Purine-Rich Foods and Gout – Rheumatic Diseases Center

Purines are important substances necessary for making amino acids, which are the basic building blocks of the human body.

Purines are found in many foods, and at different levels. They are metabolized (broken down) into uric acid, a waste product that is usually excreted with urine. If there is too much uric acid in the blood, people can develop a condition called hyperuricemia.

Hyperuricemia is the precursor to gout, which is a rheumatic disease where excess uric acid develops into small, needle-like crystals in the soft tissues and joints. Hyperuricemia can occur if the kidneys are not properly excreting uric acid, but can also arise from over-consumption of purine-rich foods.

What Is the Link Between Purines and Gout?

Studies examining the relationship between diet and gout show that people who consume a lot of certain types of meat or seafood are more likely to have this medical condition. Calvin Brown, MD, professor of medicine in the division of rheumatology at Northwestern University says that “one of the ways which the body will have too much uric acid is if it’s breaking down foods that are very rich in the precursors to uric acid.”

“In the days of the Middle Ages and the Renaissance, the very wealthy kings and nobility had quite a taste for organ meats … and hence were quite commonly affected with gout,” Dr. Brown explains. Due to changes in diet, “gout due to excess [food] is actually quite rare.”

Gout Treatment: What Foods Are High in Purines?

It is recommended that people diagnosed with gout follow a diet that does not include the following purine-rich foods:

• Seafood: Although it is recommended that a healthy diet includes a lot of fish, people who have gout should be aware that some seafood can increase levels of uric acid in the blood, and may make gout worse.
• High purine content: Anchovies, codfish, haddock, herring, mackerel, mussels, sardines, scallops, trout
• Medium purine content: Crab, lobster, oysters, shrimp.
• Meat: Though no longer part of a common diet in the United States, organ meats, such as liver, sweetbreads, and brains, are most dangerous for those with gout.
• High purine content: Bacon, turkey, veal, venison
• Medium purine content: Beef, chicken, duck, ham, pork
• Vegetables: Studies do not show an association between high-purine vegetables and gout to the same degree as with animal-based purines, suggesting other factors than purine content also play a role. However, there are some beans that are particularly high in purines, so people with severe gout may want to avoid them.
• Purine-rich vegetables: Asparagus, dried beans (especially fava and garbanzo), mushrooms, peas, spinach

Gout Treatment: Alcohol and Purines

“In this day and age the most common [route to gout] is certain alcoholic beverages,” Brown says. Beer and liquor (but not wine) lead to increased blood uric acid levels. The strongest evidence for a connection is with beer, possibly because it contains the highest amounts of purines, which come from its malt content. “To avoid gout, avoid stout,” he adds.

Gout Treatment: What Can a Low-Purine Diet Do?

In healthy individuals, it has been shown that a purine-free diet can reduce the levels of uric acid in the blood, and in a study that put participants on either a low-purine diet, a medication often prescribed for those with gout, or a combination of both, the diet led to similar reductions in uric acid levels as the medication.

Because of these factors, it is thought that a diet low in purines may help ease the symptoms and halt the development of gout. Organizations including the National Institute of Arthritis and Musculoskeletal and Skin Diseases recommend avoiding foods that have a high purine content, along with beer.

It is important to note that using diet as a means to help control hyperuricemia and gout should only be done after consultation with a medical professional. Never discontinue any medications for gout without talking to your doctor first.

Safe Foods for Gout | Arthritis Foundation

Question: I have gout. Can you tell me which fruits, vegetables, meats or seafoods I should eat – or avoid? Is there any type of alcohol – wine, beer, spirits – that is better or worse for me than others? 

Answer: Dietary management of gout is very restrictive and doesn’t always work to control gout, so a combination of medication and diet may be the best way to treat your gout. In addition to medications that treat the inflammation and other symptoms that occur during a gout attack, medications exist that can treat the underlying metabolic condition of hyperuricemia – too much uric acid in the blood. Hyperuricemia can occur either when the body produces too much uric acid or when the body does not excrete enough uric acid. Drugs exist to treat both causes. 

Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Dietary management focuses on reducing the amount of uric acid in the system and attaining and maintaining a healthy bodyweight.  

The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. You can learn by trial and error what your personal limit is and which foods cause you problems. 

High-Purine Foods Include: 

• Alcoholic beverages (all types) 
• Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock 
• Some meats, such as bacon, turkey, veal, venison and organ meats like liver 

Moderate Purine Foods Include: 

• Meats, such as beef, chicken, duck, pork and ham 
• Shellfish, such as crab, lobster, oysters and shrimp 

Ronenn Roubenoff, MD  
Global Translational Medicine, Musculoskeletal Diseases 
Novartis Institutes for Biomedical Research 
Basel, Switzerland 

Looking for help managing your chronic pain from gout? Learn to set achievable goals and get support with the free Vim app.

Making Smart Meat Choices If You Have Gout

If you’re changing your diet to help lower uric acid levels and reduce your risk of gout attacks, meat choices can have a big impact. Some meats are high in purines.  Purines are substances found naturally in the body as well as in in foods. They are broken down in the body to form uric acid. When excess uric acid in the bloodstream builds too quickly or can’t be eliminated fast enough, it is deposited as needle-shaped crystals in the tissues of the body, including joints, causing intense pain.  So, a high-purine diet puts you at greater risk for uric acid buildup.  And a 2012 study in the Annals of the Rheumatic Diseases showed that the risk worsens as more purines are included in the diet. But what if meats are your favorite food? Here’s what you should know about your options.

Avoid if Possible

• Organ Meats –  liver, kidney, heart, sweetbreads, tripe, brain and tongue
• Fish/Seafood – anchovies, herring, mackerel, sardines, sprats, whitebait, trout, scallops, fish roe, caviar, crayfish, lobster
• Game – pheasant, rabbit, venison, quail
• Goose
• Mincemeat
• Meat-based Liquids – gravies, broth, consumes, bouillon

 In Moderation

• Oysters, Mussels, and Most Other Shellfish, Prawns, Shrimp, Scampi
• Beef
• Chicken
• Turkey
• Lamb
• Pork
• Duck

Watch Protein Intake

Registered dietitian Sandra Allonen, at Beth Israel Deaconness Medical Center in Boston who provides nutritional counseling to gout patients, says the average person needs a lot less protein than they probably are taking in. She uses a formula based on weight to determine daily protein needs. A 150-pound, generally healthy person, for example, needs about 54 grams of protein daily — approximately the amount in 6 ounces of skinless grilled chicken breast — even if they are prone to gout attacks.

For people with gout, “I recommend the more alkaline proteins found in plant-based foods [first] as well as beans and nuts, then fish, then poultry and then red meat,” she says.

As for general dietary recommendations in those with gout, Allonen says it’s case-by-case. If they have regular gout attacks, “I would be more inclined to advise them to be careful with purine-rich foods. If their gout attacks are [few and far] between, I’d be a bit more liberal with their diet and work closely with the health-care provider who is overseeing their gout issues.”

Keep in mind that food is usually responsible for only 30% of the uric acid content in the blood serum. A healthy diet is an important part of managing overall health and lowering uric acid. However, it’s critical that you work with your doctor to treat the root cause of gout.

Author: Amy Paturel

Related Resources:

Tags: diet and uric acid, diet recommendations, diet tips, eating meat, gout diet, gout diet recommendations, gout diet tips, gout dietary recommendations, meat diet tips, reduce gout attacks, uric acid

6 Answers to Common Gout Diet Myths – Cleveland Clinic

Diet myths about gout run deep. It was once known as the “disease of kings” because people associated it with the rich diets of the wealthy — but if you’ve had gout, you know the experience isn’t so regal.

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The truth is much more complicated, however. Up to 4% of American adults have gout each year, and rising rates of obesity increase our risk. But don’t believe everything you hear when it comes to diet advice and gout. Diet matters — but not always in the way you think. Rheumatologist Scott Burg, DO shares more insight into this common affliction.

1. Should I avoid all rich foods?

No. “Patients often ask me about desserts, as well as entrees with rich sauces,” says Dr. Burg. It’s a common myth that these foods cause gout. When eaten in moderation, desserts and other rich foods do not affect gout flare-ups. But moderation is the key word. Rich foods may not cause flare-ups directly, but they can cause weight gain. And obesity is a major risk factor for gout attacks.

“At some point, the misconception spread that people with gout should avoid dairy. But in fact, certain dairy products — especially milk — can help you remove uric acid from your body,” he adds.

2. Is high fructose corn syrup a problem?

Yes, absolutely. High-fructose corn syrup is a known factor for gout flare-ups because it raises uric acid levels in your body. It’s also used in far more pre-packaged and processed foods than you might think. When you’re grocery shopping, always check nutrition labels. If corn syrup is an ingredient in a product, don’t buy it.

3. Do acidic foods lead to high uric acid?

No. Acidic foods such as tomatoes, citrus and other fruits, beans and dairy products do not necessarily lead to higher uric acid levels. People often assume they do simply because of the word “acid,” but acidic foods and uric acid are not one and the same.

4. Do I need to stop eating meat if I have gout?

“No, but practice moderation,” Dr. Burg reiterates. Avoid organ meats such as liver because they have higher levels of purines, which can cause flare-ups. Moderate intake of lean meats such as chicken and turkey should not affect your condition. Seafood such as shrimp and lobster tends to be higher in purines, though, so don’t make it a regular part of your diet.

5. Can I still eat dairy with gout?

Yes. At some point the misconception spread that people with gout should avoid dairy. But in fact, certain dairy products — especially milk — can help you remove uric acid from your body. In other words, dairy tends to help rather than hurt people with gout.

6. Do I need to stop drinking alcohol with gout?

Yes, it’s a good idea to cut out alcohol. Alcohol molecules in your body tend to increase uric acid levels, so drinking can push you over the edge and into a flare-up. If you’re newly diagnosed and start taking medication, try cutting out alcohol at first. Your doctor may allow you to add a small amount back into your diet over time as your uric acid levels come down. “But even then, it’s best to avoid beer and liquor and stick to safer choices such as red wine,” Dr. Burg says.

All myths aside, the best advice for people with gout is to eat fresh, unprocessed foods. Choose complex carbohydrates (from fruits, for example) over refined carbs from packaged or processed foods. And always drink plenty of water because dehydration is a risk factor for an acute attack.

Got Gout but Love Meat?

Once called “the ailment of kings” because it mainly afflicted those who could afford a rich diet, gout now affects more than 8 million non-royal Americans. To what do we owe this dubious honor? Is it because we are eating more meat than ever before?

What is gout?

Gout is a special type of arthritis in which certain joints fill up with microscopic shards of uric acid, becoming red, swollen, and exquisitely sensitive to the touch. Most people with gout have too much uric acid in their blood—higher than 6 mg/dl in women and 7 mg/dl in men (levels can reach 12 mg/dl or more in some cases). Uric acid crystals can also cause kidney stones and kidney damage. More than 20% of Americans now have abnormally high uric acid levels.

What is uric acid?

Uric acid is a breakdown product of purines—molecules that help make up some vitally important compounds present in the cells of all plants and animals, including DNA (genes), RNA (protein manufacturing) and ATP (energy). The following are the most familiar purines:

• Adenine
• Guanine
• Caffeine
• Theobromine (cocoa beans, tea leaves, kola nuts, yerba mate)

Low-purine diets

Low-purine diets (in combination with medication) have been prescribed for gout since the middle of the 20th century. This dietary advice is based on the belief that too many purines in the diet cause high uric acid in the blood. Now, since all plants and animals are made of cells, and all cells contain purines, asking someone to eat fewer purines is a tall order. However, since most animal foods are higher in purines than most plant foods (animal foods are denser and contain more cells per unit weight), doctors advise people with gout to eat less meat. You could also lower purines in your diet by simply eating fewer whole foods of all kinds. [Actually, the best advice, if you follow this reasoning to its logical conclusion, would be to eat a 100% junk food diet of flour, sugar, candy, soda, ice cream, and fruit juice—foods that have had their cells destroyed or removed in the refining process—because these foods contain few if any purines at all—sound like a plan?] The below list is adapted from Emmerson 1996:1

High-Purine Foods

• All meats, including organ meats, and seafood
• Meat extracts and gravies
• Yeast and yeast extracts
• Beer, and other alcoholic beverages
• Beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, and mushrooms

Low-Purine Foods

• Refined cereals and cereal products, such as cornflakes, white bread, pasta, flour, and tapioca
• Milk, milk products, and eggs
• Sugar, sweets, and gelatin
• Butter, polyunsaturated margarine, and all other fats
• Fruit, nuts, and peanut butter
• Lettuce, tomatoes, and green vegetables (except spinach and asparagus)
• Vegetarian cream soups made with low-purine vegetables
• Water, fruit juice, cordials, and carbonated drinks

In actuality, scientists admit that it is impossible to know the true purine content of any food, but even if we did, purines are not the only problem.

Those kings of old must have known how to party.

It has been known for centuries that alcohol consumption can trigger gouty attacks. This connection is now well supported by scientific studies. Two 12 oz beers can raise uric acid levels in healthy men by about 10%, and drinking to intoxication doubles uric acid levels in alcoholics. Interestingly, most alcoholic drinks contain no purines, so how does alcohol raise uric acid levels?

1. Alcohol cuts the kidney’s ability to rid the blood of excess purines by at least 50%.
2. When the liver processes alcohol, lots of ATP (an energy molecule) is used up in the process; ATP contains purines that get broken down into uric acid.
3. Beer is especially risky because it contains alcohol AND purines (derived from brewer’s yeast).

Fructose raises uric acid levels

It has been known since the late 1960s that fructose raises uric acid levels. Examples of foods which contain fructose are fresh fruit (max 10% fructose), dried fruit (max 40% fructose), table sugar (50% fructose) and corn syrup (55% fructose). Uric acid levels rise about 13% after eating meals containing fructose. People with gout have more exaggerated responses to fructose than healthy controls.

“subjects prone to developing gout in the 1700s and 1800s tended to be wealthy and sedentary, often with the ability to afford sugar, the latter of which is known to raise uric acid. Indeed, today gout is increasing in all populations, and if anything, is more common among the poor and less educated.”1

Yet, as you can see in this 2007 New York Times article, fructose is not even on the list of possible dietary factors in gout, which may be why celebrated NY Times food writer Frank Bruni continues to suffer with some symptoms of gout, despite following his doctors’ advice to limit meat and alcohol and to take medication:

“I’ve noticed discernible changes in my health—or at least in the way I feel. How much of that is attributable to my reduced alcohol intake and how much to the exodus of red meat is impossible to say. I haven’t lost more than a pound or two, because carbs have rushed in where protein isn’t permitted to treat . . . the flare-ups [of gout] are subtle now that I’m medicated and reformed.”2

Aye, there’s the rub! Mr. Bruni has gotten right to the meat of the problem—low-purine diets can be high in refined carbohydrates, such as sugar and flour, which raise insulin levels, and now not only do you have gout, but you have a hard time losing weight and you’ve further increased your risk for all kinds of other chronic diseases:

“Fructose is unique among sugars in that it rapidly causes features of metabolic syndrome both in experimental animals and humans. Fructose ingestion also leads to fatty liver and elevated triglycerides in humans and can also raise blood pressure. Intriguingly, fructose is a sugar that has the unique ability to raise serum uric acid. Serum uric acid levels rise within minutes of fructose ingestion… the increase in fructose intake closely parallels the rise in gout, obesity and metabolic syndrome that has occurred over the last two centuries. Serum uric acid levels increased from <3.5 mg/dl in the early twentieth century to over 6 mg/dl today in adult males.”3

How does fructose raise uric acid levels?

“The specific reason why fructose is superior than glucose in increasing fat stores likely relates to the unique first steps in fructose metabolism. When fructose enters the hepatocyte, it is metabolized by a specific enzyme, fructokinase C. Unlike glucokinase, which has a negative feedback system to prevent excessive phosphorylation, the phosphorylation of fructose by fructokinase will proceed uninterrupted, and as a consequence intracellular phosphate depletion and ATP depletion frequently occur. The fall in intracellular phosphate results in the stimulation of AMP deaminase that helps accelerate the degradation of AMP to IMP and later to uric acid. In turn, the intracellular generation of uric acid results in oxidative stress.”1

Translation: Fructose is especially good at turning into fat. The enzymes in the liver that turn fructose into fat use up lots of ATP in the process. ATP contains purines that get broken down into uric acid.

Both alcohol and fructose burn through ATP like kindling. Metabolically speaking, fructose and alcohol have a lot in common, which is why Dr. Robert Lustig mentions them both in the same breath as poisons.

But there’s more to the sugar story

Rapidly digestible carbohydrates such as sugar, flour, starch, fruit juice, and white potato are notorious for causing insulin spikes. Insulin tells the kidneys to reabsorb uric acid into the blood instead of excreting it into the urine. Why? Because insulin is, first and foremost, a growth hormone. In order to grow you need to build more cells, and to build more cells you need more purines.

Thus our dear meat-mourning Mr. Bruni is dutifully eating a low-purine, high-refined carb diet, which both lowers and raises uric acid. As comedian Steven Wright would have said, that’s like putting a humidifier and a dehumidifier in the same room and letting them fight it out.

So what is he supposed to do? What foods would he be left with if we told him he can’t eat carbs, meat, or alcohol? Fat and low-purine vegetables? Unfortunately that diet is dangerously devoid of nutrients. Which is worse for gout—meat or carbs?

My beef with the meat-purine-gout hypothesis

• We are not eating any more meat now than we did 100 years ago.
• Some cultures eating lots of meat, including 19th century Arctic peoples who lived on a diet of nearly 100% animal foods, did not develop gout. “Gout is unknown in Eskimos and Northern Indians despite their purine-rich diet.”1
• Animal foods are higher in protein than plant foods. Proteins increase the elimination of purines in the urine, which can actually lower uric acid levels.
• Some plant foods are rich in purines, including legumes, spinach, asparagus, and mushrooms (dense or rapidly growing plants).
• Purines in the diet do not have much of an effect on uric acid levels, because most of the uric acid in the blood comes from inside the body, as part of everyday cell turnover: “The purine content of the diet does not usually contribute more than 1 mg/dl to the serum urate concentration. ”2

Studies tying animal foods to gout have been epidemiological studies which have observed that people who eat more meat tend to have higher uric acid levels and/or a higher risk of gout. These studies have not taken carbohydrate in general, nor fructose in particular, into consideration. Therefore we have no idea whether people who reported eating more meat also happened to eat more fructose, which is, in my opinion, a critical omission given that we have known since 1967 that fructose can raise uric acid levels. Furthermore there are some epidemiological studies that find no association whatsoever between meat and uric acid levels.3 Either way, as many of you know, epidemiological studies are not experiments and correlation does not equal causation.

What do the clinical studies show? 

Unfortunately, as is the case with so many diseases, when the use of drugs to treat gout became popular in the 1950s, interest in dietary strategies fizzled. So we only have a wee handful of small, flawed studies to guide us:

There are ZERO studies that have attempted to prevent gout with diet.

I could only locate a grand total of ONE study of the oft-recommended low-purine, alcohol-free diet that is relevant to our question.1 In this study, 55 Brazilian adults with both high blood pressure and high uric acid levels were divided into three groups— diet alone, low-purine diet plus medication, and medication alone—for three months. Uric acid levels fell by about 2 mg/dl in all three groups by week six. However, people in this study were not gout patients, there was no control group, and the composition of the diet was not described (we are only told what was excluded from the diet), therefore we do not know if this diet contained less fructose and/or less refined carbohydrate than a standard diet. Without that information, we can’t be sure that it was the lack of purines that may have been responsible for the decrease in uric acid.

I located only ONE small pilot study exploring the role of refined carbohydrate in gout.2 Thirteen South African men with gout were placed on a 1600 calorie diet containing 40% unrefined carbohydrate, 30% protein, and 30% (unsaturated) fat, including four servings of fish per week. Purines were unlimited and alcohol was not restricted. Here are the results, on average, after 16 weeks:

• uric acid levels fell by 18%, from 10.3 mg/dl to 8.5 mg/dl on average; seven men had a normal uric acid level by the end of the study.
• frequency of gout attacks was reduced by 72%
• weight dropped by 17 lbs

This study is very promising, but unfortunately it is hard to know which of the interventions was responsible for the positive benefits—was it the lack of refined carbohydrate, reduction in saturated fat, or the weight loss itself? Even more confusing is that it is unclear whether these patients were eating much less meat than usual, given that they were told to avoid saturated fat. Uric acid levels fell by about 2 points, which is about the same as in the Peixoto low-purine diet study, although that group had much lower uric acid levels to begin with.

So, what should you do if you have gout?

The answer is that the research doesn’t have a clear answer for you yet. Many questions remain. We still don’t understand exactly why alcohol raises uric acid levels, why only a small percentage of people with high uric acid levels get gout, or even which carbohydrates might aggravate gout and why. For example, a brand new analysis of all available fructose studies calls into question whether fructose raises uric acid any more than any other kind of sugar.1

But here’s what we do know. When we combine the available science with common sense, we can say that:

• Human beings must be well-adapted, as all animals must be, to eating purines, which are found in all whole foods.
• It is highly likely that we are poorly adapted to be able to handle much refined carbohydrate or alcohol, which have never existed in nature in significant amounts.

Dietary tips for managing gout

1. Stabilize and lower your blood sugar and insulin levels by reducing carbohydrate intake, especially refined carbohydrate intake. A low glycemic index diet would be a good place to start. Depending on your chemistry, you may even need to consider a very low carbohydrate diet or ketogenic diet. Refined carbohydrate and high insulin levels have been strongly linked to metabolic syndrome and most diseases of Western civilization, and gout is probably just one more sugar-tipped arrow in the quiver of the Western diet. There is no evidence that lowering the amount of meat in your diet will protect you from these diseases, whereas there is plenty of evidence to suggest that lowering refined carbohydrate intake can. Even if it doesn’t completely cure your gout, you’ll be a lot healthier for it.
2. Minimize alcohol intake, especially beer.
3. Consider taking a vitamin C supplement. A single randomized controlled trial found that taking 500 mg of vitamin C per day for two months reduced uric acid levels by 1.5 mg/dl.

If you focus on these goals, you may be able to have your meat and eat it too 🙂

Want to learn more?

For more reassuring facts about meat and health, including information about kidney disease, heart disease, and nitrites/nitrates, please see my meats page. You may be interested to read about the history of mostly-meat diets, including the diets of Arctic and African peoples. I also recently wrote a critique of the latest study trying to connect the carnitine in red meat to heart disease.

In 2015, I wrote a five-part series about fructose, how it gets processed in our bodies compared to how we process glucose, if it is more dangerous than glucose, and how some of the fructose studies use questionable methods to single out fructose as more harmful than other forms of sugar. The series begins with the biochemistry of sugar in a post entitled: “Has Fructose Been Framed”. I dedicate a portion of part 3 “Why Sugar Is Bad for You: A Summary of the Research” specifically to sugar consumption and gout.

What about you? Have you tried any dietary strategies for gout that have worked?

References

Choi HK et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350:1093-1103.

Dessein PH et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000;59:539-543.

Emmerson BT. The management of gout. N Engl J Med. 1996;334(7):445-451.

Fam AG. Gout, diet and the insulin resistance syndrome. J Rheumatol. 2002;29(7):1350-1355.

Fam AG. Gout: excess calories, purines, and alcohol intake and beyond: response to a urate-lowering diet. J Rheumatol. 2005;32:773-777.

Garrel DR et al. Milk- and soy-protein ingestion: acute effect on serum uric acid concentration. Am J Clin Nutr. 1991;53:665-669.

Ghadirian P et al. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol. 1995;11:275-281.

Gibson T et al. A controlled study of diet in patients with gout. Ann Rheum Dis. 1983;42:123-127.

Huang H-Y et al. The effects of vitamin C supplementation on serum
concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. 2005;52(6):1843-1847.

Johnson RJ et al. Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? J Comp Physiol B. 2009;179(1):67-76.

Johnson RJ et al. Uric acid: a danger signal from the RNA world that may have a
role in the epidemic of obesity, metabolic syndrome and cardiorenal disease: evolutionary considerations. Semin Nephrol. 2011;31(5):394-399.

Lieber CS et al. Interrelation of uric acid and ethanol metabolism in man. J Clin Invest. 1962;41(10):1863-1870.

Lieber CS. Metabolism of alcohol. Clin Liver Dis. 2005;9:1-35.

Lieber CS. Hyperuricemia induced by alcohol. Arthritis Rheum. 1965 Oct;8(5):786-798.

Lyu LC et al. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr. 2003;78(4):690-701.

Matzkies F et al. The uricosuric action of protein in man. Adv Exp Med Biol. 1980;122A:227-231.

Peixoto MR et al. Diet and medication in the treatment of hyperuricemia in hypertensive patients. Arq Bras Cardiol. 2001;76:468-472.

Perheentupa J, Raivio K. Fructose-induced hyperuricemia. Lancet. 1967;9(2):528-531.

Reiser S et al. Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch. Am J Clin Nutr. 1989;49(5):832-839.

Schaefer O. Medical observations and problems in the Canadian Arctic, part II: nutrition and nutritional deficiencies. Can Med Assoc J. 1959;81:386-393.

Siener R, Hesse A. The effect of a vegetarian and different omnivorous diets on urinary risk factors for uric acid stone formation. Eur J Nutr. 2003;42(6):332-337.

Singh JA et al. Risk factors for gout and prevention: a systematic review of
the literature. Curr Opin Rheumatol. 2011;23:192-202.

Stirpe F et al. Fructose-induced hyperuricaemia. Lancet. 1970;19(2):1310-1311.

Villegas R et al. Purine-rich foods, protein intake, and the prevalence of hyperuricemia: the Shanghai Men’s Health Study. Nutr Metab Cardiovasc Dis. 2012;22:409-416.

Wang DD. The effects of fructose intake on serum uric acid vary among controlled dietary trials. J Nutr. 2012;142:916-923.

Yamamoto T et al. Effect of ethanol on metabolism of purine bases (hypoxanthine, xanthine, and uric acid). Clinica Chimica Acta. 356;2005:35-57.

Yu KH et al. Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum. 2008;37(4):243-250.

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6 Risky Foods To Avoid With Gout (No. 5 Was Unexpected)

[Last Updated, 28th December 2018]

A gout attack is not pleasant.

The pain is so bad that sufferers are often hospitalised for days, if not weeks.

More importantly, gout is typically indicative of other more serious health issues behind the scenes… Like a window into the state of an individual’s metabolic health.

Unfortunately the occurrence, or recurrence of gout is only getting worse.

Rates are on the rise from China to the UK, and it is now the most common inflammatory arthritis in the US (1, 2).

Information online about gout treatment can be particularly confusing, and even contradictory at times.

This is because we don’t yet completely understand the mechanism behind gout… But we do have a lot of big clues.

The following is a list of the top 6 foods to avoid with gout, explaining what we know and how it applies to you.

What is Gout and What Causes It?

Before we can look at foods to avoid with gout, it is necessary to briefly understand what it is.

Gout is a form of joint inflammation, caused by excessive uric acid in circulation (known medically as Hyperuricaemia).

When the body’s natural uric acid threshold is exceeded, painful crystals (urate) can form in and around the joints. These crystals trigger the characteristic symptoms and pain.

Not everybody with high uric acid levels will get gout, but those who do always have high uric acid levels. This indicates there are other factors at play, but from a dietary perspective uric acid is the focus.

Excessive uric acid in the blood stream is typically driven by two factors: genetic predisposition (family history) and the ingestion of high-purine foods. Obviously, the dietary factor we can control.

When purines we eat are broken down and metabolised by the body, uric acid is formed as a by-product of this process. It’s normal and healthy for uric acid to be formed, but excessive amounts are problematic.

Therefore, consuming less purine-rich foods should lower uric acid levels in your blood, lowering gout risk.

At least, in theory.

It’s actually not that clear-cut because other nutrients appear to aggravate gout symptoms too…

Here’s a list of foods to avoid if you have gout, based on real scientific evidence.

Summary: Gout is a type of joint inflammation that occurs when excessive uric acid levels build up in the blood. The breakdown of purines from our food is thought to drive excess uric acid levels, although there is much more to it.

1. Alcohol is the biggest risk factor for gout

It is well-established that frequent alcohol intake dramatically increases risk of gout (3).

The Framingham Heart Study of over 4,500 participants provides some perspective.

Researchers found that regular alcohol use was associated with three times greater risk of gout in women compared to those who have less than 2 standard drinks per week. For men, regular drinkers had double the risk of non-drinkers (4).

Beer seems to be the worst, followed by hard liquors such as spirits. Interestingly, moderate wine consumption is not linked with any risk (5).

The reason why alcohol increases uric acid levels is still not well-understood. Some forms, particularly beer, can be high in purines… but they are certainly not the richest source of purines in our diet.

Additional theories propose that excessive alcohol may also reduce the body’s ability to excrete uric acid. Others state that alcohol – especially beer – increases the chemical breakdown of purine-containing ATP nucleotides, which is a precursor of uric acid production (6, 7).

Summary: Regular alcohol intake severely raises uric acid levels in the blood. It doubles, if not triples your risk of gout.

2. Chicken, beef and other meats appear to be foods to avoid with gout

The conversion of purines to uric acid, in theory, causes gout.

Therefore high-purine foods are often suspected to trigger symptoms.

Meat, and to a lesser extent seafood, are prime suspects. This includes all the most common meats like beef, chicken, pork and lamb.

The data available somewhat confirms suspicions.

Each additional daily serving of meat or seafood is associated with a 21% or 7% increased risk of gout, respectively (8). This implies meat could be three times worse than seafood.

There was another similar study that found even greater risks associated with meat intake, but none for seafood. Overall this suggests seafood is far less of a concern than meat (9).

For those who already have gout, the impact of meat intake (and maybe seafood) on symptoms is even worse. This is likely due to sharper increases in blood uric acid, as well as poorer clearance by the body (10).

Therefore if you have a history of gout, it is best to dramatically reduce your meat intake, and seafood as well to a lesser extent. Anecdotal evidence suggests avoiding dark part of salmon, and de-veining prawns/shrimp before eating.

You should also buy your meat direct from the butcher where possible, or at least the better quality choices in the supermarket. Sausages and low-quality ground beef may contain traces of organ meat that can cause big problems (see the next point).

In saying that, it would be beneficial to include high-quality (purine-free) Omega-3 fish oil supplements in your diet. They have powerful anti-inflammatory properties that may help with gout symptoms.

Summary: Frequent consumption of meat is strongly linked with gout risk. The impact of seafood appears far less severe, but there is a link.

3. Organ meats are extremely high in purines and should also be avoided

Organ meats, known as Offal, contain by far the most purines of any food in the human diet.

The most common forms of offal in the Western diet include liver (such as Foie Gras), brain, heart, kidneys, and a mixture called Pâté.

Below is the purine content of a handful of foods. Note this is just an example I’ve selected, and you can find much more extensive lists on Goutpal or here.

Purine Content of Food (per 100 grams):

Consider that values listed are per 100 grams, so portion sizes must be taken into account… Meat portions we eat tend to be heaviest.

Previous studies have not differentiated between intake of conventional meat and offal, so recommendations have to be the same. Given the strong link between meat intake and gout – which is based on purine content alone – offal should definitely be avoided too.

Somewhat contradictory to the purine-gout theory, consumption of purine-rich vegetables is not associated with an increased risk of gout (3).

Researchers speculate this could be due to a lower bioavailability of purines in vegetabes, as well as other nutrients which may offset the harmful effects of their purines.

Summary: Organ meats are some of the highest purine foods and should be completely avoided if you suffer gout attacks.

4. A good diet for gout should not include soft drinks or fruit juice

Added sugar is a big problem in the modern diet.

Generally speaking, the sugar that is added to our food and drink products are 50% glucose and 50% fructose.

While glucose molecules are metabolised in the cell, fructose is metabolised in the liver. Further explanation is out of the scope of this article,  but they behave very differently in the body.

Fructose intake, and not glucose intake, is strongly linked with gout.

Soft drinks and fruit juices tend to have the greatest amount of added sugar, and therefore the greatest amount of added fructose.

In fact, gout occurrence in the US has risen in line with fructose consumption (listed as high fructose corn syrup) since 1970 (11).

In a large study of over 46,000 men, researches found that two or more sugar-sweetened soft drinks a day was associated with an 85% increased risk of gout (12).

The largest consumers of sugar-sweetened soft drinks (and foods) actually had a risk of gout comparable to the risk seen with three to five servings of alcohol.

Unfortunately the researchers did not account for family history of gout, which may or may not have changed their findings somewhat.

The strange thing out of all this, however, is that soft drinks don’t typically contain purines.

Fructose is thought to be the “culprit” linking added sugars with gout. It appears to share the same mechanism as alcohol: fructose accelerates the breakdown of purine-containing nucleotides like ATP. This in turn drives up uric acid levels (13, 14, 15).

Glucose and other simple sugars, on the other hand, have no effect on uric acid.

It still remains unclear whether the increase in gout incidence is caused directly by fructose, or indirectly through some other mechanism, such as obesity (16).

Either way, added sugars appear to play a part and should be avoided to minimise gout risk. They offer no nutritional value anyway.

If you must have something sweet, diet soft drinks (artificially sweetened) were not associated with gout and appear to be safe (17). Just know that several artificial sweeteners are thought to upset gut bacteria, and are not necessarily a healthier choice.

Summary: Drinks high in added sugar are associated with an 85% increased risk of gout in men. Fructose is thought to be the nutrient responsible as it stimulates uric acid production in the same way as alcohol.

5. Frequent consumption of certain fruits may trigger recurrent gout attacks

High sugar drinks may not be the only stimulant of gout flare ups.

Certain fruits – which are a natural source of fructose – have also been linked with gout.

This is a highly contentious area, because several studies have linked higher fruit intake with less incidence of gout. This is probably due to their high fibre content (9, 18).

And unlike fruit juice and other sugar-sweetened drinks, whole fruits are nutritious and generally good for health. There is no disputing this.

However, if you continually have gout attacks – despite cutting out alcohol and sugar-sweetened drinks – then I’m not convinced a large amount of fruits are safe for you. Especially if you are overweight and eat a Western diet.

So cutting back on certain very high-fructose fruits is like a Plan D, if you will.

The link comes back to fructose, which stimulates uric acid production in a similar manner to alcohol. Fructose is naturally found in fruit and honey.

One study found that the consumption of apples or oranges – the most popular fruits in this study – was linked with an increased risk of gout compared to those who consume less than one serving of fruit per month. No link was found with other fruits however (12).

While most fruits are very low in fructose, a few are very high. Frequent consumption of these could theoretically causes problems for gout sufferers.

Foods Highest in Fructose per 200 Calories (19):

Note this list is ranked on a per calorie basis, not per serving.

200 calories of soft drink equals just over one standard 375 ml (16 oz) can, hence why gout sufferers should avoid soft drinks.

But looking at fruits, 200 calories also equals 3 medium apples, 3 medjool dates, or 2.5 wedges of watermelon. It is easily possible to consume these amounts in the course of a few hours, or less.

If the fructose content in soft drinks and juices may contribute directly to gout, then the same can be said for an equivalent amount in fruit.

Summary: In theory, large intakes of certain fruits may also aggravate gout in those who suffer frequent attacks.

6. Aspirin and diuretics significantly increase gout risk

Not exactly foods to avoid with gout, but the ingestion of some common medications sharply raise the risk of a gout attack.

Specifically, low doses of aspirin, which one in three middle-aged Americans takes regularly to help prevent heart disease (20).

The emphasis is on low doses because aspirin has a dual effect on uric acid levels. Very high doses above 3,000 mg promotes excretion of uric acid (good in this case), whereas low doses prevent excretion (21).

In a study of 49 elderly patients, just 75 mg of aspirin per day increased blood uric acid levels by 6% within one week. A daily dose of 150 mg kept levels high during the second week, before coming down with 300 mg doses in the third week (22).

Considering the typical dose for heart disease prevention is 81-325 mg per day, it is no real surprise this dosage is associated with a doubling in gout risk.  In fact, even the use of a low-dose aspirin for two consecutive days (as a painkiller for example) increases risk of recurrent gout attacks (23).

Another type of medication known to trigger gout is diuretics. They are typically used to treat high blood pressure and oedema, and if feasible should be discontinued in gout sufferers.

I’m by no means recommending you cease your medications if you have gout, but it’s important to understand the pharmaceutical triggers. First speak with your doctor and closely monitor uric acid levels before making any changes.

And if you need a temporary painkiller, choose paracetamol or ibuprofen. No aspirin.

Summary: Low dose aspirin is a widely used drug that is proven to trigger gout, even if taken for a short period of time. Diuretics are also known to increase risk.

The cause of gout is more than just diet

While diet is critical, don’t overlook other important factors that affect gout. These include family history, sleep apnoea, and lack of physical exercise to name a few.

Further discussion of best treatment for gout is outside the scope of this article. But there are foods thought to be protective; namely dairy, cherries, and coffee, in decreasing order of evidence.

And as much as I prefer focusing on what you should eat to prevent health scares, there are just so many clear trigger foods for gout.

It’s important to deal with these factors first and foremost.

By understanding what to avoid, and why, gives you the best chance to overcome it.

Valerius Medical Group & Research Center: Rheumatologists

Gout is the most common form of inflammatory arthritis. It causes sudden, intense episodes of swelling, pain, and tenderness in one or more of your joints. Gout most often affects the big toe, and it occurs due to a buildup of uric acid crystals in a joint. 

In some cases, certain medications can lead to a buildup of uric acid. In this blog, Nathaniel Neal, MD, and Rebekah Neal-Kraal, MD, of Valerius Medical Group & Research Center explain more about what can cause gout, how medications can play a role, and how gout can be treated.

What causes gout?

Uric acid is a normal waste product that your body makes when it breaks down purines, which is a substance found in various foods. Gout can develop if the levels of uric acid get too high or if the kidneys have trouble clearing uric acid from the body. If uric acid levels stay high, this can lead to the formation of uric acid crystals, which can congregate in joints and cause joint pain.

Food and gout

Eating foods high in purines can increase uric acid levels and place an added burden on the kidneys. It’s recommended for people with gout to follow a low-purine diet. Purines are mostly found in meat. Purine-rich foods include: 

• Organ meats
• Ham
• Chicken
• Lamb
• Venison
• Shrimp
• Turkey 
• Beef

Alcohol is also rich in purines. Beer is a major contributor to gout. Additionally, certain vegetables, such as asparagus, spinach, mushrooms, and cauliflower, are purine-rich. In addition to limiting dietary purines, drinking plenty of water each day can help dilute uric acid. 

Medications and gout

There are several classes of medications that can affect your metabolism, which can lead to increased levels of uric acid and an increased chance of developing gout. These medications include:

• Beta blockers
• Angiotensin-converting enzyme inhibitors
• Thiazide diuretics
• Anti-rejection drugs
• Low-dose aspirin
• Immunosuppressant drugs
• Certain chemotherapy drugs
• Androgens

If you have gout, it’s important to discuss your medications with your provider. If you’re taking a medication known to increase uric acid levels, your provider may recommend switching to a comparable drug.

Medications that raise uric acid levels may make it more difficult for you to manage gout. If you suspect that a medication you’re taking is causing your gout, talk to your provider about it. 

Other risk factors for gout

As mentioned, eating a lot of foods high in purines and taking certain medications can cause gout. However, there are other risk factors that can increase your chances of developing gout. Here are some of them:

• High blood pressure
• Obesity
• High cholesterol
• Diabetes
• Kidney disease

Gout tends to run in families. If you have a close relative with gout, you’re more likely to develop it as well. 

Treating gout

Medications, along with diet and lifestyle changes, are the foundation for managing gout. The following are some of the medications used to treat gout:

• Corticosteroids, which can relieve pain and swelling
• Colchicine, which can help manage acute attacks
• Uric acid-lowering drugs, which can help prevent gout attacks

Your provider will recommend an appropriate treatment plan to help you manage your gout attacks and reduce the frequency and severity of future episodes. 

Gout attacks can be painful and debilitating, but with the right care, you can minimize attacks so you can function better. To get treatment for gout or to see if you have the condition, book an appointment over the phone with Valerius Medical Group & Research Center today.

90,000 Gout Diet – New Hospital

Gout is a severe systemic disease that progresses without treatment, leading to severe complications, disability or death. Gout is characterized by elevated levels of uric acid in the blood. As a result, deposits of sodium monourate crystals are formed in soft tissues, in and around joints with the formation of tophuses (gouty nodes).

Complex gout treatment:

• drug therapy
• compulsory adherence to diet therapy.

The diet is based on the elimination of alcohol, limitation of foods containing animal protein, the exclusion of sugary carbonated drinks, fatty, fried and smoked foods. The diet should be balanced with plant and dairy products.

Diet Pros

Uric acid is produced by the breakdown of purines. Purine bases are found in food, therefore, when treating gout, the patient’s diet and adherence to diet therapy are important. Diet therapy can eliminate foods that contain purines and lower uric acid levels.

While following a diet, the number of pain attacks decreases, the inflammatory process decreases, and swelling of joints and soft tissues decreases. The diet is balanced with high-calorie foods, does not cause a feeling of severe hunger. With the help of a diet, the risk of complications and the formation of tofuses is reduced.

Cons of diet

In order for the disease not to progress, diet therapy should be lifelong. Alcohol and animal products should be minimized or eliminated from the diet.You can fill the diet with protein due to protein products of plant origin.

Product table

Weekly menu

Monday

• Breakfast – omelet, cooked in the oven or steamed, you can add 50 ml of milk + a couple of slices of bread, 150 g of vegetable salad.
• Lunch – minestrone soup (vegetable), 130 g of non-fatty fish, steamed or boiled.
• Dinner – stewed vegetable sauté with zucchini and eggplants 300 g, a slice of bread.

Tuesday

• Breakfast – bulgur or oatmeal porridge with fruits or dried fruits.
• Lunch – wild rice pilaf and chicken fillet without frying.
• Dinner – oven-baked vegetable sauté with potatoes and low-fat cheese, a slice of bread.

Wednesday

• Breakfast – yoghurt with fruits and nuts.
• Lunch – cream soup of pumpkin, zucchini and potatoes, chickpea cutlets, you can add 2 teaspoons of pumpkin or flaxseeds to the soup.
• Dinner – stewed cabbage with tomatoes, onions and turkey.

Thursday

• Breakfast – bulgur or rice porridge, can be cooked in water or water + milk, berries or dried fruits.
• Lunch – bean lobio, vegetable salad.
• Dinner – bulgur or wild rice pilaf with chicken breast and vegetables.

Friday

• Breakfast – cottage cheese or syrniki baked in the oven, fruit, 1 teaspoon of sesame seeds, 1 tablespoon sour cream.
• Lunch – durum wheat pasta with seafood, vegetable sauce.
• Dinner – buckwheat with oven-baked fish.

Saturday

• Breakfast – wheat porridge with a mixture of water and milk, dried fruits.
• Lunch – vegetable cream soup, add flaxseeds or pumpkin seeds, a slice of bread or a loaf of bread.
• Dinner – vegetable sauté, seafood, boiled egg.

Sunday

• Breakfast – yoghurt with fruits, nuts.
• Lunch – perlotto with vegetables and cheese.
• Dinner – stewed cabbage with vegetables and turkey meatballs.

Results

A patient with gout who follows a diet has a much longer remission period than someone who does not follow a diet.The diet reduces the intensity of pain, inflammation. With a balanced diet, the doctor can control the level of uric acid in the patient’s body.

Diet Nutrition Objectives

The goal of dietary nutrition in case of illness is to limit the consumption of foods that contain purine bases and to increase the excretion of uric acid by the kidneys.

Therapeutic diet for this pathology

A therapeutic diet is aimed at reducing the intake of protein products of animal origin.The allowed amount is up to 1 g per 1 kg of body weight. It is imperative to observe the water balance, the amount of fluid you drink is up to 2 liters per day. As a liquid, you can use rosehip broth, fruit drink, water with lemon, mineral alkaline water. Alkaline water prevents the onset of nephrolithiasis. Salt consumption is limited, because it retains fluid in the body and disrupts lymphatic drainage.

Diet therapy for gout aims to eliminate foods that are rich in purines.

Products to be excluded:

• rich meat and fish broths;
• yeast bakery products;
• legumes;
• fatty fish, sprats, sardines, pike;
• offal;
• lard, lard;
• porcini mushrooms, champignons;
• sweets – cakes, pastries, sweets, chocolate;
• greens – spinach, sorrel, rhubarb;
• vegetables – asparagus, cauliflower, radish, radish;
• fruits – figs;
• cereals – peeled white rice;
• sausages, smoked meats;
• yeast products.

Meat is recommended to be eaten boiled, because the purine bases remain in the broth.

It is necessary to exclude or limit the consumption of coffee, strong tea, spices, smoked meats, fatty foods, alcohol.

Nutritional features and principles

Meals should be balanced and filled with foods that are poor in purines. Allowed Products:

• eggs;
• dairy products;
• vegetables;
• fruits;
• nuts;
• honey;
• cereals;
• meat and fish of low-fat varieties up to 300 g per week.

Specific nutritional status in obesity

With obesity, nutrition must be corrected. Weight loss is the primary goal. Diet can help you reduce weight and reduce the appearance of gout and gouty attacks. For obesity, a Pevzner diet is prescribed, table number 6.

Fasting days for gout

If diet therapy is followed, there is no need to spend fasting days. Complete fasting is prohibited in case of gout, i.e.because it aggravates the course of the disease.

Patient recipes

The diet contains a large number of products from which you can prepare various dishes according to the season. It is necessary to diversify the diet with new dishes.

Whole grain buns

Ingredients for 4-5 pieces: 100 g oat bran, 100 g whole grain flour, 200 ml kefir, 1 teaspoon olive oil, 1 teaspoon baking powder, salt, herbs (to taste).

Cooking recipe:

• 1.Mix oat bran with kefir, let stand for 15-20 minutes.
• 2. Mix flour with baking powder.
• 3. Stir with the bran, add flour gradually and stir.
• 4. Knead the dough, it must be elastic and soft.
• 5. Add oil, salt, herbs. Knead again.
• 6. Form buns and put in the oven for 30 minutes 180 degrees. If you bake buns on parchment, grease the parchment with butter.

Oatmeal cookies

Ingredients: oatmeal – 200 g, unsweetened yogurt – 300 g, apples – 2 pcs., Dried fruits – 50 g, cinnamon to taste.

Cooking recipe:

• 1. Pour oatmeal with yoghurt and stir. Leave to swell for a short time (20 minutes).
• 2. Grate the apple without the peel on a coarse grater, chop the dried fruit with a knife.
• 3. Mix apple, dried fruit, cinnamon, flakes.
• 4. Shape cookies into small balls and place on parchment paper. Bake at 180 degrees for 40 minutes.

Cost of services

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Gout: joint disease – ProMedicina Ufa

Gout is a joint disorder caused by the deposition of uric acid (urate) salts.About three out of every 1,000 people suffer from gout. Moreover, men make up the overwhelming majority. The disease usually manifests itself after 40 years in men and after menopause in women. Gout affects all joints: fingers, hands, elbows, knees, feet. The joints of the toes are most commonly affected by gout. Risk factors also include arterial hypertension, diabetes mellitus, hereditary predisposition, malnutrition. As a rule, an attack of gout develops against the background of drinking alcohol (especially beer) or overeating.

Reasons

The cause of gout is an elevated and persistent level of uric acid in the blood. During the course of the disease, urate crystals (a derivative of uric acid) are deposited in the joints, organs and other systems of the body. Sodium urate crystallizes and is deposited in small particles in the joints, which ultimately leads to partial or complete destruction of the joint.

A large amount of uric acid in the body can be for two reasons: the first reason is when healthy kidneys cannot cope with the excretion of unusually large amounts of uric acid, the second reason is when uric acid is excreted in normal quantities, but the kidneys are unable to excrete her.

Every year there are more and more gout patients. Doctors explain this phenomenon by the fact that in recent years people are more likely to eat foods rich in purines (for example, meat, fatty fish) and a huge amount of alcoholic beverages.

Symptoms

The disease is manifested by sudden and intense pain, redness and “heat” in the joint. Gout attacks usually occur at night. Acute pain in the affected joint can be caused even by the weight of the sheet. A recurrent gout attack is usually preceded by a tingling sensation in the affected joint.If gout is left untreated, attacks become more frequent and periods of flare-up are longer. Arthritis takes root in all new joints, often kidneys and urinary tract are affected.

Diagnostics

Directly the diagnosis is made on the basis of clinical and laboratory and instrumental examinations. For some patients, the diagnosis does not take long, while others have to undergo a series of tests and examinations. First of all, it depends on the cause of the disease, and on the severity of the symptoms.

With an intermittent course of gout, changes in ultrasound will be noticeable only during an exacerbation of the disease. In the first 3-4 days of an acute attack, there is an expansion of the joint space, edema and compaction of soft tissues around the affected joint. Already after 5-7 days after an acute attack, the above changes are hardly noticeable, and after 10-12 days, ultrasound of the joint may not reveal any abnormalities.

Scintigraphy with technetium pyrophosphate – this study is prescribed mainly for patients with a blurred clinical picture of the disease, when the doctor has problems with an accurate diagnosis.Scintigraphy involves the introduction into the blood of a specific substance (technetium pyrophosphate), which selectively accumulates in the places where urate is deposited. Subsequent scanning of the body allows you to accurately determine the localization of the pathological process.

With the help of computed tomography, it is possible to determine the degree of joint deformity in the late stages of the disease and the exact localization of the tophi. In the early stages, the images will show only compaction of the soft tissue around the joint during an exacerbation.

Treatment

Treatment of gout should be aimed at preventing and stopping an acute attack and urate deposits in tissues, as well as at their resorption.

With the help of modern medicinal preparations, one can both quickly stop an acute attack of gout and normalize the serum uric acid content in most patients (provided that the appropriate drugs are used throughout their lives).

The most important component of gout therapy is a special anti-gout diet, poor in purines, proteins and lipids.All foods rich in purines should be excluded from the diet: meat soups and extracts, kidneys, liver, lungs, brains, game, crayfish, fatty fish, fried meat, meat of young animals (young veal), green peas, cauliflower. Meat or fish is consumed only boiled 2-3 times a week. For meat products, chicken and ham are recommended, as they are relatively low in purines.

Foods rich in fat should also be excluded: eggs, sausages, fatty milk and dairy products.The food of a patient with gout should contain no more than 1 g of fat per 1 kg of the patient’s body weight. With excess weight, a hypocaloric diet is recommended, fasting (vegetable or fruit) days 1 time per week or 10 days. Alcoholic drinks, strong tea and strong coffee are prohibited.

In the presence of chronic gouty arthritis and secondary osteoarthritis, patients, in addition, need physiotherapy and balneotherapy, which have a resolving and analgesic effect. As such means, diathermy, iontophoresis with lithium, phonophoresis with hydrocortisone, mud and paraffin applications, diadynamic currents, massage, exercise therapy can be prescribed.

With large gouty nodes and massive infiltration of periarticular tissues, especially with ulceration of the skin and the presence of fistulas, surgical removal of urate deposits is recommended, since these formations usually do not dissolve when using anti-gouty agents; they can become infected and significantly limit the function of the joint.

Sometimes, in the presence of significant destruction of the cartilage and pineal glands, which disables the patient, it is necessary to resort to reconstructive surgery such as arthroplasty.

90,000 The foot is trapped. How to deal with gout?

In past centuries, gout was called the disease of aristocrats, because she chose her victims among people with high material wealth who loved pleasure, high-calorie food and alcohol.

Nowadays, gout is classified as a disease – “metabolic errors”. One of the reasons for its occurrence is metabolic disorders, in which uric acid salts are not excreted from the body, but are deposited in various organs and tissues, mainly in the joints and kidneys, and injure them, bringing the patient intolerable pain.How to coexist with this disease and whether it can be cured, we asked Inna Bashtova, a rheumatologist at the 3rd central regional polyclinic in Minsk.

– Gout was called a disease of the aristocracy and was associated with excessive eating and drinking. How relevant is it today?

– I must say right away that gout occurs in about 1-3% of the adult population. And men suffer from this disease more often. The ratio of men and women with this diagnosis is 7: 1.and, as a rule, these are fairly young men – 40-50 years old. Women get sick later – after 60. Moreover, the disease is getting younger, and we really observe that it is associated with deficiencies in the diet. We see a lot of young people with metabolic disorders who are overweight, enjoy delicious food and drink alcohol. This is the main category of patients.

– How does the disease manifest itself? What are the first signs of it?

– There are four stages in the clinical picture of the disease.The first is asymptomatic hyperuricemia. It is often discovered by accident – during the prophylactic examination, the doctor sees an increased level of uric acid in the blood. This stage can last quite a long time, and the disease does not manifest itself in any way. The second stage is acute gouty arthritis, which is provoked by improper diet, as well as injuries, surgical manipulations, prolonged use of certain drugs (eufiline, caffeine, diphenhydramine, aspirin, diuretics and glucocorticosteroids).The attack comes on suddenly, usually at night or in the morning. It is always intense, rather sharp pain, sometimes it is described as a “sheet”, because even when the sheet touches, it seems that it is pressed against a concrete slab. As a rule, the debut begins with monoarthritis – pain in one joint. It turns red, up to a bluish tint, swells, its function is disrupted. Most often this is the metatarsophalangeal joint of the first toe on the foot – the base of the thumb. This is a classic version of the development of gout.

– Why does pain appear at night?

– At this time, the level of uric acid in our body rises.Usually the patient went to bed in the evening and everything was fine, but in the morning he cannot get up.

– What is the reason for this acute pain?

– Active blood circulation in the joint and uric acid penetrates there, is deposited, which causes an attack.

– Gout is often combined with obesity and hypertension …

– There are three variants of gout. Metabolic is associated with metabolic disorders and a high concentration of uric acid in the blood.As a rule, it happens in patients with overweight and concomitant pathologies, in particular, cardiovascular. There is also a renal variant of gout, when there is a decrease in the excretion (excretion. – “Sound”) of uric acid. This option always leads to kidney failure. Uric acid urates are deposited and urate nephropathy develops. About half of all cases of gout are renal. And the last type is mixed, when there is an increase in the synthesis of uric acid in combination with a decrease in excretion, in other words, a lot is produced and little is excreted.

– Which option is more dangerous?

– The metabolic variant has a better prognosis. Diet, lifestyle modifications, hypertension medications, and uric acid control can help contain the disease. If the patient is determined and motivated to fight, the disease will not manifest itself as painful attacks. The renal variant is poorly managed, it happens that patients go to hemodialysis (extrarenal blood purification due to acute and chronic renal failure).

– Is it true that gout can be identified by the patient’s ears?

– Not always. There is a tofus form of gout, when urates are deposited under the skin and above the joints. Then they are on the auricles, above the joints on the hands, and can be palpated above the elbow joints. And there is also a topofus form – urates can be deposited in internal organs, for example, in the kidneys.

– Is it possible to completely get rid of this disease?

– If this is a metabolic option, then at the initial stage it is possible.This is the same as in diabetes mellitus, when the so-called prediabetes is diagnosed. The patient is offered a diet and an active way of life, and if he follows the recommendations, then the disease may not occur. If a patient with an increased level of uric acid and the absence of concomitant cardiovascular pathology adheres to a diet, leads an active lifestyle, then the further development of the disease can be avoided. We have patients who follow a diet and adhere to the recommendations of a rheumatologist, and they never have seizures during their lifetime.We even remove such people from dispensary observation due to persistent long-term remission.

– Can it even take several years from the first attack of pain to the next?

– Everything here is very individual – both five and ten years may pass. But it is better to consult a doctor immediately after the first attack and try to take the disease under control.

– How then peacefully coexist with gout? What should be the diet?

– In treatment, diet really occupies a separate place, because nutrition is quite effective in reducing the level of uric acid.There are a number of foods that are purine-based. They should be excluded or limited. These are meat and offal – liver, kidneys, tongue, also sausages and ham, caviar, red wine, beer and spirits, sorrel, salted cheeses, legumes, chocolate, figs, mushrooms, pickled and pickled vegetables, cocoa, strong tea, rich meat and fish broths. Boiled meat and fish can be consumed once a week during a period when there are no pain attacks.

– Does physical activity affect the course of the disease?

– No.But hypothermia, stress factors, surgical interventions can provoke seizures.

– What happens to gout if you do not follow a diet and treatment?

– Attacks will be frequent. This is a long, sluggish, relapsing gout. The joint will constantly hurt.

– What drugs is this disease treated with?

– Already at the first, asymptomatic stage, when patients have a high level of uric acid, drugs are prescribed to reduce it.This is alopurinol, its dose is selected individually depending on the level of uric acid. Normally, for patients without cardiovascular diseases, it is 360 μmol / L, and for patients with concomitant pathology – no more than 300 μmol / L. When we reach the target uric acid levels with the help of the drugs and the patient adheres to the diet, the drug can not be taken for a while. Often it is possible to control its level with the help of a diet, then it is not necessary to take the drug constantly. If this result cannot be achieved, then the dosage is selected for a constant intake.

– What to do if you have a gout attack at night? How to relieve a sharp pain?

– To relieve pain, you can take non-steroidal anti-inflammatory drugs – arcoxia, nimesulide, meloxic, which relieve pain and inflammation. Compresses with Dimexide are applied locally to relieve swelling and inflammation in the joint.

Elena KRAVETS

90,000 Nitrates in foods can be beneficial. On one condition

• Angela Smith-Welch
• BBC Future

March 14, 2019

Photo author, Getty Images

The word “nitrates” , as a rule, causes negative associations.But it turns out that is not all that bad and dangerous! BBC Future columnist explains which nitrates are potentially dangerous and which ones are n us I am our mu organism cu.

Recent calls to ban the use of nitrates and nitrites in ham production due to the risk of cancer have only reinforced the dangerous image of these substances.

However, the link between dietary nitrate and health is controversial. For example, the high content of natural nitrate in beet juice can lower blood pressure and increase muscle activity.

Nitrates are also an active ingredient in some medicines that are prescribed for angina pectoris, reduced blood flow that causes chest pain.

So are nitrates really that bad?

Nitrates and nitrites, such as potassium nitrate and sodium nitrate, are naturally occurring chemical compounds containing nitrogen and oxygen. In nitrates, nitrogen is bound to three oxygen atoms, and in nitrites, to two.

Both are food grade preservatives that inhibit the spread of harmful bacteria in bacon, ham, salami and some cheeses.

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Carrots are one of the largest sources of nitrates that get into it from the soil

However, the average European gets only 5% of nitrates from processed meat, more than 80% from vegetables.

Nitrates and nitrites enter vegetables from the soil in which they grow.

Nitrates are part of natural minerals, and nitrites are formed by soil microorganisms that process organic matter.

Greens such as spinach and arugula top the list of nitrate foods, followed by celery and beet juice and carrots.

Vegetables grown organically contain slightly less nitrates as they are fertilized with synthetic nitrates.

However, there is an important difference between nitrates in meat and vegetables, and this is what determines the level of their carcinogenicity.

Are they related to cancer?

By themselves, nitrates are quite inert, that is, they practically do not enter into chemical reactions in the body.But nitrites and the chemicals derived from them are more active.

Most of the nitrites we encounter are formed from nitrates by bacteria in the mouth. Interestingly, the use of an antibacterial rinse significantly reduces their formation.

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Unlike vegetables, in ham and sausage nitrites form dangerous bonds with proteins

Under the action of an acidic environment in the stomach, they are converted into nitrosamines, some of which are carcinogenic and associated with cancer intestines.

But this requires amines, chemicals that come from ammonia and are found in large quantities in protein products.

Nitrosamines are also formed directly in food when exposed to high temperatures, such as frying bacon.

“So it’s not the nitrates or nitrites themselves that are harmful, but the way they are processed and the environment in which they are found,” says Keith Allen, executive director of science and public affairs at the World Cancer Research Foundation.

“For example, nitrites in sausages bind to amino acids when exposed to temperature to form nitrosamines, cancer-causing compounds,” she adds.

Allen, however, adds that nitrite is just one of the reasons why processed meat contributes to bowel cancer, and the impact is uncertain.

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In processed meat, nitrites under the action of high temperatures form nitrosamines, substances that cause cancer

Other hazardous substances are iron, PAHs (polyaromatic hydrocarbons), which are formed in smoked meat, and heterocyclic amines formed when meat is roasted over an open fire.They also contribute to the development of tumors.

On the other hand, although the International Agency for Research on Cancer classifies processed meat as a “potential carcinogen”, the risk is relatively small.

In the UK, for example, bowel cancer occurs in six out of 100 people. Of those who eat 50 grams of processed meat daily (about three pieces of bacon), only seven out of 100 are at increased risk.

Maybe even good

But nitrite isn’t just bad.There is growing evidence that they are beneficial for the cardiovascular system and other organs thanks to the molecules of nitric oxide.

In 1998, three American scientists received the Nobel Prize for their discovery of the value of this gas for the cardiovascular system.

We now know that nitric oxide dilates blood vessels, lowers blood pressure and strengthens the body to fight infections.

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Nitrites found in, for example, beets and other vegetables are responsible for the formation of nitric oxide, which lowers blood pressure

Nitric oxide deficiencies have been linked to heart disease, diabetes and erectile dysfunction.

Although nitric oxide is produced in the body in several ways, its formation from nitrates is primarily important for the elderly, since other ways of its formation decrease with age.

“It is important that the substances formed from nitrates in vegetables are not associated with the risk of developing cancer, unlike those from processed meat,” confirms Amanda Cross, Lecturer in Cancer Epidemiology at Imperial College London.

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Nitrates in green vegetables have many health benefits and do not form harmful nitrosamines that cause cancer

Vegetables, primarily green leaves, do not contain protein, and also have protective components, for example, vitamin C, polyphenols and fiber, which reduce the formation of nitrosamines.

So, if most of the nitrates in our diet come from vegetables, which contribute to the formation of nitric oxide, they are probably even good for us.

One expert on the subject even argues that many of us are deficient in nitrates and nitrites and should be considered an important nutrient that can prevent heart attacks and strokes.

How much is safe?

It is almost impossible to accurately determine the amount of nitrates that we consume with food.

“Their level can fluctuate 10 thousand times, and even in water it is very different within the acceptable range of 50 mg per liter,” says epidemiologist Gunter Kulne from the University of Reading.

“This means that studies of the effect of nitrates on the body must be interpreted very carefully, since the presence of nitrates often indicates only that a person just ate vegetables.”

In 2017, the European Institute for Food Safety (EFSA) calculated the daily allowable intake of nitrates (which can be consumed without noticeable health risks) – 235 mg for a person weighing about 63 kg.

But the Institute’s report also noted that people of all ages can safely exceed this norm.

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Since the nitrate content in food varies greatly, it is difficult to say exactly how much nitrate is ingested daily.

on average, they eat 1.5 mg per day).

As noted by the EFSA, the effects of nitrite preservatives are also at a safe level for all populations in Europe, with the exception of a small excess in children who receive a lot of nutritional supplements.

Some experts even argue that these standards are outdated, and more nitrates are not only safe, but also beneficial.

However, we are talking only about nitrates, which enter our body with vegetables, and not processed meat.

The hazard is, of course, dose dependent. 2-9 g (2000-9000 mg) of nitrate can be extremely toxic, causing changes in hemoglobin and bluish tinge of lips and skin.

But it is very difficult to get such a dose with food, and it is possible only in case of poisoning with water contaminated with fertilizers.

What conclusion can be drawn?

To keep your body getting the “right” nitrates and nitrites, eat at least five servings of fruits and vegetables daily, and avoid processed meats.

Thus, the benefits of nitrates will almost certainly outweigh their disadvantages.

Gout – food trouble. Is it possible to inhibit joint destruction? | Healthy life | Health

Our expert – rheumatologist Evgeny Vasiliev .

Emergency “call”

Gout is associated with metabolic disorders of special substances – purines – in the body. Over time, an excess of uric acid in the body ends with the formation of needle-like clistals and their deposits (tofuses), which are localized mainly in the joints of the big toes, causing unbearable pain.

All these troubles are caused by overeating, especially addiction to meat, fatty sausages, ham. Some types of fish, beans, figs, coffee and chocolate, strong black tea, and red wines also contain many purines.The body cannot cope with the excess of harmful substances, and they are deposited on the cartilaginous membranes and in the vessels.

The first alarming “call” of the disease is the curvature and swelling of the big toe. Then, acute attacks may occur: in the evening or at night, a sharp pain in the joints, a rise in temperature, swelling and swelling of sore legs. Such an attack can last 3-4 days and cause serious suffering to the patient if treatment is delayed or applied incorrectly.

Attack on Pain

During a gout attack, doctors prescribe pain relievers and drugs to relieve swelling, as well as those that increase the excretion of purines from the body. In doing so, you need to drink plenty of fluids, preferably alkaline mineral waters.

At the same time, the patient must follow a strict diet that excludes sources of purines: milk porridge in the morning, vegetable soups (without peas, beans and beans) in the afternoon, stewed vegetables in the evening.Zucchini, pumpkin, eggplants and cucumbers are especially useful – they have an alkalizing effect and cause purines to react to neutralize their harmful effects. As a drink, only mineral water, decoctions of herbs, kefir are appropriate.

It is also useful to make decoctions, fruit drinks or infusions of plants that improve the solubility of uric acid salts: lingonberry, strawberry, elderberry, barberry, nettle, string.

Unfortunately, gout usually affects the urinary system as well, so drugs are removed from the body slowly and the condition improves slightly.

Phytotherapists suggest reducing the frequency of seizures by constantly eating plants that prevent the formation of uric acid deposits. These are lemongrass, capers, rose hips, corn silk broth.

And since patients with gout also have a markedly reduced immunity, in the intervals between attacks it is useful for them to eat blueberries, nightshade, black elderberry, drink decoctions from Rhodiola rosea and common agaric.

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Life Without Gout – Vitalong

Unfortunately, in recent years, PODAGRA – in the old days, the disease of aristocrats – is common.

This is facilitated by the excessive consumption of meat products and, above all, sausages by the population.

Gout is a severe metabolic disease characterized by joint damage with accumulation of uric acid and a high level of uric acid in the blood (328 – 700 μmol.l). A serious complication of gout is kidney damage. Urate nephropathy – characterized by the inconsistent presence of protein, leukocytes in the urine, as well as arterial hypertension.In the biochemical study of blood, a high level of creatinine, urea, in the general analysis of urine hematuria (erythrocytes sometimes cannot be counted), albuminuria, leukocyturia.

The basis for the treatment of gout – a diet with the exclusion of animal products: meat, sausage, ham, ham, meat and meat-bone broth; as well as fish and fish products.

In the treatment of such patients, standard medicine mainly uses allopurinol, non-steroidal anti-inflammatory drugs, immunosuppressants.These drugs, with long-term use, give many complications.

Treatment of such patients in our Clinic is always a joint work of a doctor and a patient.

In the treatment of such patients, we use:

• Obligatory remediation of foci of chronic infection.
• If necessary, infusion therapy of vascular drugs, hepatoprotectors, anti-inflammatory drugs, in severe gout with renal syndrome – alkaline solutions.
• General cryotherapy – a course of 14 to 40 daily sessions,
• Local cryotherapy of affected skin, affected joints,
• Physiotherapy for the affected joints.
• Bioresonance therapy,
• Antihomotoxic drugs according to individual schemes.

With a decrease in the level of CRP, ESR, uric acid levels to normal values, we began to slowly reduce the dose of basic drugs (NSAIDs, methotrexate, allopurinol) with weekly monitoring of clinical and biochemical blood parameters until they are completely abandoned. At the same time, the patients went under the guise of general cryotherapy, antihomotoxic and basic homeopathic drugs that restore the metabolism of the affected synovium.

The observation period for such patients is from 2005-2009.

Every year in the autumn – spring period, patients are invited to a dispensary examination with a complete clinical, biochemical and immunological blood tests, vegetative resonance testing.

It should be noted that there was no return to basic therapy in any case. The condition and well-being of the patients is in a state of relative health, the shape of the joints has recovered, the blood, urine and blood pressure indicators are in absolute norm.

90,000 Spa endocrinology: gout

Spa treatment of patients with gout in the resorts of the world

Gout known
as “the disease of kings”, was described in the time of Hippocrates. In the 1st century. AD Seneca
described gouty attacks, as “gout makes itself felt in
a certain time. ” Even then, chronographs noticed the relationship between the degree
development and prosperity of cities and even states and the spread among
population of gout. At the beginning of the XX century. this assumption was confirmed by the work of G.Ellis “The Story of an English Genius”, which not only showed a very high
frequency of gout among prominent people in England, but also gave a clear definition
gouty genius. The clue to the increased frequency of gout among geniuses
found in 1955 in another remarkable work of E. Oruan “The origin
human “, who showed that uric acid is structurally very similar to caffeine
and theobromine, known to stimulate mental activity. [5]

Relevance

Gout affects 1–2% of the population, mostly men.Overproduction of uric acid is caused by a genetically determined deficiency of hypoxanthine-guanine phosphoribosyltransferase. By the end of the 20th century, gout began to be considered as a disease of the accumulation of urate crystals in the structure of the joint, subcutaneous tissue and bones, kidneys in the form of urolithiasis or tubular nephropathy. Hyperuricemia is defined in all patients with gout, but the vast majority of people with hyperuricemia have never experienced an episode of acute arthritis. This means that the development of gout is due to pathophysiological features that determine the deposition of urate crystals in tissues, accompanied by inflammation and subsequent degenerative changes.

Hyperuricemia is a necessary, but insufficient antecedent for the development of urate microcrystalline disease. If early asymptomatic disorders of purine metabolism are potentially reversible, subject to timely diagnosis and correction, then at the stage of tofus gout with damage to blood vessels and target organs (heart, brain, kidneys), the prognosis of the disease is unfavorable. [2]

Complex spa treatment aimed primarily at eliminating hyperuricemia is a method of preventing the development and progression of gout in all its clinical manifestations.

Gout in literature

Here rhyme to me Vasily Lvovich *!
What can I tell you about him?
He is sitting with gout together;
But your reverend Turgenev –
His gout is the most vicious
Even more murderous a hundred times:
P.A. Vyazemsky
* [V.L. Pushkin, the poet’s uncle]

Clinical presentation and methods
treatment of gout has been described in detail in many eminent literary
works. “The poet Publius Porfiry Optatianus with sad thoughtfulness
looked at his legs, disfigured by gout, “wrote D.S. Merezhkovsky
the novel Death of the Gods. Julian the Apostate. Another one liked to complain about gout
the hero of this novel, the famous theurgist and sophist, Iamblik of Chalkis, Greek
the philosopher, whom everyone called the divine Yamblik.
Michel Montaigne believed that gout spares neither kings nor their subjects:
“At the first attack of gouty pains, no matter how
or majesty dressed in gold, does he not forget about his palaces and about
your greatness? ” However, in fairness, it should be noted that he did not consider gout as a disease at all,
since it is not fatal.Five centuries after M. Montaigne I.S. Turgenev described his
illness in a letter to L.N. Tolstoy:

“My disease … is not dangerous at all, though
rather painful; the main trouble is that, having a hard time giving in to drugs, she
can continue for a long time and deprives me of the ability to move. ”

Turgenev repeatedly
was treated on the waters in Baden-Baden. S. Maugham disagrees with their opinion, describing
Eliot’s urekimia in the novel “Razor’s Edge”, so the doctor considered his condition
severe because the kidneys are seriously affected and full recovery is impossible.That is why Eliot drank only Vichy, treating his friends with the best wines. Probably,
in this case, gouty nephropathy is described, which includes various
forms of kidney damage caused by impaired purine metabolism. Especially dangerous
tofus lesions of internal organs. So in the play “Uncle Vanya” by A.P. Chekhov
After an attack of gout, Serbryakov complains of difficulty breathing and notes:
“They say that Turgenev got angina pectoris from gout.”

Gout: A History of Spa Treatment

Since ancient times, healing waters have been used to treat gout.To the gouty geniuses of humanity
we owe a lot to the development of balneology. As Seneca wrote in his
Philosophical writings “in the water lies the hope of the future world, and useful
the properties of waters are no less varied than the taste. ” Baths built on healing
sources, served one purpose: to restore the health of the august persons. The main
the resort of ancient Rome was the hot sulfide Baisky springs near Naples,
where the procurator of Judea, Pontius Pilate, treated gout. Septimius Sever was treated for
gout and urolithiasis with radon waters of the Bulgarian resort of Hisar, and
Marcus Agrippa sulphide waters of the Acque Albule of the ancient city of Tivoli in
Italian province of Lazio.Michelangelo, suffering from gout and urolithiasis
disease, for many years he was treated with the waters of the Italian resort of Fiuggi.

Gout: Treatment in a Resort

The main goal of gout treatment is to reduce
the content of uric acid in the blood is a fundamental factor in the baseline
therapy of the disease and should be carried out for a long time (sometimes constantly).
Effects on hyperuricemia include decreased intake
purines by prescribing a special diet, using drugs that depress
synthesis of uric acid (uricodepressors), which increase the excretion of uric acid
compounds (uricosuric drugs) and providing their chemical decomposition
(urico-destroying agents).

The main method of spa therapy for gout is drinking treatment with alkaline mineral waters, predominantly hydrocarbonate or sulfate-hydrocarbonate composition.

Complex spa therapy in
the form of drinking cure, mud therapy and balneotherapy twice a year allows
achieve stable remission during gouty arthropathy and prevent
damage to internal organs. [8, 9]

Indications for spa treatment and the choice of a resort for gout:

* In endocrinology, a violation of purine metabolism without damage to the kidneys and joints is considered.

———–

E79.0 Hyperuricemia without signs of inflammatory arthritis and gouty nodes

M10 Gout

M10.0 Idiopathic gout

Idiopathic (primary gout), chronic gouty monopolyarthritis, oligopolyarthritis, without visceritis, mild and moderate course, not higher than I degree of activity of the inflammatory process, insufficiency of joint function not higher than II degree

————

When treating gout, spas with two therapeutic factors are preferable – with drinking water (treatment of disorders of uric acid metabolism) and mud or balneotherapy waters (treatment of gouty arthritis).

For gout, balneotherapy resorts are indicated:

With latent and urolithiasis types of kidney damage, drinking spas are indicated, and with proteinuric –
climatic.

Yalta (southern
Crimea coast), Yangan-Tau (Bashkiria), Tinaki (Astrakhan region).

Contraindications and restrictions to spa treatment for gout :

1. Chronic renal failure and poorly corrected arterial hypertension.
2. In case of kidney damage, resorts with sulphide waters are excluded.
3. With urolithiasis type of nephropathy
   patients should be sent to drinking spas without hindering the passage of urine from
   sides of calculi, as well as persons after lithotomy and lithotripsy.

Drinking cure for gout

Drinking regime, even in an out-of-resort setting, assumes at least 2-3 liters of fluid per day. An insufficient amount of fluid impairs kidney function and leads to an increase in the concentration of uric acid in the blood plasma.However, all norms must be individualized.

Low-mineralized alkaline mineral waters, mainly of hydrocarbonate or sulfate-hydrocarbonate composition, are used for drinking treatment. Hypotonic waters, taken internally, are rapidly absorbed, increase the volume of extracellular fluid,
mobilize metabolic processes and are quickly excreted from the body, providing a kind of “washing” of the intercellular space and urinary tract.

An increase in diuresis due to drinking treatment with mineral waters helps to reduce hyperurekimia, and alkalinization of urine increases
solubility of uric acid and thereby prevents the occurrence or progression of tophus lesions of target organs and gouty nephrolithiasis.

The effects of drinking cure for gout are due to the mineral composition of the waters, since many of the microelements act as catalysts for enzymatic reactions of important biochemical processes. [6, 9] action. The low content of minerals in radon waters used for drinking cure increases urine output and excretion of urates.Some authors explain this by an increase in the permeability of the basement membranes, as well as the transition
extracellular uric acid into a soluble state. [6]. In addition, radon has a normalizing effect on the basic (protein), carbohydrate, mineral, cholesterol and water metabolism in the body. When drinking radon water, an improvement in urinary exchange is observed
acid in patients with gout, which is associated with the normalization of liver function under the influence of radon procedures. [1]


HCO ₃ Hydrocarbonate ions alkalizing urine in mineral waters, help dissolve urates and remove them
with urine, dissolving mucus in the urinary tract, promote proliferation
inflammatory process.

SO ₄ Sulfur-containing sulfate and sulfide mineral waters H ₂ S have diuretic, anti-inflammatory, choleretic effects. Thiosulfates act as coenzymes for many biochemical processes. Sulphate and slobosulphide waters have a pronounced choleretic effect, by regulating the stool, they improve the elimination function, and contribute to the reduction of hyperurecemia.

Mg The magnesium ion in mineral waters is useful for patients with concomitant nephrolithiasis, which is present in about 25% of patients with gout.[4] Urinary stones most often have a urate nucleus with an oxalate membrane. Magnesium ions bind up to 40% of oxalic acid in urine, and their deficiency is manifested by the formation of calcium oxalate crystals. In addition, magnesium sulfates have antispasmodic and atispastic effects.

Ca Calcium ion in mineral waters for drinking treatment for gout increases the solubility of uric acid in the urine, which explains the effectiveness of treatment with calcium-containing waters for gout.In addition, Ca ions have a desensitizing and anti-inflammatory effect due to an astringent and thickening effect on the cell membrane. In combination with silicon, Ca has
antioxidant and membrane-protective effect. [7]

Si Silicon , which has the ability to restore the colloidal-crystalloid state of urine and has a membrane-protective effect. Drinking treatment with siliceous waters enhances the diuretic effect, reduces the degree of crystallization of mineral salts, and affects metabolic processes.The high silicon content in water enhances the solubility of oxalic acid crystals, preventing the growth of urate stones, which are usually coated with oxalates.

F Fluorine-containing waters for gout have a therapeutic effect due to the inhibitory effect of fluorine on the synthesis of uric acid.

Balneotherapy for gout

Balneotherapy for patients with gout is carried out in the interictal period. Balneotherapy improves microcirculation, improves blood supply and trophism of tissues and synovium of the affected joints.Under the influence of radon, iodine-bromide and sodium chloride baths, it significantly improves kidney function, increases the clearance of uric acid, increases urine output, which leads to an increase in the excretion of urate from the body. This, in turn, promotes the removal of uric acid salts from the synovial membranes and tissue depots. Under the influence of balneotherapy, inflammation in the joints decreases, the activity of lysosomal enzymes decreases, the functional capabilities of the liver and kidneys increase, and the indicators of purine and lipid metabolism improve.

Rn Radon stimulates the activity of tissue lipolytic enzymes, reduces the level of uric acid in the blood. In gouty atropathy, the leading role is assigned to the restoration of the adaptive-trophic function of the sympathetic-adrenal system, local mechanisms of regulation of cellular metabolism and microcirculation in the synovial membrane (transport of plastic and energy substances, hormones, electrolytes, activation of enzymes, increased evacuation of metabolites). Essential in the mechanism of the therapeutic and physiological action of radon baths is their effect on the terminal link of blood circulation – microcirculation in the skin.Radon baths improve the hemodynamics of the kidneys and liver, normalize the metabolism of uric acid, improve liver function, have a beneficial effect on lipid metabolism, have an anti-inflammatory effect, have a hypotensive effect, stimulate the glucocorticoid function of the adrenal glands, improve the urodynamics of the lower urinary tract, and have a uricosuric effect. The main sanogenetic effects of radon therapy for atropathy: desensitizing, anti-inflammatory, trophic, analgesic, restoring the impaired functions of the joints, preventing the progression of the process determine its effectiveness when used in the form of baths, including “dry” air-radon – Reabox-VRV.[1, 8]

H ₂ S Sulphide or hydrogen sulphide baths. The specific effect of sulphide baths is due to hydrogen sulphide entering,
mainly through the skin. Hydrogen sulfide has a positive effect on the liver, which affects the state of purine and other types of metabolism. In addition, sulfide (hydrogen sulfide) baths enhance microcirculation, trophic processes in the tissues of the joints, improve cartilage nutrition, reduce the level of uric acid in the blood, and have a uricosuric effect. Contraindications to hydrogen sulfide baths are: acute gout attack and phase of incomplete remission, renal and liver dysfunction, chronic hepatitis, cholelithiasis and urolithiasis.


CO ₂ Carbon dioxide baths are indicated for patients with concomitant diseases: ischemic heart disease, hypertension, lipid metabolism disorders. Nonspecific reactions of the body to carbon dioxide baths are generally similar to those on
hydrogen sulfide, but their specific action is different.So, if hydrogen sulfide baths mainly affect the course of metabolic processes, increasing their recovery phases, then carbonic acid stimulates the cardiac mechanisms of self-healing and compensation through vegetative devices regulating the activity of the heart and the state of the vascular system, contributing to the improvement of the function of redox systems due to the utilization of oxygen.


Cl Na Sodium chloride baths have a tonic and regulating effect on the central nervous system, improve renal blood flow, acting on the body more gently than other mineral baths.

I Br Iodine-bromine baths have a vasodilating, diuretic and hypotensive effect, have a sedative effect. Trace elements iodine and bromine, forming a depot in the skin, partially penetrate into the humoral environment of the body. As part of various enzyme systems, they
affect metabolic processes, improve kidney function, increase urate excretion, reduce blood urate levels, and normalize lipid metabolism. The effect of iodine-bromine baths on the kidneys and urinary tract is due to the improvement of renal blood flow, the functional state of the kidneys, and the normalization of metabolic processes in the kidneys.The anti-inflammatory, antitoxic, bactericidal effect of iodine-bromine baths allows them to be used by patients with gout with the presence of fistulas in tophuses, contributing to their rapid cleansing and scarring. Iodine-bromine baths are well tolerated by patients. They are indicated for the combination of gout with hypertension of the 1st-2nd stage, obesity, urolithiasis, coronary artery disease not higher than FC II without disturbance of the heart rhythm. [3, 8]


Hydrotherapy in the complex spa treatment of patients with gout has a therapeutic effect due to a combination of thermal, chemical and mechanical irritations.Healing showers are widely used: jet, rain, Charcot’s shower, underwater massage shower; baths (shared, two-, four-chamber). As a result of the action of hydrotherapy, blood and lymph circulation, tissue trophism improve, muscle tone decreases, pain decreases, and the range of motion with joints increases. Under the influence of thermal irritation in the body, metabolic processes are enhanced, the rate of biochemical reactions, and microcirculation increase. In addition, when various decoctions of herbs or active substances are added to fresh baths, an additional desired effect is obtained, which helps to improve movement in the joints and reduce pain due to the active substance.[9]

In case of gout in complex spa treatment, various methods of massage, exercise therapy, apparatus physiotherapy, and extracorporeal methods of treatment are widely used.

Diet therapy for gout in the sanatorium

An indispensable component of gout treatment in a resort is the organization of proper nutrition. Despite the fact that the diet, as part of complex therapy, has been known for a long time, many patients neglect it or use it incorrectly in practice. The heroes of O’Henry’s novel “Soulmates” believed that joint pain “only one thing in the world helps.A kind, old, intoxicating, heart-rejoicing drink. ” They were wrong.

The effect of alcohol on gout: Scientists from Boston University (USA) examined 179 patients who had at least one gout attack per year. [9] Even small to moderate doses of alcohol can exacerbate gout because alcohol reduces the excretion of uric acid by the kidneys.

The gout diet involves limiting foods that contain high amounts of purines. These include liver, kidneys, brains, meat, mushrooms, broths, jellies, sausages, ham, fish, beans, beans, lentils, cocoa, strong tea and coffee, and chocolate.Uriconormalizing action (mainly uricosuric) is possessed by grapes, lingonberries and eggplants.

In case of concomitant arterial hypertension, the use of sodium chloride and liquids should be limited, and in cases of decreased kidney function – protein products.

Overweight, as well as exhausting diets lead to an increase in the concentration of uric acid in the blood.[3, 9]

Treatment of gout, like other diseases of the endocrine system and metabolic disorders, largely depends on the active position of the patient. Translated from Latin “ Patiens ” – patient. Compliance with the doctor’s recommendations, changes in eating behavior, an active lifestyle are the main factors in gout, which determines the way of life.

The combination of medication, diet therapy and spa treatment allows achieving good results in more than 2/3 of patients with gout.Gout is one of those “gratifying diseases”, early recognition of which, and the correct therapeutic tactics help to maintain the health and ability of patients to work for many years.

Resorts for gout patients

The well-known resorts indicated for gout with various types of medicinal natural factors are given.

Resorts with drinking waters of low mineralization

The resort of Truskavets, Ukraine is known for Naftusa – low-mineralized (M 0.63-0.85 g / l) hydrocarbonate magnesium-calcium water, the healing properties of which are associated with the presence of organic substances of petroleum origin in it.


Fiuggi Resort, Italy. The mineral waters of the two Fiuggi springs contain organic substances belonging to the family of fulvic and humic acids, and are characterized by low mineralization – 0.133 g / l. [4]

Chianciano Terme resort, Italy. Waters of the spring of St. Helena Chianciano Terme, Italy: low-mineralized (0.49 g / l) hydrocarbonate-sulphate sodium-calcium is used for drinking treatment for gout. The waters of the other three springs are indicated for drinking cure for diseases of the liver and biliary tract and for balneotherapy.The Chianciano Terme resort is indicated for patients with concomitant pathology: gout and diseases of the digestive system. [4]

Resort Slanic Moldova, Romania. The spring “300 steps” is distinguished by low mineralization – 0.197 g / l. It has long been used as a drinking cure for kidney disease and gout. The waters of the 20 springs of the resort are used “for all diseases of the digestive tract.” In addition, the resort has mofettas (a natural release of carbon dioxide), which are considered one of the effective treatments for diseases of the cardiovascular system.The largest speleotherapy hospital in Europe is located in the salt grottoes of Targu Okna. Treatment at the Slanic Moldova resort should be recommended to patients with concomitant pathologies: gout and concomitant diseases of the circulatory system, digestive system, respiratory system (especially speleotherapy is indicated for patients with bronchial asthma). [3]

Radon spas for balneotherapy for gout

In the resort of Teplice, Czech Republic, patients with gout have been treated since the 18th century. The main natural factors of the resort: radon thermal fluorine-containing hydrocarbonate-sulphate sodium-calcium waters of mineral springs, peat mud.[4]

In Baden-Baden, Germany thermal (up to 68.8 ° C) radon (35.7-44.7 nK / L) waters are used for balneotherapy, and bicarbonate-sulphate sodium-calcium waters are used for drinking treatment. magnesium waters.

Sulfur spas for balneotherapy for gout

In Baden near Vienna, Austria Peter I was treated, who, as you know, suffered from urolithiasis, and, according to many historians, the “rheumatism” of the emperor was most likely due to tophus lesions of the joints – gout.Low-mineralized (up to 2 g / l) sulfur-containing waters from 14 springs are used for balneological procedures and swimming in pools.

Spa Baden, Switzerland. Thermal mineral waters (46.5 ° C) sulphate-chloride sodium-calcium are used for balneological procedures and swimming in the pool. Spa treatment was described by G. Hesse in the novel “The Spa Man”.

Spas with several types of water: for drinking cures and balneotherapy for gout

The Siberian resort of Belokurikha is famous for the sources of radon nitrogen siliceous springs (42 ° C).Low-mineralized sulfate-chloride magnesium-calcium-sodium waters – “Belokurikhinskaya east” are used for drinking treatment. [2, 4]


In Pyatigorsk radon waters of the Goryachaya mountain springs are used for balneological procedures (from 5 to 274 nCi / l). Sulfurous waters are characterized by high temperatures (42-47 ° C), relatively low salinity (5 g / l), therapeutically active concentration of hydrogen sulfide (10 mg / l) and silicon (50 mg / l). These waters are mainly used for balneological procedures (Pirogovsky, Lermontovsky, Pushkin, Ermolovsky and Narodny baths), and some of them are taken out into the drinking pump rooms of the Academic and Drinking galleries.Pyatigorsk narzans are also used for drinking treatment (Cold and Warm narzans, Krasnoarmeiskie springs). [2, 4]

Vichy resort, France (from lat. Vicus calidus , literally – a warm village). Mineral waters from 15 Vichy springs are subthermal and thermal (17-66 ° C) – sodium bicarbonate-sulphate carbonic waters (M – 3.3-8.9 g / l) are used for drinking cures, baths, inhalations, balneological procedures, including the famous shower Vichy and four-handed Vichy massage under shower jets.[4]

Noboribetsu Onsen Resort, Hokkaido, Japan : According to Japanese balneologists, 3 of 11 springs are effective in treating gout patients. Sodium sulfate: improve the elimination function of the intestines. The sulphate calcium spring, Sekkoh-sen, is called the hot spring of gout, Tsufu no Yu. These waters have analgesic and antispasmodic effects. In addition, calcium ions increase the solubility of uric acid in urine. Radon waters of other sources of the resort, increasing diuresis, help to reduce hyperurekimia.

References
1. Gusarov I.I. Radon therapy. – M.: Medicine, 2000 .– 200 p.
2. Manshina N.V. Spa treatment for everyone. For health at the resort. : M, Veche, 2007, p. 596
3. Manshina N. V., Nizovskiy A. Yu. Romania; Travel for health. Historical guide. – M.: Veche, 2005, 272 p.
4. Manshina N.V. A guide to the resorts of the world. 200 European resorts. Issue 1, Second edition revised and enlarged – M.: Medsi, 2004. – 286 p.
5. Nasonova V.A., Barskova V.G. Gout at the end of the 20th century. // Consilium medicum. – 2002, No. 8, volume 4
6. A. N. Okorokov. Treatment of diseases of internal organs. Volume 2. – M.: Medical literature, 2003. – 608 p.
7. Emmerson B.T. Urinary stones. / Whitworth J. A., Lawrence J. R. Guide to Nephrology under the editorship of, translated from English / – M.: “Medicine”, 2000. – 290 p.
8. Efroimson V.P. Prerequisites for genius. // Man, No. 2-6, 1997, No. 1, 1998. 9.
9. Albertini, M.C., Dachà, M., Teodori, L.and Conti, M.E. Drinking mineral waters: biochemical effects and health implication – the state-of-the-art // Int. J. Environmental Health. – 2007. – Vol. 1, No. 1.pp. 153-169.
10. Fabiani D., Partsch G., Casale R., Cerinic M. M / Rheumatologic aspects of mineral water. // Clinics in Dermatology. –1996. – Vol. 14 (6) .- pp. 571-575
11. Messina B., Tirri G., Fraioli A., Grassi M., Bernardi di Valserra M. De. Medicina Termale e Termalism. Genova. : Caleidoscopio. – 1999; 132.– p.80
12.Petraccia L., Fraioli A., Liberati G., Lopalco M., Grassi M. Gout and related morbid conditions: pharmacological and SPA therapy. // Minerva Med. – 2008. – Apr; 99 (2). – pp. 203-212

© Nadezhda Manshina 2008—2015
Manshina, N.V. Gout. Sanatorium treatment at the resorts of the world //
Medical Council, Scientific and practical journal for doctors. No. 7-8, 2008

Author’s edition, with corrections, additions, 2015

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