Giving Gout the Boot
Acorn - January
2008
By: Michael Zapf, DPM, MPH,
FACFAS
David was a 32 year old teacher who came to the office with
a sudden onset of an excruciatingly painful right foot without any history of
trauma. He pointed to the big toe joint and thought he had a bunion like his
wife’s. The good news, I told him, it was not a bunion; the bad news was he had
gout. He was one of 2 million Americans with the somewhat inherited disease that
is definitely modified by lifestyle..
Gout is getting more common in my practice. It is
associated with obesity, diabetes, high blood pressure and a protein rich diet.
David was guilty on all counts. When proteins that contain purines are broken
down, uric acid is produced. Gout is caused when high blood levels of uric acid
form crystals in the cooler joints, like those in the feet. The body fights the
crystals and mounts a large immune response resulting in a red, hot and swollen
joint. Surprisingly treating this joint with an ice bag only makes the situation
worse by causing more crystals to form.
Uric acid is easy to measure with a blood test. Low uric
acid levels of 4 or 5 mg/dl will not cause gout but David had a level of 8mg/dl.
That high level combined with his near miraculous 1-day response to treatment
with an anti-inflammatory pill, confirmed for me that he had gout. Once the
attack was over I sent him back to his primary care doctor to get his uric acid
levels to a lower level. There are some medicines, like allpurinol, that do this
very effectively with minimal side effects.
When he asked me what he could do to prevent future
attacks, besides taking medication, here is the game plan I gave him based on
the most recent research by Dr. Choi of Harvard Medical School:
 | Daily exercise and weight control |
| Keep diabetes and high blood pressure, if present, well
controlled |
| Avoid red meat and lean towards chicken and other white
meat. |
| Avoid bread, potatoes and pasta unless they are made of
whole wheat |
| Milk, especially low-fat, reduces the risk and two
glasses or more a day are recommended. |
| Coffee and tea have no effect on gout |
| Fish increases gout risks slightly but are also
cardioprotective so giving it up is a tough call. Consider purified fish oil
which has no gout-causing purine content |
| Nuts, legumes and even purine rich vegetables like
cauliflower have no influence on gout so eat heart healthy doses |
| Dark cherries (1.5 cups worth) can dramatically
lower uric acid levels |
| Beer increases the risk of gout but moderate wine (and
probably other alcohol) does not and has cardioprotective benefits |
| 500mg of Vitamin C seems to lower the risk |
| Low dose aspirin and some diuretics increase the risk
and you need to consult with your doctor on the relative risks of these
medications |
David thanked me and I heard he spent a painless New Year’s
Eve. He was able to dance all night and toasted his health at midnight, not with
his traditional glass of beer but with his new non-purine favorite, champagne.
Dr. Michael Zapf is a board certified podiatrist in private
practice with the Agoura – Los Robles Podiatry Centers (Drs. Zapf, Payne,
Robinson and Benson). For more information call
818-707-3668 or 805-497-6979 or see the web site www.conejofeet.com.
