It’s not just old men with gout
We have the highest prevalence of gout in the world — it’s suffered by more than 100,000 Kiwis.
When I say the word gout, I bet you picture a floridfaced, whisky-soaked old gent with an inflamed big toe, a cigar in one hand and a steak in the other.
That’s the traditional view of gout; the idea that it’s a disease of decadence and overindulgence.
In fact, in New Zealand, gout is the most common form of inflammatory arthritis, and its prevalence is growing. We have the highest prevalence of gout in the world — it’s suffered by more than 100,000 Kiwis.
Gout affects more men than women, and more Maori and Pacific people. A letter published in the NZ Medical Journal in 2016 estimated that nearly half of Pacific men and more than a third of Maori men over 65 have gout. In general, Maori and Pacific people have twice the gout prevalence of other ethnicities.
Gout is extremely painful; it’s described as being like needles in the joints. It’s caused by the build-up and crystallisation of urate (or uric acid) around the joints.
It often does affect the big toe, but it can happen in other joints too, such as the elbow and fingers, and cause painful and debilitating attacks of inflammation.
Urate is an end product of metabolising purines, which we get from food and drink. Alcohol is one of these — beer and spirits more than wine, although gout sufferers are advised to cut back on all alcohol. Red meat and seafood are also sources of purine. You don’t need to cut them out completely, is the advice, but keep portions moderate.
Emerging research suggests that foods and drinks high in sugar can also be a factor in triggering gout attacks, in particular foods high in one type of sugar, fructose.
Because fructose is metabolised differently from glucose, it can disrupt other metabolic processes in the body, which it does in the case of serum urate levels. (High serum urate levels are the precursor to gout.)
There’s also emerging evidence that fructose intake modifies the excretion of urate from the body, which also increases serum urate levels and so further increases gout risk.
Some of this gout research is being done by researchers at Otago University, and one of the researchers, Dr Tanya Major, presented this work at the recent FIZZ conference in Auckland. She has turned her attention to the link between gout and sugary drinks, in particular.
Around 20 per cent of adults’ sugar intake comes from drinks such as soft drinks and juice, and quite a bit of that sugar is fructose. So addressing sugary drink consumption can, Major says, have an impact for gout sufferers.
The Otago research has found sugary drinks increase the risk of developing gout; you’re 1.5 times more likely to develop gout if you have one sugary soft drink a day and 1.4 times more likely with one fruit juice a day. Being overweight is another risk factor for gout. Cutting back on sugary drinks will help here, too. One more reason to switch to water.