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Oct 16

Gout Triggers

Gout has been traced to the ancient Greeks, Egyptians and Romans.  Its name is derived from he Latin, gutta.  Hippocrates I 400 BC thought that the cause was and imbalance of the four humours.  He referred to gout as “the unwalkable disease”.  During this time it was thought that all disease came from an imbalance in the humours.  The humours were blood, black bile, yellow bile and phlegm.  The cause of gout according to Hippocrates was an excess of one of the humours that managed to leak or drip into a joint causing pain and inflammation in that joint.

In the 2nd century AD. Claudius Galen who was a physician to five Roman Emperors, advocated an annual bleeding to rebalance the humours that became unbalanced due to an excess of food, drink and sex.

When Anton Van Leeuwenhoek, a Dutch naturalist in the 1600s.  He was the first to see the needle shaped crystals that cause gout with his newly designed microscope.  This discovery was not pursued for nearly 100 years.

It was not until the American Revolution (1776) when Carl Wilhelm Scheele, a Swedish German scientist while examining urinary solid matter discovered  a new acid which he named lithic acid.  This later became known as uric acid.  In the same year, found the same acid while examining a bladder stone.

In 1848, Sir Alfred Garrod, A British physician, determined that gout was caused by excess uric acid in the blood.  He even developed a test to determine if uric acid was in a patient’s blood.  Acetic acid (vinegar) was added to a blood sample and a linen thread was placed in the treated blood.  After 36 to 60 hours, the uric acid crystals would accumulate on the thread and could be seen under a microscope thereby confirming the existence of uric acid in the patient’s blood confirming that the patient did, in fact, have gout.

Throughout history Gout has been associated with rich foods and excessive alcohol consumption.   In the past it was clearly associated with a lifestyle that could only be afforded by people of affluence.  Because of this it has been called the “disease of kings”.  There is a painting by Eduardo Rosales, Spanish painter of the 19th century whose painting depicts King Charles I of Spain seated in a chair with his right leg elevated and resting on a pillow.  It seems that King Charles was fond of rich foods and drink.  In 1528 he developed gouty arthritis and by 1552 gout was affecting his ability to rule and prevented him from leading his forces into an important battle.  By 1556 his gout had become so severe that he abdicated the throne and retired to a monastery.  He had a special chair constructed with a footrest just to elevate and pamper his gout affected foot.

Colchicine, a derivative of the autumn crocus was first used in ancient Greece.  It is in limited use today to treat gout as are several others such as NSAIDS (non steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and some prescription drugs).  A discussion of treatment will be discussed in greater depth.

Do I have Gout?  What are the symptoms?

Gout flares are usually experienced at night suddenly and without warning.  During an attack, the affected area becomes red, swollen hot and tender.  Pain in the big toe is the most common area for gout to appear but it does occur in other areas of the body.

Big Toe   76%

Ankle or foot   50%

Knee   32 %

Finger  25%

Elbow  10%

Wrist   10%

More than one place simultaneously   11%

Silent gout build up

Between flares of gout, there can be silent attacks that may go unnoticed but are continuously building up in the joints.  In time this may lead to attacks in other joints, persistent pain and joint destruction.   Consult your health care professional to determine the cause of your discomfort.

Who gets gout?

Gout is the result of uric acid build up in the blood.  When the uric acid level increases, the potential for gout rises.  There are some characteristics that canaffect whether or not you will get gout.

Men are more likely to develop gout than women and usually experience it between ages 40 and 50.

Women are more likely to get gout after menopause.

There is a possible genetic link and gout does tend to run in families.

Those with certain conditions are more likely to experience gout.  Included are high cholesterol, diabetes, high blood pressure, and kidney problems.

Gout Triggers

Excess uric acid is known to form crystals which cause inflammation leading to pain and swelling.  It is not always certain what causes an attack but certain things may be linked.  These include:

Alcohol, stress, some medications, an unrelated illness .  Other possible triggers are eating too much of certain foods, Surgery, crash diets, infection, or even rapid lowering of uric acid levels from uric acid lowering drugs.

In the recent past there have been some new dietary recommendations.   Because of the recommendations to restrict purine rich foods, gout sufferers are increasing their intake of highly refined carbohydrates.  Unfortunately this can lead to insulin resistance and a tendency toward metabolic syndrome.

A diet that reduces insulin resistance (low fat, low glycemic index) will also reduce uric acid levels.  Diets high in saturated fat, organ meats and red meats can still raise the levels of uric acid, insulin and can contribute to heart disease so are best avoided.

The good news is that previously it was recommended that gout sufferers stay away from beans, peas and other legumes .  Findings have shown that these foods as well as nuts will not contribute to uric acid increase.

Two servings of low fat dairy in the form of cottage cheese or yogurt is recommended and may help to lower uric acid levels..

An interesting recent finding is that fructose and fruit juices tend to increase uric acid levels.  Consequently gout sufferers need to avoid both fruit juices and high fructose sweetened soft drinks.

Regular coffee and decaf have been shown to lower uric acid levels.

Alcohol remains on the list of things to avoid.  Alcohol limits the kidney excretion of uric acid which increases build up in the blood.