GOUT - KEEPING YOU ON YOUR TOES - HEALTH SERIES | ISSUE 06
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GOUT – KEEPING YOU ON YOUR TOES How to keep gout in check, in your own stride HEALTH SERIES | ISSUE 06 livegreat.greateasternlife.com
CONTENTS Ancient Beginnings ....................................................................................................... 1 Detecting Gout ....................................................................................................... 4 When Gout Attacks! ....................................................................................................... 5 Taking Action ....................................................................................................... 6 Gout-Free Living ....................................................................................................... 8 MEDICAL DISCLAIMER Please note that the material in this guide is provided by way of information only. It is not and does not purport to be, or it is not a substitute for, nor does it replace, medical or other professional advice, or treatment of health conditions. Whilst Great Eastern endeavours to ensure that the contents of the material are accurate, errors or omissions may occur and we do not accept any liability in respect of them. For full terms and conditions, please refer to our site at https://livegreat. greateasternlife.com/sg/terms_of_service.htm
ANCIENT BEGINNINGS
Known throughout settle in the soft tissues surrounding What causes gout?
the joint and cause the area to redden, A build-up of uric acid crystals
history as the ‘rich swell and become painful. These occurs when uric acid, a common
man’s disease’ or swellings often occurs in the joints of waste product, builds up. Uric acid
the ‘disease of the body, especially the big toe. Other is produced when the body digests
parts such as the ankles, knees, wrists, purines – a substance found in many
kings’ – gout is one
fingers, elbows and even instep of the types of food and in the tissues of
of the oldest forms foot can also be affected. the body.
of arthritis.
Usually the kidneys can pass out
Records of ancient Egypt and Rome excess uric acid in the urine. However,
have been found to describe the if there is too much uric acid for the
disease, which was associated with kidneys to excrete effectively, the levels
indulgent lifestyles. Gout is a chronic of uric acid in the blood rises. This
– or long-term disease – but it can be condition is called hyperuricemia –
managed with medications and lifestyle a term that means “too much” (“hyper”),
changes. Early detection of gout in “uric acid” (“uricemia”). Prolonged
its early stages can also reduce the hyperuricemia may lead to gout
occurrence and severity of the painful over time.
swellings that mark the disease.
Other risk factors
What is gout? Many different factors can cause gout –
Very simply, gout occurs when there is and although it is commonly associated
too much uric acid in the body, causing with a rich diet, diet is not the only
uric acid crystals to form. These crystals factor. However, if you already have a
1
How Is Gout Formed
Purine Sources Uric Acid Hyperuricemia Gout
Purine is a During the digestive If the kidneys cannot When uric acid
naturally occurring process and bodily eliminate uric acid in forms into tiny
substance found functions, the body the urine, the level needle-like crystals
in food and the breaks down purines of uric acid rises in that collect in the
tissues of the body. into uric acid the blood joints, it causes pain,
redness and swelling
high chance of developing the disease, of high-purine foods, such as organ
a rich diet and a sedentary lifestyle meats, dried beans, peas, anchovies
can increase the chance of getting and gravy can lead to high level of
gout. In most cases gout is most likely uric acid in the blood (hyperuricemia).
to develop due to a combination of In the long term, hyperuricemia may
factors. In some cases, gout is caused lead to gout. Typically, it takes about
by medical conditions and/or medicines. 20 to 40 years of ongoing
hyperuricemia to develop gout, which
Genes: Gout is mostly inherited is why the condition usually develops
If your grandfather or father had in older adults.
gout, you stand a higher chance of
developing the disease as well. One More weight, more purines
study from the National Institute of If you are overweight, you have a higher
Arthritis and Musculoskeletal and Skin chance of getting gout. This is because
Diseases in the United States found that purines are not only found in food, but
18 per cent of people who suffer from also in our tissues. It is a normal bodily
gout had a family member who also higher level of uric acid in the blood. In process to break down tissues. This
had the disease. One of the causes of women, the female hormone estrogen releases the purines that break down to
gout is a genetic condition that prevents appears to have a protective effect uric acid. In people who are overweight,
the body from breaking down purines that improves the removal of uric acid there are more tissues in the body for
efficiently, leading to more uric acid in excretion by the kidneys. However, breakdown and thus more production
the blood. after menopause, the risk of a woman of uric acid.
getting gout starts to be the same
Gender and age: as the risk for men. Women tend to Medical conditions
Men above 40 are most at risk develop gout at a later age than men. Some diseases and conditions can
Men aged 40 and above have a increase the risk of gout. These include
significantly at higher risk for gout. Diet: High-purine foods high blood pressure (hypertension)
This is because men tend to have a A diet that consistently contains a lot and diabetes, high cholesterol in the
2
blood (hyperlipidemia), the narrowing
of the arteries (arteriosclerosis),
kidney impairment or kidney failure,
an underactive thyroid gland
(hypothyroidism) and psoriaris
(a skin condition). People who have
had organ transplants are also at risk
of developing gout.
Alcohol: Excessive intake of
beer and spirits
Drinking too much alcohol can increase than those who did not drink. Not only the risk of gout the most. Wine drinking
the risk of gout. In a 2004 American does alcohol break down to purines in moderation is not linked to the risk of
study published in the medical journal, and uric acid, it actually also increases developing gout. In recent times, binge
Lancet, it was found that men who the body’s production of uric acid and drinking among young adults has been
drank two or more beers in a day had a reduces the body’s ability to remove linked to the earlier development of
2.5 times higher chance to develop gout uric acid. Beer in particular increases gout, particularly among women.
Are You At Risk Of Gout? What To Do If You Are At Risk
• Male over 40 years old • Talk to your doctor about your concerns and take a
• Overweight blood test if needed
• Have a family history • Cut down on rich food, especially high-purine foods
• Eat a diet high in seafood, organ meats, like meat, organ meat and seafood
anchovies or gravy • Cut down on excessive alcohol intake
• Drink alcohol in large amounts • Increase your water intake
3
DETECTING GOUT
Some ways to detect if Joint fluid test
you have gout A more accurate way to detect if you
Blood test have gout is to check if you have uric
A blood test may be used to check the acid crystals in your joints. The test
level of uric acid level in your blood. is called a joint aspiration. A needle
This is not always accurate – some is used to draw some fluid from your
people have high uric acid levels, but affected joint and examined under
never develop gout, while some people the microscope. If there are uric acid
get gout, but do not show unusually crystals in the fluid, a diagnosis of gout
If you suspect you high levels of uric acid in their blood. is confirmed.
are at risk of gout
or have suffered
What To Do If You Have Gout
an attack, it’s best
to seek medical
• Follow your doctor’s advice
advice from your on medicine prescriptions
general practitioner and follow-up appointments,
(GP) who can help including blood tests
• Reduce the amount of high
in diagnosing the purine foods in your diet
condition and (refer to page 2)
recommending the • Drink plenty of non-alcoholic
fluid, especially plain water,
best way to tackle
to flush uric acid from the body
the disease. • Avoid alcohol, particularly beer and liquor as they increase uric
acid production
• Avoid sugary and carbonated drinks – these are linked to an increased
risk of gout attacks
• If you are overweight, attempt to lose some inches. Even if you are
not, be sure to exercise regularly. Avoid ‘quick fixes’ – such low-
carbohydrate diets -- as these can end up increasing the level of uric
acid in your blood
4
WHEN GOUT ATTACKS!
Gout can also cause Kidney stones: All that excess uric
other complications acid crystal may also collect in the
Tophi: Untreated gout may cause uric urinary tract, causing kidney stones.
acid crystals to not only be deposited
in the joints but also under the skin to Deformity: The affected parts can
form lumps called tophi (pronounced become so swollen that it causes
‘toe-fi’). These lumps are not painful, permanent deformity. If it affects the
but can become sore and swollen feet and hands, the condition can also
during a gout attack. limit actions walking and typing.
A gout flare-up can
happen suddenly –
and usually at night. The Stages Of Gout
Gout progresses in four main stages
An episode of gout
is aptly called an
‘attack’ – because Stage 1: Asymptomatic Hyperuricemia
Asymptomatic means ‘without symptoms’. In this early stage,
the pain is described the uric acid level in the blood is high, but does not cause any
symptoms. In most cases, treatment is not needed.
as being so intense
that even the lightest Stage 2: Acute Gout (also known as Acute Gouty Arthritis)
Acute means ‘sudden’. In this second stage, the uric acid
touch is unbearable. crystals collect in the joints and cause a sudden onset
of severe pain and swelling. An episode of gout usually
subsides within 3 to 10 days, even without treatment. The
Some people say it is as if the skin next attack may not occur for some time, but if not managed
with medication or lifestyle changes, attacks can last longer
is “on fire”. An attack can last from and happen more frequently.
between 3 and 1 days. In between
attacks, there is usually no pain Stage 3: Interval Gout
and one can go about daily life with This is the period between (hence ‘interval’) acute attacks.
In this stage, a person does not have any symptoms.
no hindrance.
Signs and symptoms you need to Stage 4: Chronic Gout
look out for This is the most disabling stage of gout. It usually develops
over a long period, such as 10 years. In this stage, the
• Sudden development of a swollen, disease may have caused permanent damage to the affected
red, and warm joint joints so they are deformed and so make it difficult to walk,
use your hands or arms.
• Swelling, redness and pain that
affects only one joint, often the toe,
ankle, or knee
5
TAKING ACTION
pain and look for solutions.
• Take your medications
as prescribed
• Try applying ice to the affected
joint and raise it slightly
• Increase your intake of water. Be
sure to drink more fluids (about
2 to 4 litres a day and ensure at
least half your fluid intake should
be water)
• Be sure to rest during a gout
attack and let the episode pass.
Distract yourself with activities
such as reading, deep breathing
and other light hobbies.
Know your gout medicines
The type of medication for gout
depends on the stage of disease, so
What happens Managing gout and management is often tailored for your
preventing attacks specific needs and severity of the
after a diagnosis of The goals of disease management disease. The common medications
gout is confirmed? are to: used in gout management seek to:
The good news is 1. Relieve the pain and swelling • Reduce the discomfort of a gout
during a gout attack
that the symptoms attack by relieving the pain and
2. Prevent future gout attacks swelling
of gout can be 3. Prevent or reduce tophi and reduce • Prevent future attacks by reducing
controlled and the risk of kidney stones the level of uric acid in the blood
reduced with 4. Lower risk of long-term damage to The specific brands of medications
the affected joints and the most effective dose will be
medications and
determined by your doctor. Here are a
change in diet. What to do in a gout attack! list of common types of medicines used
If gout still strikes, it’s important to have in gout management.
a plan so you will take your mind off the
6
Non-steroidal anti-inflammatory used you who cannot take NSAIDs Medications to reduce uric
drugs (NSAIDs) or colchicine. acid production
Drug action: NSAIDs are a group of Apart from medications to reduce and
drugs that reduce inflammation but are Side effects and risks: Corticosteroids prevent gout attacks, your doctor may
not steroids. NSAIDs work by lowering lower the immune system and also prescribe medications to prevent
the body’s production of chemicals that decreases the body’s ability to fight and reduce your risk of gout-related
cause inflammation, pain, and fever infection, long term intake of the drug complications. These include drugs that
(known as prostaglandins). also leads to weakened bones and block uric acid production, or help the
poor wound healing. Because of their body expel uric acid. These medicines
Side effects and risks: Be aware serious side effects, your doctor will find also can help reduce the size of tophi
that NSAIDs can cause stomach the lowest dose for you that effectively and kidney stones.
irritation. In rare cases, they can also controls your symptoms and prescribe
affect the kidneys. Though NSAIDS are them for the shortest time possible. Take your medicines!
effective pain medicines, the longer you Speak with your doctor about your
take them, the more likely side effects Colchicine concerns about medications and side
can occur. These include vomiting, Drug action: Colchicine is a type of pain effects, but be sure to comply with his
nausea, constipation, diarrhea, poor reliever that, if taken soon after gout or her advice. Taking your medications
appetite, headache, dizziness, rashes symptoms appear, will reduce the pain regularly in the prescribed dose and
and drowsiness. in a short time. Colchicine is given if frequency is the best way to control
NSAIDs or corticosteroids fail to control gout and prevent painful flare-ups.
Corticosteroids symptoms. To prevent future attacks
Drug action: Corticosteroids are strong your doctor may also prescribe a low
anti-inflammatory hormones that act daily dose of colchicine.
quickly to reduce pain. They can be TIP
taken in pill form or injected directly Side effects and risks: Colchicine can Use a pill box or download a medication
into an affected joint to relieve the pain cause abdominal cramps, nausea, reminder app to help you remember to
and swelling. Corticosteroids are usually vomiting and diarrhoea. take your medicines on time!
7
GOUT-FREE LIVING
Your doctor will work out an effective you make those positive steps to
disease management plan for you that feeling better physically and mentally.
may include: medications, blood tests
and follow-up consultations. You may A healthy eating plan for gout
also be advised to make some lifestyle A diet low in purines is the best way to
and diet changes that are useful in prevent gout attacks. Avoiding purines
preventing gout from getting worse. completely is impossible, but you can
It is important to be proactive about strive to limit them. Some foods can
your condition – these steps can help trigger gout in others but not in you.
EMPOWER YOURSELF
Understand your condition: Read up on it; talk to your doctor;
ask for advice. The more you know, the more prepared you are to
handle the disease
If you or a family
member have been Make a change: Gout is partly caused by lifestyle factors, so
diagnosed with if you recognise any of the risk factors in your own life, make
a stand to change them. If you smoke, stop. Eliminate alcohol
gout, it can be a intake. Reduce the amount of caffeine you drink. If you are on the
worrying time. Fear heavy side, lose weight. Start exercising!
not, the good news
Clean out your diet: One of the main causes of high uric acid in
is that gout can be
the blood is the excessive intake of foods high in purine. While it’s
controlled effectively. not possible to avoid purine entirely (your cells contain it after all!),
lowering your intake of high-purine food is a good way to lower
the risk of a gout attack.
8Learn to identify your body’s own you may add more foods from Lowering your uric acid level through
tolerance level and which foods are this ‘moderate’ category. diet can help you to manage gout
more problematic. more effectively, said Dr Tan York
• STEP 1: Eliminate foods in the What someone else with gout finds Kiat, Consultant, Rheumatology and
‘high-purine’ category safe to eat, may or may not be safe Immunology Department, Singapore
• STEP 2: Reducing the intake of for you. By consulting a doctor and General Hospital (SGH), in an article for
foods in the ‘moderate-purine’ careful choice of low- and moderate- Health Xchange .
category. If you can eat from this purine foods, you can determine a
group and don’t have gout attacks, ‘safe’ level of purines in your diet.
High-Purine Foods Moderate Purine Foods Gout-Friendly Foods
Eliminate these foods Eat in moderation Eat in moderation
Eat only very occasionally About 2-3 times a week Safe for gout
• Anchovies • Beef • White bread, pasta, noodles, rice
• Asparagus • Chicken • Nuts: walnuts, almonds,
• Organ meats: beef kidneys, • Duck flaxseed, cashews
brains, liver, sweetbreads • Pork and ham • Eggs (limit to 3 times a week)
• Dried beans and peas • Seafood: crab, lobster, • Low-fat dairy products
• Game meats oysters, prawns, scallops • Coldwater fish: tuna, salmon,
• Gravy • Wholegrain bread cod (limit to one serving a day)
• Mackerel • Wholegrain pasta • Kailan, cabbage, squash,
• Mushrooms beetroot, red peppers,
• Sardines corn, potatoes, celery,
• Bacon tomato, eggplant,
• Meat extracts • Oranges, apples, pears,
pineapple, papaya, tangerine,
berries, bananas, peach, cherries
• Avocado
• Coffee and tea
• Chocolate, ice-cream
(in moderation)
9HEALTHY RECIPES FOR YOU
Breakfast ideas Meals on the go Something piping hot
• Cornflakes, low-fat milk or • Shredded chicken breast, • Roast chicken marinated
cereal and some strawberries, cubed apple, chopped with rosemary and garlic
berries or a banana walnuts and sliced with potatoes
• Toast with almond butter and celery tossed with a little • Fish soup with tofu,
banana slices light mayonnaise bittergourd and steamed
• Vegetable omelette with • Pasta with avocado, roasted white rice
tomatoes, red peppers eggplant and red peppers • Pasta with spicy tomato
and onion strips, corn kernels and a sauce and grilled vegetables
• Smoothie made with sliced hardboiled egg • Stir fried kailan and taukwa
plain low-fat yoghurt, fruit • Sandwich wrap with cream with beef slices served with
and flaxseed cheese, smoked salmon and steamed white rice
salad leaves
10Alternative remedies for gout lowering uric acid. Some dark cherry
Some types of foods may help reduce juice, and a serving or two of fresh
the symptoms of gout by lowering uric cherries and other dark-coloured fruits,
acid. Though more research is needed, including blueberries, blackberries,
try adding moderate amounts of these raspberries and purple grapes may be
into your diet: a good way to get your vitamins and
lower uric acid production as well.
Vitamin C: Though vitamin C has not
been accepted as a ‘treatment’ for Deep breathing: Try natural pain
gout, it may reduce the levels of uric management while waiting for your
acid in the blood . Be aware that large medications to kick in. Deep breathing
doses of vitamin C may increase and not only fills the body with energising
not decrease uric acid levels, however. oxygen, it also triggers the relaxation
The best way to get your vitamin C is to response and may help take your mind
include more fresh fruits and vegetables off the pain. Try other mindful exercises
in your diet. like meditation, tai chi and yoga when
your gout is not active as these may
Cherries: The dark-coloured help with pain relief, reduce stress and
compounds that give cherries their build emotional health.
attractive colour may have the effect of
Top apps for managing gout
Gout Channel Gouty Uric Acid Database
(Free; Android and iOS) (Free; Android)
Learn more about the causes and Can’t remember which foods are high in
symptoms of gout and how to manage purines? Use this app as a reference to
the problem with a proper diet and find out whether your lunch or dinner is
lifestyle changes. in the safe zone.
11GREAT STARTS SMALL. LIVE GREAT. Great, meaningful changes to our lives oftentimes have small beginnings. At Great Eastern, we are more than just a life insurance company – we are a LIFE company. We champion these little changes, which change life for the better. For a better, healthier you. We want to encourage you to live great, every day, and created this series of guides to help you do just that. Want to view them all? Simply go to www.greateasternlife.com/guides We’re regularly growing the list of topics for you. REAP THE BENEFITS These guides are part of the Live Great programme, which was created to help you live and feel well. Join us at livegreat.greateasternlife.com to find a host of wellness tools, handy mobile applications, health and wellness tips, invitations to expert talks and exclusive privileges to help you along your Live Great journey! LET’S TALK ABOUT LIFE Want to learn more about protection and retirement solutions from Great Eastern? Do get in touch with your Great Eastern Life Distribution Representative, or contact us at +65 6248 2211 or wecare-sg@greateasternlife.com COPYRIGHT DISCLAIMER Copyright is held by the publishers. All rights reserved. Reproduction in whole or in part without permission is prohibited. SOURCES: http://www.mayoclinic.com/health/gout/DS00090; http://www.arthritistoday.org/ tools-and-resources/expert-q-and-a/gout-questions/food-for-gout.php; http:// health.nytimes.com/health/guides/disease/gout-chronic/causes-and-risk-factors. html; http://www.healthxchange.com.sg/healthyliving/SpecialFocus/Pages/ Gout-Rich-Man-Disease-No-More.aspx; http://www.healthxchange.com.sg/ healthyliving/DietandNutrition/Pages/Diet-for-Gout-What-Foods-Can-You-Eat-to- Keep-Your-Uric-Acid-in-Check.aspx; http://www.acumedico.com/purine.htm Any third party links provided by Great Eastern on any of our web properties, communication channels and social media are provided for your convenience – their inclusion does not imply any approval or endorsement by us. We have no control over the content of those sites and accept no responsibility or liability in respect of them.
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