Henry VIII of England. What comes to your mind when you hear that name? Is it the 6 marriages? Is it the schism in church to get married 6 times? There are lots of historical tidbits that make this ‘Lord’ morbidly fascinating! My favorites are his diet and his health. The man lived a life of exorbitance, to re-confirm, 6 marriages! However, his love of food and drink were legendary. The man drank red wine and meat with almost militant fanaticism.
This zealotry towards food led him to be the sufferer of a disease which is making its comeback today in certain parts of the world. Gouty arthritis (Gout) is an inflammation of the small and medium sized joints of the body, caused by a buildup of uric acid in the blood.
Henry suffered from it, and to a certain extent, we are all beginning to follow in his footsteps.
Gout is a lifestyle disease now. With the industrialization of the meat industry and the economics of food making meat so cheap and plentiful, parts of the population have begun to eat meat and fish with almost Tudor Era abandon, leading to the resurgence of this curious malady.
Let’s talk a little bit about gout, what causes it and how it can be managed.
During an attack of gout, crystals of sodium urate form on the insides of and around joints.
These crystals cause inflammation when the joints move, leading to severe pain, swelling and redness. The joint of the big toe is very commonly affected. Usually, the small and medium sized joints are first affected and then gout characterizes in pretty much every joint in the body.
An attack of gout can come on quite rapidly (within a day in most cases) and can last for up to 10 days on average.
What causes gout?
Gout is caused by a buildup of a common metabolic waste called uric acid in the blood. Uric acid is constantly manufactured by the liver and its normal fate is to be excreted, via the kidney. The liver makes this stuff especially when it has to break down a class of molecules known as purines. You will hear more about purines later.
If a high level of uric acid is created by the liver, or if the kidney cannot get rid of it fast enough, crystals of uric acid are formed causing a predictable result. Some of the crystals move from the joint cartilage and irritate the lining of the joint (aka the synovium), leading to the typical symptoms of gout. Other excess crystals pack together to form hard, slowly expanding lumps called tophi (singular: tophus).
The tophi cause progressive damage to the cartilaginous joints and the nearby bone. This causes progressive and irreversible damage to the affected joint.
What are the risk factors of gout?
- Age - More common as we age
- Gender - 3 times more likely in men
- High blood pressure
- Genetics: Having close relatives with gout (gout often runs in families)
- Having long-term kidney problems that reduce the elimination of uric acid
- A diet rich in purines, such as frequent consumption of sardines and liver
What are purines?
Let’s talk a bit about them. Purines are very important; they are organic molecules which make up the DNA of a person. The liver knows only one way of dealing with purines, when they are broken down and the waste needs to be removed, the liver creates uric acid.
To avoid gout, the most effective measure is to cut back on food that is rich in purines. Some of the foods rich in purines are:
- Organ meats such as liver, kidneys, sweetbreads and brains
- Meats including bacon, beef, pork and lamb
- Game meats such as venison, quail, turkey etc
- Any other meats in large amounts
- Fishes such as sardines, herring and mackerel
How does one manage gout?
Gout has to be treated with two main goals in mind:
- Reducing the symptoms of the attack: This can be done by using ice packs, taking non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers (ibuprofen, naproxen etc). In extreme cases, alternative medication such as colchicine or powerful steroidal anti-inflammatory drugs like corticosteroids may also be needed.
- Preventing future attacks: Since this is a lifestyle disease, managing one’s lifestyle will help in spades here. The first step would be to lose weight, if you are overweight. Secondly, avoid or cut down on purine rich foods.
There are some medications available which lower the uric acid levels in the blood but they have their own side effects and are to be the last resort, after lifestyle modification; allopurinol is one such drug.