IS GOUT PARTIALLY ABOUT GIRTH?: As more people get the "disease of kings," scientists are trying to parse how gout might be tied to lifestyle--and increasing rates of obesity and hypertension.
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The "disease of kings" has now reached the masses. In the past half century the prevalence of gout in the general U.S. population has more than doubled. Once thought of only for the privileged few who had the means to overindulge in food and drink, gout now afflicts more than eight million American adults. And research suggests that the rates of this form of localized arthritis are still on the rise.
The new study found that some 3.9 percent of U.S. adults have been diagnosed with gout at some point. Some people have only one or infrequent flare-ups. But others are plagued by chronic, recurring symptoms. And the condition continues to affect men more often than women (some 5.9 percent of men versus 2 percent of women), according to the new analysis, which was published online July 28 in Arthritis & Rheumatism. The researchers also found that, in their study of more than 5,000 people, about 21.4 percent had high levels of uric acid in their blood, which is known to be a risk factor for developing gout.
Much of the evidence points to a link between gout and the increasing prevalence of obesity and hypertension. And as body mass indexes continue to rise worldwide, "it's only going to grow," says Jennifer Hootman, an epidemiologist at the U.S. Centers for Disease Control and Prevention, who was not involved in the new research.
But, researchers say, the condition is also largely preventable, and new medications have made it easier to treat.
A disease of the rich (nations)?
The steady climb of gout rates over the past 50 years comes as no surprise to many researchers. "This is not the first paper" to find the increasing rates of gout, says Allen Anandarajah, an associate professor of medicine and a rheumatologist at the University of Rochester Medical Center, who was not involved in the new research. He says that doctors are probably doing a better job of diagnosing patients, but many people—possibly even the majority who have more episodic gout—do not see their doctors about it at all. Acknowledging that likelihood, he says, the occurrence of gout in the general population might be as high as 10 percent of adults.
Data from global analyses suggest that an increase in gout has not just been limited to the U.S. Along with increasing rates of obesity and hypertension, research has also indicated a rise in gout's prevalence in Europe, Asia and even urban sub-Saharan Africa.
Even though gout rates have been climbing "I don't think it's on people's radar screens," Hootman says. "I really don't think they think about it"—especially that it is so often correlated with larger health problems such as metabolic syndrome, which is a cluster of symptoms that include elevations in blood pressure, cholesterol and body fat.
Anandarajah suggests that the new study is "a timely reminder to all of us," too, to be more attuned to patients—especially those who are older or suffer from obesity, hypertension or diabetes.
Joint risks
For those who have a bout with gout, the experience is not easily forgotten. A build up of uric acid, because of diet, lifestyle, disease or medication, can cause small crystals to form in a joint, leading to inflammation characterized by a swollen red area and intense pain. Gout most commonly manifests itself around the big toe joint, but it can also crop up elsewhere in the foot or in the ankle, knee or other joints.
Chronic cases can also frequently be misdiagnosed. Daniel Mueller, a physician at the University of Minnesota Medical School who treats patients with gout, notes that especially in older adults, the condition can often be mistaken for other joint problems. "And we're going to see more of that as the population gets older," he says.
There's also suggestion that too much uric acid "might contribute to other conditions," such as heart attack, stroke or diabetes, says Hyon Choi, a professor of medicine at the Boston University and co-author of the new study. But given that heart disease and diabetes are also associated with metabolic syndrome—and thus with gout—"it's not completely proven if they're causally linked or just an association," he notes.
And a harmful cycle might be underway. "It could also be that gout feeds back and contributes to obesity and to hypertension," Mueller says. He explains that high levels of uric acid might stimulate the immune system, and that extra activity could lead to chronic inflammation and, eventually, cardiovascular problems. But, he notes, "it's still just a hypothesis."
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21 Comments
Add CommentOnce more unto a proper diet, dear friends, once more;
Reply | Report Abuse | Link to thisOr close the wall up with our gout-ridden dead.
(Sorry, William)
Purely anecdotal but I'm very healthy and have gout ans so is my brother in-law. In my case my Doctor and I believe it is a hereditary ailment. In my case it only shows up when I stub my toe or over stretch it when Hiking.
Reply | Report Abuse | Link to thisSee this article about a unpublished chapter from Taubes' book that links excessive fructose consumption to gout. There is a lot of hidden fructose in the SAD. http://bit.ly/qgF4kz
Reply | Report Abuse | Link to thisI have a gout disease but it s genetic and I have a pain sometimes. We must patient and God help us!!!
Reply | Report Abuse | Link to this@drafter --- same thing with me. It all started when I was wearing a pair of wing tips that were narrower than usual for me. Incredible pain! then a couple of years later I banged the side of my big toe -- two weeks of pain. Bent the big toe back hiking up a hill -- two weeks of pain.
Reply | Report Abuse | Link to thisEverytime I've tested low on U acid but I definitely get the burning hot and fiery red toe joint -- can't even sleep with a cotton sheet on it. Some times I feel it coming on and try to treat it.
I too am prone to gout, as is my brother and (was) my maternal grandfather - none of us is obese. Fortunately, there is an effective prophylactic in the form of allopurinol which has (for most people) almost no side effects. My brother manages his gout through diet, but I prefer to medicate rather than risk the effects of chronically elevated uric acid levels, referred to in the article.
Reply | Report Abuse | Link to thisYou can suffer gout attacks even with normal serum uric acid levels, and there are other related diseases caused, for example, by calcium crystals. High uric acid levels have been shown to be a cardiovascular risk factor, but it wasn't shown that lowering blood uric acid reduces risk. The goal uric acid level for men is 6 mg/dl. When you start taking some uric acid lowering drugs, the uric acid pool inside your body mobilizes, and the first year on uric acid lowering drugs you may have an increase in the number of gout crisis. Diet is the cornerstone of gout therapy.
Reply | Report Abuse | Link to thisI meant goal uric acid level is less than 6 mg/dl, however, too low uric acid levels are linked to an increased cancer risk, although no cause-effect relationship was found.
Reply | Report Abuse | Link to thisVery low blood cholesterol levels are linked to increased cancer risk too.
Reply | Report Abuse | Link to thisClearly your "diet" does not include a serving of compassion. Even a cursory search reveals that gout has many triggers, only one of which is diet.
Reply | Report Abuse | Link to thisI have had intermittent gout attacks for the last 30 years. With the first such attack, I thought I had a stone bruise from my previous days 3 mile run(I was also doing some heavy power lifting). My body fat levels were under 20 in those days. I finally determined that the usual trigger for my gout was dehydration(I rarely notice being thirsty). These days I have to force myself to drink two to three liters of water every day and that usually takes care of the problem(except when I'm doing outside work and sweating).
Reply | Report Abuse | Link to thisIn reading comments, I see that there is a possibility that some self-diagnosis may have misdiagnosed hallux valgus, or bunions, as gout.
Reply | Report Abuse | Link to thisHallux valgus does have hereditary component, but it might not occur if one is careful not to wear footwear that constricts the toes.
(I made the mistake of wearing shoes too narrow while performing, jumping and flexing the toe over an extreme range of flexibility for years.)
Hallux valgus symptoms include swelling, enlargement of the first metatarsal pharyngeal joint, big toe turned toward the other toes, rather than in line with the flexor tendon.
It is painful, and essentially a specific form of arthritis (which merely translates as joint inflammation.
Gout, as was pointed out, is uric acid crystallization, especially at that joint.
The x-ray photo show a significantly bunioned foot. The shadowy surround of the joint may be uric acid crystals. There may be pain from both conditions.
I have been working at a part-time job that exposes me to a lot of "average" suburban Americans lately. Sadly, I've observed that at least a third of these people are morbidly obese; another sixth are very overweight; another sixth just overweight; and only about a third of average weight. I myself am slightly overweight.
Reply | Report Abuse | Link to thisHaving written about medical issues for some time myself, I am deeply suspicious that at least half the blame for this epidemic can be placed on the food industry. The other half can be blamed on the pharmaceutical industry. These are gross overstatements, but with the latter's overriding interests in keeping Americans just a hair shy of death's door and the former's interests in getting us sugar and fat addicted, my points are certainly valid.
Sadly, the average joe in the US works very hard so he doesn't have time at the end of the day to discern what he sees in front of him: the barrage of commercials for fatty prepackaged foods or for the bevy of drugs that can make him combat the high cholesterol, high blood pressure and insomnia that the aforementioned items create.
Gout is one part of the equation, and not at all surprising.
I did a post a while back on Emotions for engineers about gout. It referenced Taubes work, Cordain's as well as others.
Reply | Report Abuse | Link to thishttp://bit.ly/k6T8Gd
Regards,
Tony
By the way, fatty meat is not a cause of gout in any case. The author was off on that.
Reply | Report Abuse | Link to thisGot a good laugh reading the posts by people that injured a toe and foolishly labelled it gout. If you seriously impact a joint in your foot (or elsewhere in the body) it will naturally hurt. This has nothing to do with uric acid crystals building up. What kind of idiot thinks that for thousands of years only royalty stubbed their toes. Apparently they didn't actually read the article.
Reply | Report Abuse | Link to thisThank You 'Old Salt 72' for the info about Gary Taubes and the chapter left out of "Good Calories, Bad Calories". If you read this article, then one has to assume that in addition to an interest in gout you may have an interest in nutrition and health in general. In which case I would urge you to read Taubes' 'Good Calories, Bad Calories. If your interest is merely about gout and/or you suffer from gout then do yourself an enormous service and go to the web site that Old Salt 72 referred to (or just Google: 'Gary Taubes gout'). 'Good Calories, Bad Calories' is a rather imposing work (640 pages)but well worth the read. If your not inclined to take an introductory course in endocrinology which is what 'GC,BC' essentially is, then read 'Why We Get Fat' by Taubes which the author says he wrote because people pointed out to him that 'GC,BC' was JUST TOO LONG. Either book will absolutely change the way you think about what you're eating. You'll never look at a bagel again the same way.
Reply | Report Abuse | Link to thisYou're quite right, but your assertion needs fine-tuning: I have zero compassion for all those who incur such problems as a result of irresponsible self-indulgence.
Reply | Report Abuse | Link to thisThe portion of compassion that would normally go to those people is instead aimed at those who bear the problem through no guilt of their own. They have my full sympathy and my best wishes.
(sigh) My previous post was a reply to comment #10.
Reply | Report Abuse | Link to thisIt would have been nice if a little biochemistry had been included. What exactly causes gout?
Reply | Report Abuse | Link to thisIt's alimentary- whether we like it or not!
Reply | Report Abuse | Link to thisAcid-causing food,mainly meats, and eggs and cheeses, are they worth the pangs of gout?
Try a vegetarian approach; with a fruit-and salad menu before ingesting those animal cadavers....
And feel the difference it makes.
It's evolutionary; we are chimps de luxe by design.
How about caring about our own pH values as much as those of our swimming pools?
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