crystals. Since the toe is the part of the body that is farthest from the heart, it’s also the coolest part of the body – and the most likely target of gout. Gout, however, can affect any joint in the body.
Genetics also play a role in why people may have high uric acid levels. Other factors that put a person at risk for developing gout may include high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and taking certain medications such as diuretics (water pills) and some vitamins. While gout is more common in men aged 40 to 60, it can occur in younger men as well as women.
Gout presents with intense pain that comes on suddenly – often in the middle of the night or on getting up in the morning. There may be other signs of inflammation such as redness, swelling, and warmth over the joint or foot, as well as difficulty walking or standing due to the pain.
To diagnose gout, the podiatrist will ask questions about your personal and family medical history, and your diet, followed by an examination of the affected joint. Laboratory tests (uric acid level) and x-rays may also be ordered.
The initial at-home treatment of an attack of gout typically requires rest, elevation and limiting activity until symptoms resolve. The symptoms of gout and the inflammatory process will usually resolve in three to 10 days with treatment. If gout symptoms continue, regardless of what you do at home, it is time to see a podiatrist.
There are many treatment options for gout.
Medications: Prescription medications or injections are sometimes used to treat the pain, swelling, and inflammation. An anti-inflammatory and/or medications to help lower the uric acid level may be ordered by the podiatrist.
Food and gout: Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid and can cause gout attacks. People prone to gouty attacks should avoid purine-rich foods such as shellfish (shrimp, crab, lobster, conch, etc.), organ meats (kidney, liver, etc.), red meat, processed meats and cheese, red wine and beer. Foods that help prevent gout include pineapple, ginger and turmeric for their anti-inflammatory properties; bananas, low fat milk products and watercress also help prevent gout.
Cherries: Recent studies have shown that people with gout may be able to cut their risk of recurrent attacks in half by eating about one cup or 20 cherries a day. The report states cherries help keep the inflammation in check and may reduce the uric acid levels and inflammation in the body. The researchers credit anthocyanins – antioxidant pigments found in red and purplish fruits and vegetables, including cherries for the beneficial effect. These antioxidants stabilize unstable molecules called free radicals, which cause inflammation and damage cells and tissue. More studies are being done in this area. To get the benefit, cherry juice and extract tablets can also be taken if you cannot find fresh cherries.
Fluids: Drink lots of water every day to help flush out the uric acid. Avoid alcoholic beverages, coffee and other caffeinated beverages that act as a diuretic (causes you to urinate a lot) which can cause more dehydration making the gout worse.
Immobilize and elevate the foot: Rest your affected foot by avoiding long standing and walking. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling. Sometimes the podiatrist may put a bandage on the foot to help with the pain and swelling.
If repeated gout attacks occur, you may need long term treatment that will mean daily medications to control the uric acid level. It is important to treat and resolve the gout because repeated episodes of gout can damage the joint permanently and cause arthritis.
• For more information, email us at firstname.lastname@example.org or visit www.apma.org. To see a podiatrist, telephone 325-2996 for an appointment, visit Bahamas Foot Centre on Rosetta Street, or call 394-5824 for an appointment; or visit Bahamas Surgical Associates Centre on Hilltop Medical Centre off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment.