What is Gout? Gout causes attacks of painful inflammation in one or more joints. The pain can be severe. It affects about 1 in 200 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age, but it sometimes occurs in younger people

What causes gout?

Gout is caused by a chemical in the blood called uric acid (urate). Uric acid is usually harmless, and is made in the body from certain foods. It is passed out with the urine. The amount of uric acid in the blood builds up in some people. From time to time the level may become too high. When the level of uric acid becomes high tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. This causes inflammation, swelling, and pain - a gout attack.
Note: some people have a high level of uric acid but do not form crystals or have gout. Also, rarely, some people with a normal level of uric acid have gout attacks. However, as a rule, the higher the level of uric acid, the greater the chance of forming crystals and developing gout.
In most cases there is no apparent reason for the build up of uric acid. In some people, the build up of uric acid may have a known cause. For example:
If you drink too much alcohol it can cause uric acid to build up.
Some medicines such as diuretics ('water tablets'), low dose aspirin, and some used as chemotherapy for cancer may raise the level of uric acid.
More uric acid is made than usual in illnesses where the cells of the body have a rapid turnover. For example, severe psoriasis and some blood disorders.
Certain foods may 'tip the balance' to raise your uric acid higher than normal. In particular, eating heart, herring, sardines, or mussels frequently may increase the level of uric acid. However, eating a normal balanced diet should not have much effect on the uric acid level.

What are the symptoms of gout?

Gout usually occurs in 'attacks'. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint. Walking can be very painful and even the weight of bedclothes can hurt.
However, any joint can be affected. Sometimes two or more joints are affected. Affected joints usually swell, and the nearby skin may look red and inflamed. If left untreated, a gout attack may last several days, but usually goes completely within 7-10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks. Some people only ever have one attack.
Is gout serious?
Although a gout attack can be very painful, it is uncommon to cause other problems even if it is not treated. Joint damage may occur if you have recurring attacks. In a few people, uric acid crystals form kidney stones. Sometimes the crystals form bumps (tophi) under the skin. These are usually harmless and painless, but sometimes form in awkward places such as at the end of fingers.
How is gout diagnosed?
Gout is usually diagnosed if you have the typical symptoms and a raised blood level of uric acid. If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint. This is done with a needle and syringe. The fluid is looked at under the microscope. Crystals of urate (uric acid) can be seen in the fluid to confirm the diagnosis of gout.

What can I do if I have recurring gout attacks?

If you drink a lot of alcohol then it may help if you reduced the amount that you drink, You do not need to stop drinking alcohol altogether but cutting down may help if you drink a lot.
If you are taking any medicines, check whether they are a cause of gout (see above). An alternative medicine may be available.
If you are overweight, try to lose some weight, this can help to lower the uric acid.
Have your blood pressure checked at least once a year, high blood pressure is more common in people with gout.

What is the treatment for a gout attack?

An ice pack (or pack of frozen peas) held against the inflamed joint may ease the pain until the other treatments start to work.
Wrap the ice pack (or peas) in a towel to avoid direct skin contact and ice-burn, apply for about 20 minutes, then stop. (It should not be applied for long periods.)
Repeat as often as required BUT.... Make sure the temperature of the affected part has returned to normal before applying again.
It is believed by some that cherries/juice can be beneficial to people suffering from gout/arthritis, this is because they can help counteract high uric acid levels in the blood, known as hyperuricemia.

Uric acid is a salt contained in the blood; it normally dissolves, like sugar in a warm drink. It then passes out through the kidneys and out through the urine, if the body increases the amount of uric acid it makes, the kidneys cannot get rid of enough of it, and if it doesn't dissolve properly it builds up in the blood and forms crystals, in some people this eventually settles in the fluid surrounding the joints, leading to pain, swelling, stiffness, heat/redness.
A change in the blood chemistry is thought to be the cause, although some foods which are high in purines and eaten in excess are thought to contribute to the change in blood chemistry, this is because there may be an enzyme defect that makes it hard for the body to break down purines.

It is believed that a high protein low carb diet can aggravate and worsen gout and arthritis.
Some beneficial foods to eat are tofu and eggs. Limit high fat foods and oils, alcohol, especially Beer. Drink plenty of fresh water, warm if possible.

The following foods have very high purine levels, and should be avoided completely:

• Anchovies
• Bouillon
• Brains
• Broth
• Consommé
• Dried pulses
• Goose
• Gravy
• Heart
• Herring
• Kidneys
• Liver
• Mackerel
• Meat extracts
• Mincemeat
• Mussels
• Partridge
• Roe
• Sardines
• Scallops
• Shrimp
• Sweetbreads
• Yeast (baker’s and brewer’s)
• Yeast extracts (e.g., Marmite, Vegemite)
   

These foods have high purine levels

• Fish
• Shellfish
• Poultry
• Meat (except those with very high purine content, noted above, or those with moderately high purine levels, noted below)

These foods have moderately high purine levels

• Asparagus
• Cauliflower
• Pulses
• Lentils
• Mushrooms
• Porridge
• Peas (dried)
• Soya
• Spinach
• Tripe
   

Best bets

• Drinks (carbonated)
• Butter
• Cereals and cereal products
• Cheese (all kinds)
• Cocoa (however, caffeine is prohibited in Lesch-Nyhan Syndrome)
• Corn
• Cornbread
• Eggs
• Fruit juices
• Fruits
• Gelatine
• Ice cream
• Milk
• Noodles
• Nuts
• Refined wheat flour
• Tapioca
• Vegetables (except those noted above)
• White bread and biscuits (but not whole wheat, which is moderately high in purines)
• White rice