Expert tips for life with gout

Gout is a metabolic disease caused by increased levels of uric acid (hyperuricaemia) in the blood. Since an unhealthy lifestyle with improper diet and excessive alcohol intake contributes to an elevated uric acid level, gout is considered a disease of affluence. If the disease remains untreated for a long time, the deposition of uric acid crystals can lead to joint deformities, permanent joint damage, kidney stones and inflammation of the kidneys. Nevertheless, gout can be treated well by medication and a corresponding change in lifestyle habits.

Avoid a gout attack

A strict avoidance of triggers for a gout attack, however, is usually associated with significant restrictions for those affected. In our expert interview, Dr. med. Andreas Niedenthal, internist and gastroenterologist in the gastrointestinal center in Darmstadt, how gout patients can get their illness under control, without sacrificing quality of life.

What impact does lifestyle have on uric acid levels?

Niedenthal: Uric acid is the end product that results from the breakdown of purines. Purines are building blocks of DNA and occur in human, animal and plant cells. Thus, a purine-rich diet increases uric acid levels. Normally uric acid is excreted via the kidney, but this is not unlimited: if the amount of uric acid exceeds a certain maximum, the excretory function of the kidney is no longer sufficient and the concentration of uric acid in the blood increases.

The risk of a gout attack increases with increasing uric acid levels. Once the disease has come to an outbreak, a consistent dietary change must take place. As a rule, a treatment with medication is necessary.

What should dieters be aware of?

Niedenthal: For gout patients, it is very important to eat purinarm. In the case of foodstuffs, there are considerable differences in terms of purine content. For example, offal and red meat, but also lentils, contain a particularly large number of purines. Ideally, gout patients get a table with the purine content of various foods to look up.

It is also important in gout to support the excretory function of the kidney. It is enough to drink between 1.5 and 2 liters daily. Larger amounts of drink have no additional positive benefit. For patients with heart failure, it can even be dangerous to take in too much fluid. Recommended drinks are water and fruit or herbal tea. In moderation, however, there is nothing wrong with coffee, cocoa and black tea.

Do gout patients have to do without alcoholic beverages?

Niedenthal: Alcohol should be consumed with care. Because the decomposition of alcohol produces lactate, which inhibits the excretion of uric acid and can trigger a gout attack. Beer is especially unsuitable for gout patients because yeast contains purines.

Despite all prohibitions: Are there also alcoholic drinks and meats that are allowed from time to time?

Niedenthal: Unlike beer, a glass of wine is harmless during the day. Certain types of fish or meat, such as poultry, also contain fewer purines than others and can therefore be consumed in moderation.

What happens when a patient hits the strings?

Niedenthal: A "sin" is not necessarily followed by a gout attack, but the risk increases. Because when the uric acid concentration exceeds a certain limit, the uric acid normally dissolved in the blood drops out and causes an inflammatory reaction in the joints. Typically, the metatarsophalangeal joint of the big toe is affected first.

If patients have "sinned", they should by no means try to compensate for the overconsumption of purine-containing foods by taking an increased dose of gout medication. Because overdose of drugs threaten dangerous side effects.

What role does overweight play?

Niedenthal: In contrast to other affluent diseases, overweight in gout only plays an indirect role. Because obese people often feed on purine, the disease can sometimes lead to an earlier or stronger outbreak. Achieving normal weight is therefore not a primary goal for gouty patients.

Fasting diets and radical diets are much more critical than being overweight, because with rapid weight loss, purine is increasingly produced by protein breakdown. In addition, metabolic products that inhibit uric acid excretion in the kidney arise. If sufferers want to reduce their weight, so they should pay particular attention to a slow weight loss in the context of a balanced, purinarmen diet.

Is sport recommended? What should stakeholders be aware of?

Niedenthal: Sport has no direct influence on the uric acid level, but exercise generally has a positive effect on the metabolism and is therefore recommended for gout patients.

In principle, those affected can do all sports, particularly suitable joint-preserving endurance sports such as cycling or swimming. In an acute attack, however, patients should refrain from sports.

What else do you recommend to your patients to get the disease under control?

Niedenthal: If the disease has come to an outbreak, a lifelong treatment and a regular check of the uric acid level are absolutely necessary. It is important to me that patients consistently change their diet and do not understand the medication as a license to dine.

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