The pain in his right ankle was so intense, he couldn’t rest his foot on the floor. Yet there was no swelling or inflammation. This is what Alex Anthony, 56, a retired naval captain and a maritime lawyer in Kochi, recalls vividly about his first attack of gout 11 years ago. “It felt like thousands of needles were piercing my ankle,” he says. When Ayurvedic massage offered no relief, he decided to consult a rheumatologist, who ordered an X-ray and a blood test.
“At first, we thought it was a particularly painful sprain,” he says. “However, the X-ray showed no signs of injury or trauma. A blood test revealed high levels of uric acid which led to a condition called gout.”
“Gout is an inflammatory form of arthritis,” says Shrikant Yeshwant Wagh, consultant rheumatologist at Apollo Jehangir Hospital, Pune, and founder-president of Know Your Arthritis, a charitable trust that works to raise awareness about arthritic ailments. “The condition arises because of the build-up of uric acid crystals—an excess of which is called hyperuricemia—in the blood. It is possible to have elevated levels of uric acid (higher than 6mg/dl, which is the norm) without developing gout, but when this excessive uric acid is deposited in a single joint, it results in gout pain.” Uric acid is a waste product that should be excreted by the kidneys. If it isn’t, it can lead to a build-up in the bloodstream.
“And though it can affect any joint, the common sites where excess uric acid is deposited are the big toe, the finger joints, the ankles or the knees—the result is intense and chronic pain,” says Dr Wagh.
Affecting younger people
According to a study published in 2015, in the medical journal Nature Reviews Rheumatology, the incidence of gout has been increasing worldwide over the past 50 years. In India, the disease is affecting a growing number of younger people too. “In some cases, gout is genetic, but a diet high in protein, frequent abuse of alcohol and a high intake of fast foods can increase your uric acid levels and put you at greater risk of developing it, especially if you’re already predisposed to it,” says J.V. Srinivas, director of orthopaedics, Fortis Hospital, Bengaluru. “We are seeing a lot of cases of people in their early 30s and 40s, though it can affect anyone at any age.”
As in Anthony’s case, the pain occurs without warning and keeps escalating. During an attack, your physician will prescribe painkillers and, depending on the intensity, even steroids that offer some measure of relief. Prevention, however, is most essential.
Since uric acid is a waste product formed when the body breaks down purines—a type of protein that is found in many foods and even occurs naturally in our cells—changing dietary habits has long been linked to the treatment of gout.
“Dietary restrictions depend on how high your uric acid levels are and the frequency and intensity of your attacks,” says Saman Zaman, nutritionist at Philips Healthcare, New Delhi. “For non-vegetarians with chronically high levels of uric acid, it is best to avoid red meat, and consuming meat from organs such as brain, liver and kidney,” she says. “If your attacks aren’t as frequent, you can have limited intake of meats such as lamb, fish (tuna, salmon, trout) and poultry as these have moderate levels of purine. Portion sizes shouldn’t exceed 100-150g daily,” she says. “Chronic gout sufferers who are vegetarians may have been asked to avoid certain pulses and legumes such as beans, chickpeas and rajma, but recent studies show that moderate intake of purine-rich vegetables like these don’t aggravate symptoms of gout. A balanced diet that includes fruits, vegetables and dairy is recommended.”
In a study published in November in the Journal Arthritis & Rheumatology, it was established that the DASH (Dietary Approaches to Stop Hypertension) diet, originally formulated to help patients with high blood pressure, could also greatly help in controlling gout attacks.
“The DASH diet is a simple plant-rich diet. It’s high in fibre, low in sodium and red meat. Salt is restricted to around 1,500mg per day (2-3 tsp). It requires you to eat a lot of vegetables, fruits and whole- grain foods which increase your fibre intake. You can include fish and poultry and nuts, but must eliminate red meat. It also requires you to cut the simple carbs like sugars, sugary drinks, canned and tinned foods, Indian sweets, and junk food that contain trans fats and cholesterol,” says Payal Banka, a dietitian based in Bengaluru.
Associated health risks
A study of 409 obese patients, published in the June 2012 journal of Obesity Surgery, found that 47% of them had hypertension or high blood pressure. The group that had hypertension was more likely to develop hyperuricemia as well. Researchers found that though abdominal fat doesn’t directly cause the condition, gout patients had a propensity to become obese and develop diabetes.
Controlling gout, then, is essential to good health. Frequent monitoring is required, says Dr Wagh. “Keeping uric acid levels below 6 is critical to prevent the occurrence of other health issues,” he says. People who suffer from gout do have a tendency to develop kidney stones too, another excruciatingly painful condition to deal with. “Drink plenty of water to excrete the excess uric acid so that kidney stones don’t form and keep a strict eye on your blood sugar levels,” says Dr Wagh. “Ideally, patients should take a blood test once every month (for four-six months) to constantly monitor their uric acid levels.”
Understanding your body and its needs is critical in living and coping with gout and staying free of pain.