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Gout

Gout boosts your heart attack risk, so no beer and seafood for the Holiday Season

 

     We all know that obesity, high blood pressure, smoking and a sedentary life-style are risk factors for heart disease and now we have a new risk factor, gout.

Researchers from the University Of Pittsburgh School Of Medicine have just published a study in which they conclude that having gout can further boost the chances of having a heart attack.

Gout is a form of arthritis marked by sudden attacks of painful, inflamed joints, usually the big toe, but feet, ankles, knees, hands and wrists can also be affected. Unlike rheumatoid arthritis, which is a chronic inflammatory condition, gout is very transient and eventually the inflammation subsides. If the swelling occurs in one toe, or part of one foot, or part of one calf it is probably gout. If you have equal amounts of swelling in both feet it could be congestive heart failure or some other condition but it is NOT gout. More than half of those who have had a gout attack will have a recurrence within one year.

One in 30 Canadians has gout, with men four times more likely than women to develop the condition. It usually shows up between the ages of 40 and 50 in men and after menopause in women.

Gout is caused by an accumulation of uric acid in the metabolic pathways of the joints of the body. Your body either makes too much of it or loses the ability to excrete enough, causing uric acid crystals to form in your joints.

A New study published in the Archives of Internal Medicine suggests that having gout can do more than just damage your joints. It may also cause heart problems if you already have risk factors for heart disease.

In the study, researchers followed 9,105 men aged 41 to 63 years who were at above-average risk for heart disease to assess the link between gout and death from heart disease. (The men in the study had high cholesterol, high blood pressure and were smokers.) After 17 years, men with gout were 30% more likely to die of heart attack or stroke compared with their peers who did not have gout. Another study done in 2004 of 1,423 middle-age Finnish men found that those with excess uric acid in their bloodstream had a 2.5 times greater risk of dying from heart disease than men with low uric acid levels. The normal range for serum uric acid is 200 to 440 micromoles for men and 140 to 340 for women.

The theory is that having too much uric acid in the blood creates oxidative stress, a state that damages LDL cholesterol, causing it to be oxidized. (Oxidized LDL cholesterol is considered more dangerous because it causes hardening and narrowing of artery walls as opposed to normal LDL cholesterol which heals oxidative damage in the body.) High uric acid is also associated with higher levels of C-reactive protein in the blood, an inflammatory compound linked to atherosclerosis and heart attack.

Not everyone with high uric acid develops gout. In the Finnish study, although the incidence of heart attacks was higher in men that had gout, the rate of death from heart attacks did not increase if you had high levels of uric acid and did not develop gout. People who take diuretics or consume an aspirin a day will have lower serum uric acid levels when they are tested.

There is a serum blood test that will determine if your uric acid levels are normal. If you have severe swelling in an affected joint your physician can confirm your blood test by drawing out some of the synovial fluid and have it tested for monosodium urate which is precipitate of uric acid.

The treatment for gout is a combination of prescription medication and dietary changes to reduce uric acid. The drug allopurinol taken in 300mg strength once a day stops the accumulation and allows your body to eliminate excess uric acid. It eliminates most attacks. Many physicians use products such as indomethicin and naprosyn which are powerful anti-inflammatory drugs but they only take away symptoms and have no effect on uric acid and can be very hard on the stomach. Only allopurinol works as a preventative.

Limit Purine-Rich Foods

Purines, natural compounds found in certain foods, are broken down into uric acid in the body. They are found in organ meats (liver or kidneys), sardines, anchovies, canned tuna, mackerel, lobster, scallops, shrimps, clams, asparagus, mushrooms, spinach, green peas, cauliflower, beans and lentils.

In the past, people with gout were told to lay off all purine rich foods. However, a 2004 study involving 47,150 men found that while high intakes of meat and seafood increased the odds of developing gout by as much as 50 per cent, eating purine-rich vegetables did not. It is important to note that fish oil supplements contain only purified Omega-3’s and are microfiltered to remove any traces of purines that may have been in the organs.

Go Easy on Meat and Seafood

Each day, consume no more than two or three servings of meat, fish, poultry, eggs, soy and legumes. Eating larger portions may increase uric acid and the risk of gout. One serving is 2.5 ounces of meat, fish or poultry: two eggs, or ¾ cup of cooked legumes.

Include Low-Fat Dairy

The same study found that men who drank at least two 8 ounce glasses of skim milk each day were 44% less likely to develop gout than men who drank less than one serving per month. Some feel that the proteins in milk help reduce uric acid levels.

Reduce Saturated Fat

Choose lean cuts of meat, skinless poultry breast and low fat dairy products to reduce saturated fat, the type that raises LDL cholesterol.

Avoid Beer

Sorry guys but I have to be honest. Alcoholic beverages, especially beer and spirits prevent uric acid from leaving your body. For some reason moderate wine drinking does not have the same effect. It may be because beer contains purines and wine does not.

Drink Plenty of Fluids

Because the uric acid accumulates in crystal form, drinking 2 or 3 litres of water a day will dissolve the uric acid crystals and flush them out through your kidneys. However, you must avoid sugar-sweetened soft drinks and fruit juice, which have been linked to a higher risk of gout.

Coffee drinkers actually have a lower risk of gout probably because of the antioxidants that naturally occur in coffee.

Lose Excess Weight

If you are overweight, sliming down may help prevent gout attacks. Excess weight puts more stress on your joints and thus boosts uric acid levels. Try to lose it slowly at the rate of 2 or 3 pounds a month. This is 25 pounds a year. Rapid weight loss and fasting can increase uric acid levels in the blood. Avoid low-carbohydrate, high-protein diets since they also elevate uric acid levels.

Many people believe that gout is a disease of excess and gluttony and this belief comes from the 12th to 14th centuries in which kings and noblemen seemed to suffer an undue amount of gout. It turns out that only the rich could afford the services of a doctor and they were the only ones that were diagnosed. There were probably many poor people who hunted, ate their own meat and drank their own homemade beer and wine who suffered not knowing what they had.

The key to a healthy life is moderation and if you practice moderation and avoid binging and over-eating you will no doubt be a healthier person.                                               [print_link]

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