You wake up during the night to a throbbing, swollen, and red big toe. After you rip the sheets off to see what is causing the pain, you see that there is nothing. However, the pain is so severe that you cannot fall back to sleep and just the sheet touching the toe is causing excruciating pain. Pain is an 11 out of 10…This is a classic scenario of someone who is suffering from a gout attack.
To begin with, there is a biochemical component to understanding how and why purines and uric acid may lead to gout. Purines are a component of the body’s cell structure and are in most foods. So, when cells die and food is metabolized, purines will be broken down and uric acid will be produced. This is a very normal process; however, if the uric acid is not excreted from the body, a buildup and accumulation can occur, which may result in problems such as gout.
Gout is a type of arthritis that usually only affects one joint at a time; the most common site is the big toe joint, and the other is the ankle. Gout symptoms are caused by inflammation due to the uric acid crystal accumulation within the joint of the big toe. The pain will hit very suddenly due to the immune system trying to dispose of the uric acid crystals and in the process of doing so the toe will become hot, painful, swollen, and red. The pain can be so severe that even a bed sheet touching the toe will be unbearable. Paradoxically, some patients who are found to have high levels of uric acid floating in the blood will not have any symptoms of gout. However, those who have normal levels of uric acid may experience gout. Additionally, during the time when gout symptoms are attacking, the uric acid level in the blood may actually be very low! These relationships between uric acid crystal accumulation and presence or absence of gout have yet to be understood.
Unfortunately, 8.3 million people in the United States are plagued with gout and this number keeps growing. However, not all of the population is at an equal risk for gout. Men are nine times more likely to experience gout than women. The average age of men for the onset of gout is 75 years old. If gout does affect women it will most likely be noticed after menopause. Some other additional risk factors that may lead to uric acid accumulation are:
- Alcohol intake
- High blood pressure
- Medications-example: aspirin
- Diseases-examples: leukemia, lymphoma, and kidney disease/failure
Attacks of gout may be able to be diminished by losing weight and starting a diet that is low in purines. Foods that are low in purines are:
- Whole grains
- Low fat dairy products
- Drink water (8-16 ounce glasses per day) to help flush uric acid out of the body
Foods high in purines that must be avoided are:
- Candy and other sugary foods
- Red meat
Diet alone may not stop gout from attacking, so a medication may help to regulate uric acid levels for long-term relief. During an acute attack, non-steroidal anti-inflammatories, steroids, and pain medication may be needed to get through this period.