ALL ABOUT GOUT

MEN­TION THE WORD ‘GOUT’ AROUND A BRAAI FIRE, AND YOU’LL SEE MOST PEO­PLE FLINCH IN RE­SPONSE – MID­DLE-AGED MEN IN PAR­TIC­U­LAR. IT’S A COMMON CON­DI­TION – BUT DOES LCHF HELP OR HIN­DER IT?

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How liv­ing LCHF can af­fect gout

ev­ery per­son af­flicted by gout will be­have in much the same way when you raise the sub­ject: they’ll tell you their own (of­ten gru­elling) ex­pe­ri­ences in graphic de­tail, dis­pense free ad­vice, and share reme­dies they swear by – some of which are rather strange. Ev­ery­one has their own, very strong, opin­ion. That’s be­cause gout is one of the most painful, un­pleas­ant con­di­tions imag­in­able.

WHAT HAP­PENS?

An acute gout at­tack hap­pens when uric acid (urate) crys­tals pre­cip­i­tate into the tis­sue in or around a joint, most of­ten in one par­tic­u­lar joint (the base of the big toe is the most common). This causes a sud­den pain so sharp that it would cer­tainly wake you up at night – and no mat­ter how you try to po­si­tion your foot, the pain will not only stay, it will get worse. Even if you’ve never had a gout at­tack be­fore, you’ll know it the in­stant you ex­pe­ri­ence it: a con­stant, nag­ging, throb­bing, burn­ing pain that de­mands all your at­ten­tion. The af­fected joint swells up and be­comes red and hot. To walk is nearly im­pos­si­ble – if you do, you look like you’re 145 and peo­ple laugh. In other words, noth­ing about gout is fun.

WHERE DOES URIC ACID COME FROM?

Purines are nat­u­ral sub­stances found in the cells of all an­i­mals and plants. They pro­vide part of the chem­i­cal struc­ture of genes in the cells. Most of the purines in our bod­ies are man­u­fac­tured by our own bod­ies, and a small per­cent­age are added by the foods we eat. Foods high in purines are or­gan meats, an­chovies, mack­erel, mus­sels, yeast and beer. When cells die and get re­cy­cled, the purines in their ge­netic ma­te­rial are also bro­ken down, and it’s the break­down of those purines that forms uric acid. It is com­pletely nor­mal and healthy for uric acid to be formed in the body from break­down of purines. In our blood, for ex­am­ple, uric acid serves as an an­tiox­i­dant and helps pre­vent dam­age to the lin­ings of our blood ves­sels. The prob­lem oc­curs when the uric acid is raised to un­nat­u­rally high lev­els.

WHY DO PEO­PLE GET GOUT?

The real an­swer is, we don’t re­ally know. Although gout is linked to in­creased lev­els of uric acid in the majority of cases, up to 30% of pa­tients with an acute gout at­tack have nor­mal, or low, uric acid lev­els. And not all peo­ple with high uric acid lev­els get gout. But let’s look at the majority of cases, where uric acid does play a role. In th­ese cases, there could be sev­eral rea­sons why that hap­pens:

1. You’re pro­duc­ing too much uric acid

This could be hered­i­tary – some­times the lack of cer­tain en­zymes can cause raised uric acid lev­els, and this is usu­ally the case when the suf­ferer is younger. It can be ex­ten­sive and de­bil­i­tat­ing be­cause it can cause per­ma­nent dam­age to the joint. Some­times over­pro­duc­tion of uric acid is caused by re­peated trauma to the joint, and some­times by dis­eases in­volv­ing dam­age to or the break­down of body cells (like can­cer or chemo­ther­apy), or by other med­i­cal con­di­tions, like in­fec­tions.

2. You’re con­sum­ing too many purine-con­tain­ing foods

Beer, meat, liver, kid­neys, an­chovies and sweet­breads are all cul­prits be­cause of their high purine con­tent. New stud­ies have also shown that a high fruc­tose in­take stim­u­lates the syn­the­sis of purines, and high fruc­tose corn syrup is a ma­jor prob­lem here.

High fruc­tose foods in­clude • soda drinks, sauces, fast foods,

pas­try, with corn syrup • honey • ap­ples, pears, cher­ries, figs, mango, grapes, wa­ter­melon, black berries • dried fruits and fruit juices. Low fruc­tose fruits are av­o­cado, lime and le­mon.

3. You’re not get­ting rid of enough uric acid in your sys­tem

This can be be­cause of kid­ney dam­age from hyper­ten­sion or di­a­betes, or be­cause you’re tak­ing med­i­ca­tion like di­uret­ics, which cause un­der-ex­cre­tion. It might be that you’re drink­ing too much al­co­hol: al­co­hol in­creases the pro­duc­tion of lac­tic acid, which blocks uric acid ex­cre­tion from your kid­neys – or it could be that your in­sulin lev­els are too high, be­cause in­sulin also sup­presses the ex­cre­tion of uric acid.

WHO GETS IT?

Mainly mid­dle-aged men and menopausal women – it’s rare for younger women in their pro­duc­tive years to suf­fer. Some younger peo­ple with ge­netic flaws in their purine metabolism also get it, and that can lead to chronic gout. And then, of course, peo­ple who suf­fer from our old friend, meta­bolic syn­drome (over­weight, hyper­ten­sion and di­a­betes are all signs), which causes de­creased ex­cre­tion of uric acid.

RIGHT. WHAT ABOUT THE ROLE OF DIET?

In the past, all the blame was placed on overindul­gence in wine and meat, but new re­search shows that high in­take of fruc­tose might also be a ma­jor cause of acute gout. But, con­trary to pre­vi­ous popular belief, purine-low di­ets have lit­tle ef­fect on the low­er­ing of uric acid lev­els in the blood. So – again – this is a mat­ter of per­sonal ex­per­i­men­ta­tion, to see what works for you. There are some peo­ple whose gout wors­ens when eat­ing LCHF, in which case you’ll need to mod­ify your diet (see be­low), or even stop com­pletely.

But the good news is that for most peo­ple, eat­ing LCHF means your kid­ney func­tion will im­prove, and with that the ex­cre­tion of uric acid. Plus, it will lower your in­sulin lev­els, which means you‘ll be more ef­fec­tive at ex­cret­ing uric acid – both should help.

If you have gout and are just start­ing to eat LCHF, you need to: stay on your med­i­ca­tion (like Al­lop­uri­nol) un­til you have lost most of your ex­cess weight check your uric acid lev­els after 6 weeks on the diet to de­ter­mine whether they’ve risen. Pre­vi­ous stud­ies have shown that your lev­els will come down to be­low the pre-diet lev­els within 6-12 weeks. limit or, even bet­ter, avoid food with a high purine con­tent like red meat, or­gan meats, mus­sels and mack­erel. In­stead, eat more mono-un­sat­u­rated fats like olive oil, avos, egg yolks, al­monds, macadamia nuts and nut but­ters, and sat­u­rated fat-rich foods like lard, but­ter, cream, co­conut oil and cheese. drink enough wa­ter for proper kid­ney func­tion.

of wa­ter! Drink lots

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