Managing Gout
Judy Seybold, MS, RDN, LD, CLC
Chief Nutrition Officer
Sharp, sudden pain in your big toe may be a sign of gout, which is a common, yet painful, form of inflammatory arthritis. It occurs in about 4 percent of Americans and is caused by the buildup of uric acid crystals in the joints. Uric acid results from the breakdown of purines, substances found naturally in body tissues and many foods. Most people dissolve the uric acid that is in the blood, but people with gout don’t, and they form needle-like crystals. These crystals cause sudden, severe episodes of pain, tenderness, redness, warmth, and swelling in the joints.
Gout can be caused by a variety of reasons. The body may make too much uric acid or may not be clearing uric acid from the blood, or people may be eating too many high-purine foods.
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There is no cure for gout, but you can effectively treat and manage the condition with medication and lifestyle changes. Doctors who specialize in arthritis, rheumatologists, can diagnose gout by assessing symptoms, x-rays, and lab tests. Gout can only be diagnosed during a flare-up when a joint is hot, swollen, and painful and when a lab test finds uric acid crystals in the affected joint.What Are the Risk Factors
- Advanced age
- Alcohol
- Genetics
- Diuretics
- Heart disease
- Male gender
- Obesity
- Red meat and shellfish intake
- Soda intake
Symptoms
For many, excruciating pain and swelling in the big toe is the first sign of gout. Although gout may appear in the toe initially, it can also occur in another lower-body joint, such as the ankle or knee. Gout usually affects one joint at a time. But if left untreated, it can affect many joints, and pain can become progressively worse. Signs and symptoms are often sudden and occur at night.
Intense joint pain: Gout most frequently appears in the large joint of your big toe, but it can occur in any joint. Ankles, knees, elbows, wrists, and fingers are also commonly affected. Gout pain is typically most severe within the first 4 - 12 hours after it begins.
Continuing discomfort: Once the worst pain subsides, lingering joint pain may continue for a few days to a few weeks. Each gout attack tends to last longer and affect more joints than the one before it.
Inflammation: Joints affected by gout become red, swollen, tender, and warm.
Limited range of motion: As gout worsens over time, your joints may lose their ability to move as well as before.
Healthy Eating Tips
Treatment for gout includes both medication and lifestyle changes. Medication can help block uric acid production and aid in the removal of it from the body. In addition to medication, achieving and maintaining a healthy weight can help reduce the risk of flareups. Staying hydrated, eating a balanced diet, and avoiding high-purine foods can also help with self-management of the disease. While avoiding all purines is not possible, the goal is to limit them. People with gout can learn by trial and error what their personal limit is for purine and which foods cause the most problems.
Foods to include (low purine):
- Fruits
- Low-fat dairy foods
- Nuts and nut butter
- Vegetables
- Water
- Whole Grains
Foods to avoid (high purine):
- Alcohol, especially beer
- High-fructose foods
- Organ meats
- Seafood and shellfish
A low-purine diet should be personalized to fit an individual’s dietary needs and food preferences. Some people with gout may need to limit moderate-purine foods in addition to high-purine foods. Talk to your doctor or dietitian for more information on a gout-friendly diet.
Additional Resources
Academy of Nutrition and Dietetics: Gout
American College of Rheumatology: Gout
Arthritis Foundation: Gout is an inflammatory type of arthritis that can come and go