SCRIPT NUMBER 70
GOUT
(TWO SPEAKERS)
PROGRAM NAME: HEALTH NUGGETS
PROGRAM TITLE:
GOUT
PROGRAM NUMBER: 70
SUBJECT: CAUSES, RISK FACTORS, PREVENTION OF GOUT ATTACKS
KEY WORDS: URIC ACID, KIDNEY STONES, TOFU, HIGH FRUCTOSE CORN
SYRUP, ALTERNATIVE THERAPY
DATE OF SCRIPT:
JULY 27, 2012
AUTHOR: RICHARD YUKL, MD, FACS
SPEAKER 1:
Gout is a significant form of arthritis, accounting for
approximately 5% of all arthritis cases. It is characterized by sudden, severe
attacks of pain, redness and swelling in your joints, particularly the large joints of
your big toes. It can also occur in the joints of your ankles, knees, hands or
wrists.
SPEAKER 2:
Attacks are always sudden, occurring without warning, often
in the middle of the night. An acute attack of gout can awaken you with the
sensation that your big toe is on fire. The affected joint is hot, swollen and so
tender that even the weight of the sheet on it can seem intolerable. The pain is
likely to be most severe in the first 12 to 24 hours after it begins, but lingering
discomfort lasting from a few days to a few weeks may continue after the most
severe pain subsides, and the affected joints will remain swollen, tender and red.
SPEAKER 1:
What is the underlying cause of gout?
SPEAKER 2:
Your liver produces uric acid when it breaks down certain of
the foods you have eaten, foods such as red meat, especially liver, sea food
such as anchovies or herring, and other foods such as asparagus, mushrooms
and red wine. Normally, this uric acid dissolves in your blood and passes through
your kidneys into your urine. If, however, your body produces too much uric acid
or your kidneys are unable to filter it fast enough, the uric acid levels in your
blood build up, forming crystals. Gout is caused by the buildup of uric acid
crystals in your joints. These crystals are sharp and needle-like. They settle in
your joints or surrounding tissues, and there they cause the pain, inflammation,
stiffness and swelling.
SPEAKER 1:
Are there causes for gout attacks other than my diet?
SPEAKER 2:
What you eat is the most important factor relating to gout
attacks. Factors that will increase your uric acid level other than diet include
lifestyle factors such as drinking excessive alcohol. More than two drinks a day
for men and more than one a day for a woman, has been shown to increase the
risk of gout attacks. Also, some diseases and conditions increase your risk.
These include untreated high blood pressure, high fat and cholesterol levels in
your blood, arteries narrowed by cholesterol plaque, and chronic conditions such
as diabetes.
SPEAKER 1:
I hear gout runs in families, and that attacks occur only in
men.
SPEAKER 2:
If other members of your family have had gout attacks, you
are at an increased risk as well. A genetic abnormality causes the liver of people
in some families to overproduce uric acid. Female hormones protect women
against suffering gout attacks because they help to filter uric acid from the blood
into the urine. As women age, however, their levels of female hormones
decrease with menopause, and they become increasingly susceptible to attacks.
SPEAKER 1:
What are complications that can occur if I have gout?
SPEAKER 2:
People with gout are prone to have multiple attacks. Without
proper treatment, uric acid crystals will eventually form under the skin where they
will become swollen and tender during gout attacks. Collections of these crystals
can also accumulate in your kidneys and urinary tract, causing kidney stones.
SPEAKER 1:
What should I do if I awaken with an acute gout attack?
SPEAKER 2:
Your doctor will prescribe certain powerful medicines to
decrease the inflammation and pain, medicines that block the production of uric
acid by your liver, and other medicines to improve your kidney’s ability to filter
uric acid from your blood.
SPEAKER 1:
What should I do for myself during a gout attack?
SPEAKER 2:
The American Dietetic Association has guidelines that you
can follow at home during an acute gout attack. Drink 8 to 16 cups of fluid a day.
That is 2 to 4 liters of fluids every day, with at least half of that volume being
water. Avoid drinking alcohol. Decrease the amount of protein you eat, and make
that protein come from healthy sources such as low-fat or fat-free milk products,
tofu, and nut butters. Finally, limit your daily intake of meat, fish and chicken to 4
to 6 ounces, or 113 to 170 grams, per day. Eggs, by themselves, do not increase
your risk of a gout attack.
SPEAKER 1:
Are there any diet and lifestyle changes that will protect me
from suffering future gout attacks?
SPEAKER 2:
During symptom-free periods, there are some guidelines that
may help protect you from suffering future acute attacks. First, keep your fluid
intake high. Aim for 8 to 16 cups, or about 2 to 4 liters, of fluid each day, with at
least half that volume being water. Limit how many sweetened beverages you
drink, especially those drinks sweetened with high fructose corn syrup. Next, limit
or avoid drinking alcohol. Recent evidence suggests that beer in particular
increases your risk of a gout attack, especially in men. Importantly, eat a
balanced diet. Your daily diet should emphasize fruits, vegetables, whole grains,
and fat-free or low-fat milk products. Eating meat, fish and chicken is associated
with increasing the likelihood of developing an acute gout attack, so limit your
use of these foods. Eating cherries and other dark-colored fruits, such as
blackberries, blueberries, purple grapes and raspberries lower of uric acid levels
in studies, and they may be helpful. Finally, maintain a desirable body weight.
Losing weight to a normal level will decrease uric acid levels in your body. If you
diet to lose weight, however, avoid fasting or overly rapid weight loss, since such
extreme changes can temporarily raise your uric acid level and therefore your
risk of suffering an acute attack.
SPEAKER 1:
Health Nuggets is written by Dr. Richard Yukl, a medical
doctor working in the United States. The medical views expressed in this
program are his and may differ for your particular health needs. If you need
medical advice, please consult a medical professional in your area.