What’s the first thing that comes to mind when you hear the word gout? When most people think of , they picture a stout old Englishman, sitting by a fire with his foot up after yet another round of gluttony and excess. This “disease of kings” stereotype and stigma have led too many people to avoid seeking meaningful help.
Research published in August 2015 in Clinical Rheumatologyshowed that people prefer to treat gout symptoms as they occur rather than plan a lifetime prevention approach. Bad idea: If gout isn’t treated, each attack will last longer, you will have more attacks, and you may eventually suffer irreversible joint damage. You will also be at higher risk for kidney disease or kidney stones. A study published in the BMJ published on October 10, 2018 posits that genetics (family history) may play a more important role in the disease development than diet.
“The study from New Zealand is an important step to try to correct these societal misconceptions that gout is caused by dietary habits. People with gout should be reassured that high urate levels are influenced more by genes than by diet, countering the widespread misconception that gout is a self-inflicted disease,” comments Edward Roddy, MD, a coauthor of the Clinical Rheumatology study, a reader in rheumatology and an honorary consultant rheumatologist at the Research Institute for Primary Care and Health Sciences at Keele University, in Staffordshire, England.
First, some background: Gout is a form of arthritis involving hot, swollen, stiff joints caused by the buildup of uric acid, which forms painful needle-like urate crystals. It will often appear in the big toe but can also affect ankles, heels, knees, wrists, fingers, and elbows. It is more prevalent in men older than 40, according to MedlinePlus.
Up until now, it’s been believed that diet was the main driver of the disease. Many people don’t go for gout treatment because they believe that they don’t fit the stereotype or they are too ashamed to seek it. “Diet is a well-established trigger of gout attacks in people who already have urate crystals in their joints. Because individual foods associate with small changes in urate levels, this has led to an incorrect belief that levels of urate can be managed by diet,” says one of the study’s authors, Tony R. Merriman, PhD, a professor in the department of biochemistry at the University of Otago, Dunedin, New Zealand.
This study shows that genetics play a bigger role in disease development than diet. The researchers from University of Otago, Dunedin, New Zealand, compared dietary information from 8,414 men and 8,346 women older than 18 and of European ancestry from five U.S. cohort studies. Participants did not have gout, and were not taking urate-lowering or diuretic drugs. In these studies, researchers looked at genetic profiles and urate levels.
The team found that certain foods did minimally affect urate levels:
But the increases and decreases were very small — less than 1 percent variation. Genetic history, on the other hand, was responsible for nearly 24 percent of variations in urate levels.
“When we compared the dietary scores to the overall genetics of people, the effect was very different,” Dr. Merriman explains. “Diet was not an effective way of keeping urate levels down. The effect of genetics was much greater,” he adds. “Genetics explained in the general population a nearly 100-fold increased variance in urate levels than did diet.”
Treatment is done on two levels:
In order to maintain low urate levels to prevent attacks and disease progression, your healthcare provider may prescribe the following medications:
“Taking urate-lowering drugs has been shown to be very effective because this treats the underlying cause of gout rather than focusing on preventing a symptom,” says another of the study’s coauthors, Tanya Major, PhD.
Sorry, this is not a hall pass to the all-you-can-eat buffet! While diet may have very little influence on the underlying cause of gout (you have to have high urate to get gout), you still should aim to eat a healthy diet.
“Gout has been linked to diet for centuries because flares often occur after eating particular foods. It varies a lot between individuals which foods will cause a flare, and it can be inconsistent in an individual as well. We don’t really know how these foods relate to flares,” says Dr. Major.
This content was originally published here.
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