Gout is a metabolic disease caused by elevated levels of uric acid (hyperuricemia) in the blood. Because an unhealthy lifestyle with poor diet and excessive alcohol consumption contributes to elevated uric acid levels, gout is considered a disease of affluence. If the disease remains untreated for a long time, the deposition of uric acid crystals can lead to joint deformities, permanent joint damage, kidney stones and kidney inflammation. Nevertheless, gout can be treated well with medication and appropriate lifestyle changes.
Avoiding a gout attack
Strictly avoiding the triggers for a gout attack, however, is usually associated with considerable restrictions for those affected. In our expert interview, Andreas Niedenthal, MD, an internist and gastroenterologist at the Gastrointestinal Center in Darmstadt, Germany, reveals how gout patients can get their disease under control without sacrificing quality of life.
What influence does lifestyle have on uric acid levels?
Niedenthal: Uric acid is the end product formed when purines are broken down. Purines are building blocks of DNA and are found in human, animal and plant cells. Thus, a purine-rich diet causes uric acid levels to rise. Normally, uric acid is excreted by the kidneys, but this is not possible indefinitely: if the amount of uric acid exceeds a certain maximum, the excretory function of the kidneys is no longer sufficient and the uric acid concentration in the blood increases. The risk of a gout attack increases as the uric acid level rises. Once the disease has broken out, a consistent change in diet must be made. Treatment with medication is also usually necessary.
What should affected individuals keep in mind regarding diet?
Niedenthal: For gout patients, it is very important to eat a low-purine diet. There are significant differences in foods with regard to purine content: Offal and red meat, for example, as well as lentils, contain particularly high levels of purines. Ideally, gout patients should obtain a table with the purine content of the various foods for reference. It is also important in gout to support the excretory function of the kidneys. Drinking between 1.5 and 2 liters a day is sufficient for this. Drinking larger amounts has no additional positive benefit. For patients with heart failure, it can even be dangerous to take in too much fluid. Recommended beverages are water and fruit or herbal tea. In moderation, however, there is nothing wrong with coffee, cocoa, and black tea.
Do gout patients have to avoid alcoholic beverages?
Niedenthal: Alcohol should be consumed with caution. This is because the breakdown of alcohol produces lactate, which inhibits the excretion of uric acid and can thus trigger a gout attack. Beer is particularly unsuitable for gout patients, because purines are contained in yeast.
Despite all the prohibitions: Are there then also alcoholic beverages and kinds of meat, which are permitted from time to time?
Niedenthal: Unlike beer, a glass of wine a day is harmless. Also, certain types of fish or meat, such as poultry, contain fewer purines than others and can therefore be enjoyed in moderation.
What happens if a patient does go overboard?
Niedenthal: A “sin” is not necessarily followed by an attack of gout, but the risk of it increases. That’s because when the uric acid concentration exceeds a certain limit, the uric acid that is normally dissolved in the blood precipitates, causing an inflammatory reaction in the joints. Typically, the metatarsophalangeal joint of the big toe is affected first. If patients have “sinned,” they should not under any circumstances try to compensate for the excessive consumption of purine-containing foods by taking an increased dose of gout medication. This is because there is a risk of dangerous side effects if medications are overdosed.
What role does obesity play?
Niedenthal: Unlike other diseases of affluence, obesity plays only an indirect role in gout. Because overweight people often eat a diet rich in purines, the disease may have an earlier or more severe onset in them. Achieving a normal weight is therefore not a priority goal for gout patients. Much more critical than obesity are fasting cures and radical diets, because rapid weight loss results in increased purines due to protein breakdown.In addition, metabolic products are formed that inhibit uric acid excretion in the kidneys. If sufferers want to reduce their weight, they should therefore pay particular attention to slow weight loss as part of a balanced, low-purine diet.
Is exercise recommended? What should affected individuals keep in mind?
Niedenthal: Although sports have no direct effect on uric acid levels, exercise generally has a positive effect on the metabolism and is therefore recommended for gout patients. In principle, patients can do all kinds of sports, but endurance sports that are easy on the joints, such as cycling or swimming, are particularly suitable. However, patients should refrain from sports during an acute attack.
What else do you recommend to your patients to get the disease under control?
Niedenthal: Once the disease has reached an onset, lifelong treatment and regular monitoring of uric acid levels are mandatory. It is important to me that patients consistently change their diet and do not see the medication as a license to feast.
