James Gillray's "The Gout" | Wellcome Images via Wikimedia | CC by 4.0

Today, I am going to write about gout. Why write about gout on a website dedicated to weight loss and fitness? This is because there is a link between obesity and the development of this painful condition. People who manifest insulin resistance when they accumulate fat, particularly fat in the abdominal area, have a higher chance of developing gout.


Insulin resistance

About half of overweight/obese people are insulin resistant. They typically have or will develop high blood pressure, high triglycerides, low HDL (good cholesterol), glucose intolerance, and evidence of inflammation, such as elevated C reactive protein. If allowed to progress, many people who are insulin resistant will develop type 2 diabetes. They also have an increased risk of having heart attacks and strokes. Gout is an additional problem that folks with insulin resistance may develop.


What is gout?

Gout is a type of arthritis that is triggered when uric acid crystallizes inside of a joint. This usually happens when blood levels of uric acid are elevated. Uric acid is formed in our bodies when purine, a substance found in foodstuffs, particularly animal proteins, are metabolized.

The most common joint to be affected by gout is the metatarsophalangeal joint of the big toe—that is the joint where the big toe is attached to the rest of the foot.

When uric acid crystals precipitate in joint fluid, they invoke an inflammatory response that causes the joint to swell up, turn red, and become extremely painful. Gout has been described as one of the most painful conditions known to humans. Even the lightest touch of a bedsheet on the inflamed joint is intolerable in the midst of an acute gout attack.


How is it treated?

Acute attacks are most often treated with non-steroidal anti-inflammatory drugs, such as ibuprofen. In some cases, very high doses are needed to control the pain and reduce the inflammation. If an individual suffers from frequent, recurrent attacks, he or she may be prescribed a medication, such as allopurinol, to lower their blood levels of uric acid. This can reduce or prevent future attacks.


What about diet?

Reducing purine in the diet can lower uric acid levels and reduce the frequency of gout attacks. High intake of meat and seafood is associated with higher levels of uric acid, and thus gout, in susceptible people. Although purine occurs in grains, such as oatmeal, and some purine-rich vegetables (e.g., peas, beans, lentils, spinach, mushrooms, and cauliflower), consumption of these foods does not increase risk for gout. Gout experts, such as Dr. Hyon Choi, suggest that dietary purine restriction apply to purines from animals but not from vegetable origin.

Alcohol consumption also increases the risk for gout. It does so, in part, by increasing the body’s production of uric acid. It may also decrease the excretion of uric acid by the kidneys. Interestingly, the impact of alcohol on uric acid varies by type of alcohol consumed. Beer, which contains a highly absorbable type of purine called guanosine, is more likely than hard liquor to increase uric acid levels and gout attacks. A recent scientific report documents that moderate wine drinking does not increase the risk of gout. (Hooray!)


Milk helps

A 12-year-long study of diet and gout in men, conducted by Dr. Choi and colleagues and reported in the prestigious New England Journal of Medicine (March 11, 2004), documented a decreased risk of gout with increased intake of dairy products. The effect was limited to consumption of low-fat dairy products, such as skim milk and low-fat yogurt.


Losing weight

Since obesity and insulin resistance are both associated with high uric acid levels, it follows that weight loss may be helpful in reducing gout attacks. Indeed, the results of the small study suggest that weight reduction may decrease uric acid levels and the risk of gout.

So, once again, the medical literature points out that attaining and maintaining a healthy weight has benefits beyond getting into our skinny jeans. For anyone who has lived through a gout attack, the prospect of preventing another is added impetus to shed the pounds.