Those with a history of hearty eating may want to push back from the Thanksgiving table early this year, a practice that could help prevent gout down the line.
Gout, a type of inflammatory arthritis caused by high uric acid levels, has become increasingly prevalent in Americans over the past two decades, notably in middle-aged men who over-indulge in meat and alcohol.
The ailment, commonly referred to as the “disease of kings” because of its affiliation with a rich diet, made headlines this past month as the suspected cause of North Korean ruler Kim Jong-un’s limp. On the rise in the United States, gout affects an estimated 8 million Americans compared to 6 million in 2005, according to data from the U.S. Centers for Disease Control and Prevention.
“Gout is getting to be a big concern,” said Dr. Clement Michet, rheumatologist at the Mayo Clinic. “It’s part of the whole problem we’re continually facing in the United States of people who are not eating right, and it’s going to get worse.”
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The rise has been linked to climbing rates in obesity, as well as high blood pressure, diabetes and heart disease. As generations with poor eating habits age, the uric acid levels in their bodies build, ultimately to a point where the kidneys can’t properly excrete the byproduct.
The body produces uric acid when it breaks down purines, which are found in animal products (as well as other food and drink). When levels become too high, the acid gathers in tissues and fluids, forming crystals that apply pressure to the joints. The build-up causes an angry red swelling, often around the big toe, knees or elbows, and sporadic flare-ups of excruciating pain.
The list of high-purine foods contains a number of Thanksgiving favorites, including poultry, gravy and mushrooms, but goes on to include all meat and seafood (particularly herring, anchovies and mackerel).
When it comes to drinking, studies find beer to be a bigger culprit than wine because of its high level of guanosine, one of the most easily absorbed dietary purines. Sodas and concentrated fruit juices also can contribute to gout, as metabolizing fructose increases uric acid levels. Milk and coffee, however, are recommended for the gout-prone.
Chris Pierson, a 42-year-old Sacramento resident who was diagnosed with gout in his 30s, said he has a handful of friends his age who have come down with the condition.
“I don’t know if there’s something in the water, or we all drink too much beer, or what,” he said.
Gout occurs seven to nine times more often in men than women and is the most prevalent form of inflammatory arthritis in men older than 40, according to Harvard Medical School.
Uric acid levels can begin to elevate in men as early as adolescence, but do not usually show up in women until after menopause, when the production of estrogen, which aids in the excretion of the acid, slows. People can go many years with high uric acid levels before having a gout attack, Michet said.
It sets in suddenly, usually at night, and can last for several days and then go away on its own, only to recur days, weeks or even years later with just as much bite.
“The pain can be so severe people often wonder if they broke their foot in bed,” Michet said. “The crystals will often initiate the inflammation at night. … In a cooler environment, the acid crystallizes easier. The white blood cells eat the free crystals and set off an inflammatory cascade that starts the attack.”
While cutting down on purine-rich foods can help keep acid levels down once they normalize, anti-inflammatory medication is almost always needed to treat the condition initially, Michet said. Once uric acid levels are stable, gout sufferers can continue to eat high-purine foods, but only in moderation, or risk a recurrence.
There is evidence of gout passing from one generation to the next, but researchers say it’s diet, not genes, that plays the biggest role. Pierson said the condition runs in his family, and blames a combination of genetics and bad habits for the swollen big toe that flared up on him eight years ago. Even after diagnosis and treatment, he continued having episodes that kept him from walking for days. Now, after a change in diet and new medications, he said he’s learned to better manage the condition.
“It was the beer,” he said. “I love my beer. I love IPAs, especially around Sacramento. I’d really consider myself a beer drinker, but not anymore. It sucks. Basically, you have to become a sober vegetarian.”
Sacramento’s growing craft beer scene, and its many popular meat-centric restaurants, may put it on the map in terms of gout potential. Chef Michael Tuohy said he orders 600 pounds of sausage per week for LowBrau Bierhall, and the menu at his charcuterie, Block Butcher Bar, features pig-liver mousse and shaved tongue salad, among other delicacies. Research shows that organ meats are particularly high in purines.
Tuohy said patrons are taking more of an interest in eating different kinds – and parts – of meats. The key, he said, is eating it in small portions.
“I’ll eat offal when there’s offal – I’m not afraid of cheeks or liver or kidney,” Tuohy said. “Do I eat it every day? Probably not. You don’t need a lot with food like that.”
Call The Bee’s Sammy Caiola, (916) 321-1636.