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Newsletter Archive  Doctor's Corner Newsletter Archive

Nutrients for Gout - good and bad

By Leonid Magidenko, MD.
Monday, July 30, 2007

What is it?

Gout, which causes reddening and swelling of joints, more frequently afflicts stout middle-aged men, but can also affect women and younger people. The occurrence of the disorder is connected with an excess production of the albuminous exchange product, uric acid. The organism egests this product with the help of kidneys, however sometimes the kidneys cannot cope with the work-load and the uric acid accumulates in the body. It is present not only in the blood, but also in large concentrations in the joint liquid where it can cause severe discomfort and pain. As the concentration of uric acid in the body increases, so does the concentration of uric acid in the joint liquid and beyond a critical concentration, the uric acid begins to precipitate into crystals. Formation of such crystals causes inflammation of the affected joint, which reddens and swells. Thus pains begin, sometimes so severe that the patient cannot bear the touch of a bed sheet to the affected joint. Occurrence of such symptoms is called an acute gout attack.

Commonly, gout develops in the joint of the big toe, but frequently it also affects other foot joints, as well as the ankle, knee and elbow joints, while in general it can occur in any joints. When crystals of the uric acid appear in the soft fabrics surrounding joints, they lead to the formation of gouty adjournments, producing tumors-like growths filled with white chalk-like substance. These tumors can also redden, heat up and become inflamed during an attack.

Let us have a look at what nutrients can help people suffering from gout.

What can help?

Results of several studies carried out in the 70’s assumed that folic acid can reduce the level of uric acid and thereby reduce the risk of gout. However, later research has failed to prove the presence of such effect, even at high dozes. Recommendations: though folic acid is essential for health, its role in gout treatment is not yet clear.

Vitamin C stimulates excretion of uric acid by means of kidneys and thereby reduces the risk of occurrence of a gout attack. Recommendations: gradually increase consumption of vitamin C at least up to 4 g a day.

What can make things worse?

A diet rich in sucrose, or table sugar, may lead to gout as it raises the level of insulin, which prevents excretion of uric acid from the body. Here you should bear in mind that sugar can not only be found in sweets or what food sweeteners. Besides rolls with glaze, soft drinks, cakes, pies, cookies, ice-cream and sweets, sugar is used in preparation of numerous other products; therefore consumption of it has grown to incredible levels in the 20th century. In 1890 each person - man, woman and child – used approximately 800 g of sugar a year. In the 1980’s the common consumption of sugar averages to more than 50 kg annually. Recommendations: stop or sharply reduce consumption of sugar and products derived from it: corn treacle, molasses, and syrup with high content of fructose.

If a fruit contains more fructose than sucrose it does not necessarily mean that the fruit may help the gout condition. In fact, the opposite is true, as fructose increases generation of uric acid which promotes development of gout. Recommendations: do not try to replace sucrose by fructose. Do not use sweets and soft drinks with fructose. These substances can only complicate the problem, and should not be used as a substitute for sucrose. One or two fresh fruits will probably contain the maximum quantity of fructose which you can consume daily without increasing the risk of a gout attack. Also, avoid drinking large amounts of fruit juice. Use of artificial sweeteners (e.g., aspartame, saccharin) does not increase the risk of disease.

Alcohol is among the foods which are most likely to cause a gout attack. Metabolic products of alcohol compete with the uric acid in the process of absorption by the kidneys, which leads to accumulation of the uric acid in the organism. Particularly, beer causes gout attacks as it contains more purines (see below) than wine or hard liquor. Recommendations: if you have a high risk of gout, stop or sharply reduce consumption of all forms of alcohol. At a minimum, do not drink more than one glass of wine or beer daily.

Such foods as red meat, liver, kidneys, clams, crabs, lentil, beans and peas increase the risk of attack because they contain high levels of purines, a substance from which the uric acid is formed in the body. Recommendations: if you suffer from gout or are in the risk group (i.e. if you are a person with excess weight, taking diuretics for blood pressure, or you suffer from diabetes), reduce the consumption of products rich in purines. As the basic sources of protein, use lean fish, poultry (skinned), egg-whites and low-fat dairy products.

Taking vitamin A can cause a gout attack in those who suffer from it, and also, possibly, in individuals in the risk group. Recommendations: do not take vitamin A under such circumstances.

High dozes of nicotinic acid, those used for the reduction of cholesterol, for example, can cause a gout attack as the by-products of nicotinic acid compete with the uric acid in the process of absorption by the kidneys, which again can lead to an accumulation of uric acid and hence to an attack. Recommendations: if you suffer from gout or belong to the risk group, do not take more than 50-100 mg of nicotinic acid a day.

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