Time to take Gout seriously

Gout occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint. If you’ve experienced gout, then you’ll be familiar with the intense pain, redness, stiffness, swelling and tenderness associated with the condition. A lot of the time, it affects the big toe but it can affect more than one joint at the same time, including joints in your foot, ankle, knee, elbow, hand or wrist. Some people describe it as ‘having a joint on fire’, whilst others say that the pain gets to the point of anything touching the skin around the affected joint becoming unbearable, such as a sheet even touching their toe, or that putting on a shoe is impossible during an attack.  

A gout attack can come on quickly and can last anywhere from a few days to up to 10 days or longer. Gout is often stereotyped as only affecting overweight, middle-aged men who overindulge in rich food and wine, so this is where the stigma lies (more on this in our Inflammation Nation podcast). But the truth is that gout can affect anybody, and it can even have a genetic element to it. Up to 1 in 40 adults will experience gout at some time and not all of those are overweight men – some are relatively fit, younger men or postmenopausal women.  

The risks of not seeking treatment 

When left untreated, gout can cause permanent damage to your joints. Gout is also linked to other medical conditions including kidney disease, high blood pressure and some heart diseases. Gout is a long term, progressive condition that, if not properly managed, can affect you for your whole life. It can interfere with work and relationships and, understandably, can put a huge strain on someone’s mental health and wellbeing. Despite this, many people do not seek help for their gout because they mistakenly assume the gout is gone between flares and that they don’t need medication to treat it. These gaps between flares sometimes encourage complacency. But you should not have to go on suffering in silence. There are treatments that can help, as well as self-management techniques to prevent a gout attack in the future. 

Prevention: early diagnosis and treatment 

Many of the negative outcomes of gout are preventable with early recognition and consistent treatment. Medication is one of the first steps in treating gout. Medications have a huge impact, not just on helping to reduce the amount of time that you suffer from a gout attack, but also the chances that you’ll experience future attacks. In fact, without treatment, your gout flares could become more frequent, spread to other joints and become more severe. In fact, ignoring gout, for some people, can lead to long term, irreversible pain and disability so it’s crucial to seek help.  

Urate lowering treatments (ULTs) work to lower the level of uric acid in your blood. This reduces the likelihood of crystals forming which, in turn, prevents further gout attacks and long-term effects such as tophi (large bumps that form where gout crystals have accumulated) and joint destruction. Gout is caused by a build-up of uric acid in the blood. Your doctor should take regular blood samples to measure your uric acid levels. It sounds very basic, but it really can be hard to get into a routine of taking your tablets on a daily basis, especially if you feel quite well. However, if your doctor has prescribed a long-term treatment for you it is because you need to take it in order to keep your uric acid levels under control. Remember, gout is very treatable and taking your tablets correctly can dramatically improve your symptoms.  

Lifestyle medicine 

We know that gout can result from having too much uric acid in the blood. This uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it's also found in certain foods. Therefore, making changes to your diet may lower the risk of recurring gout attacks and slow the progression of joint damage. However, it’s important to note that people with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.  

The main aim of a diet that helps gout is to avoid some (not all) foods with purines, include some foods that help control uric acid levels and help to manage weight (since research suggests that losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. We also know that losing weight also lessens the overall stress on joints).  

Eat more: Colourful vegetables and fruits, as well as wholegrains, which is a typical ‘Mediterranean diet’. Don’t forget pulses also, which can sometimes be overlooked. These include things like lentils and chickpeas, which are packed full of nutrition and also easy to include in soups and main meals. Nuts are high in healthy fats and are great to snack on (or use nut butters like almond, cashew or peanut butter). Also, don’t forget to consume 8 glasses of water a day, or drink herbal teas in order to increase your fluids.  

Avoid or reduce: Foods with moderate-to-high amounts of purines such as organ meats (liver, kidney and sweetbreads), red meat (limit serving sizes of beef, lamb and pork to the palm of your hand), certain types of seafood (such as anchovies, shellfish, sardines and tuna – but other fish, such as salmon and white fish are important to include as they are an excellent source of low fat protein in the diet), sugary foods (limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and sweets and fruit juices, and limit your consumption of fruit), as well as alcohol (the advice is to avoid alcohol during gout attacks, and to limit alcohol to small amounts otherwise. Binge drinking can lead to a sudden gout attack and it is advised that you have at least three completely alcohol-free days per week).