In the news:Strategies to Prevent & Fight Gout

Making Gout-Fighting Lifestyle Changes

The last issue of Staying Healthy focused on diet and recurring kidney stones, the hard deposits made up of tiny crystals in the kidney or urinary tract. Sharp crystals that form from excessive amounts of uric acid and are deposited in the joints can cause another problem: gout.

Gout is a health problem on the rise. A study published in 2018 reports that the incidence of gout has more than doubled over the past 20 years in tandem with an upswing in obesity rates.

Gout, which is a form of inflammatory arthritis, usually starts in the big toe but can affect other joints as well, causing pain and swelling. Considered a “lifestyle disease”, there are changes in daily habits that can help minimize the frequency of flare-ups or ‘gout attacks’ for those with this condition or reduce the risk of getting gout in the first place.

Weight control is very important as excess weight can increase blood levels of uric acid and put more stress on joints. Recent findings also show that exercise may decrease pain and inflammation in gout patients.

Drinking lots of water is a must since that helps the kidneys clear uric acid, and dietary changes are in order too.

Since uric acid is a by-product of the body’s metabolism of purines naturally present in the diet, some gout suffers often must limit high purine-containing foods and beverages. These include alcohol, red meat, shellfish, gravy, drinks and foods high in fructose, and animal-source protein.

Role for Vitamin C in Gout Prevention?

There are effective treatments for gout – the drug colchicine, for example, which is used to help prevent gout attacks and treat pain during flare-ups. However, the drugs are not without the risk of side effects, and people often forgot to take medications when they’re using them regularly to prevent gout episodes. That’s why lifestyle changes like weight control and diet are so relevant to prevention and reducing gout episodes.

The results of a recent Harvard study(1) suggest that vitamin C may reduce the chances of developing gout. Since some short-term intervention trials have reported that 500 mg/d vitamin C reduces blood levels of uric acid, the researchers analyzed data from over 14,000 male participants in a large, 10-year trial that examined the effects of vitamin C in heart disease.

The researchers found that those taking vitamin C lowered their risk of getting gout. And men who weren’t overweight had the most risk reduction. While vitamin C did result in fewer new cases of gout, it did not show a reduction in gout flare-ups for participants who already had a diagnosis of gout.

Other studies have shown that vitamin C reduced uric acid levels in gout-free individuals and broke down urate crystals in blood. Emerging work also suggests that vitamin C lessens inflammation and pain caused by the immune system’s response as it tries to break down urate crystals.

What About a Vegetarian Diet?

Although some vegetables are rich in purines, researchers analyzing two large studies report that a vegetarian diet is associated with lower uric acid and lower risk of gout(2). So, going vegetarian – or at least adopting a plant-based diet – could be another strategy for staving off gout. Some even speculate that the vitamin C in fruits and veggies may reduce the effect of purines on forming uric acid.

If you have gout and are thinking about making dietary changes, it’s always a good idea to let your doctor know. Also, note that some prescription drugs can elevate blood uric acid either by decreasing uric acid secretion or by reabsorbing uric acid. Most notable are the diuretics.

References

1. Juraschek SP, et al. Effects of vitamin C supple-mentation on gout risk: results from the Physicians' Health Study II trial. Am J Clin Nutr.116:812-819, 2022.
2. Chiu T, et al. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clin Nutr. 39:837-44, 2020