GOUT

DESCRIPTION

Gout, a common joint disorder, is one of the most controllable metabolic disorders. Gout occurs when uric acid such as monosodium urate accumulates in the blood. This accumulation is due to the inability of kidneys to process this normal waste product. The dysfunction may be due to excess uric acid in the blood, a disorder of purine metabolism, or decreased kidney efficiency. In either case, uric acid crystals form and then accumulate in body areas where blood flow is too slow or sluggish to remove the crystals. The knuckles, elbows, knees and toes are common places of accumulation. If found between the joints, the surrounding tissue becomes inflamed. Nerve endings then become irritated and this causes extreme pain. There may only be one attack, or several. If the crystals lodge in the kidneys themselves, they can cause partial or complete kidney damage. Furthermore, gout can be a symptom of a more serious underlying disorder.

Males contract the disorder after puberty, females after menopause. It is at these times that uric acid levels increase. If not treated, gout may cause joint deformity. Death may occur from kidney disease, hypertension, coronary artery disease, or stroke. Treatments include a change in dietary habits, decrease in ethyl alcohol consumption, and use of diuretics and antibiotics. Aspirin should not be taken since, like alcohol, it inhibits uric acid secretion.

CAUSES

Primary Factor Gout is primarily due to more serum uric acid than the kidney can process, such that elevated levels cause crystals to form.

Predisposing Factors

SIGNS AND SYMPTOMS

DIETARY CONSIDERATIONS

Most cases of gout are managed by drugs alone. However, an individual may be advised to follow a Low Purine Diet to eliminate any needless increase in uric acid levels, and to increase the efficacy of antigout medication. Uric acid is the end product of purine metabolism. The increased uric acid levels found in gout are caused by increased ingestion of purines, or the kidney’s inability to excrete the metabolic waste product. Sodium urates then collect in the joints and tissue, creating inflammation and inducing great pain which resemble that of arthritis. The Low Purine Diet is designed to restrict the intake of purine-rich foods, thereby decreasing uric acid levels and joint inflammation.

Foods to be restricted in a Low Purine Diet:

Care should be taken to include one serving per day in the following category:

• Meat
• Fish
• Milk
• Cheese
• Eggs
• Poultry

Otherwise the diet will be deficient in iron, niacin, and thiamine. The individual is encourage to drink plenty of fluids to help the kidney flush uric acid from the body. The person would benefit by incorporating elements of the Alkaline Ash Diet into the Low Purine Diet.

The Alkaline Ash Diet, composed primarily of fruits and vegetables, increases the alkalinity of the urine. Cranberries, plums, prunes, and corn are excluded from this recommendation because they are acid-forming. Milk and milk products, olives, molasses, chestnuts, almonds and coconuts are all considered alkaline-forming foods.

The serum levels of vitamin B-12, fat, carotene, sodium, potassium, lactose, nitrogen, and cholesterol should be monitored periodically. Supplements should be prescribed if deficiencies arise. In general, antigout drugs decrease the absorption of fat-soluble vitamins; therefore, supplements should be prescribed for the user.

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