Gout and Purines

Gout is known to be a ‘rich-man’ disease that has been around since ancient times. The Egyptians first wrote about gouty big toes in 2600 B.C. With increasing affluence, anyone can be a victim of this ailment that can cause unbearable pain and discomfort, especially men who tend to have acidic blood. In recent times, youngsters are seeking treatment for it, as a result of consuming too much soft drinks, taking fast foods like fried chicken, sausages and avoiding fresh fruits and vegetables.

What is gout?

Gout is a joint condition and a type of arthritis. It attacks single joints, especially the big toe or multiple joints for more critical condition. It is caused by uric acid built-up in the blood being deposited as crystals in the joints and surrounding tissue. If left untreated, an acute attack will subside in a week or two, but gout is prone to recurrence. There are instances where patients get lumps of uric acid under the skin at the joints, known as tophi.

What are purines?

Uric acid in the blood is formed by the breakdown of purine which is found naturally in humans as well as plant and animal cells. They make up important components of the genetic materials, DNA and RNA, and energy molecules such as ATP, GTP and coenzyme A. Hence, they are essential constituents of life and consists of adenine, guanine, hypoxanthine and xanthine.

When cells die and get recycled, the purines in their genetic material are broken down, producing the chemical byproduct, uric acid. As most foods contain purines, it becomes a normal and healthy process for uric acid to be present. In fact, uric acid serves as an antioxidant and helps to prevent damage to the blood vessel linings.

Heavy purine breakdown is a prime factor that causes elevated uric acid in the blood if the body is unable to get rid of it fast enough. Coupled with the consumption of high purine foods, serum uric acid may rise above the normal level. Even though uric acid acts as an antioxidant and has a free-radical scavenging effect, when it accumulates to a high level in the blood, uric acid crystals are formed and deposited in our tendons, joints, kidneys and other organs.

The body’s defense mechanisms, including the white blood cells (neutrophils) engulf the uric acid crystals, which leads to a release of inflammatory chemicals (called cytokines) which cause all the signs of inflammation, including heat, redness, swelling and pain. This cycle also recruits more white blood cells to the joint which accelerates the inflammatory process.

Uric acid crystals can be thought of like matches, which can sit quietly or can be ignited. Crystals can be present for years in the cartilage, or even in the joint fluid, without causing inflammation. Then, at some point, due to increasing number of crystals or other inciting factor (eg. injury), the matches are “struck” and the inflammation begins. No wonder it occurs for the first time when someone is in their 80’s!

What is the normal level of blood uric acid?

Men	232-494MMOL (3.9-8.3mg/L)
Women	140-340MMOL (2.3-5.7mg/L)

Some people tend to have higher levels of blood uric acid than others, especially in those who have kidney disease, are overweight or obese, or are certain types of medication. As our kidneys are responsible for helping to keep the uric acid level balanced, critical kidney problem can lead to excessive accumulation of uric acid being transferred to other parts of the body as well. Uric acid level rises when there is massive destruction of cells or during fasting period.

Causes

+ Hereditary - The most common cause is a genetic defect in substances referred to as organic anion transporters in the kidney, which leads to an excessive reabsorption of uric acid from the kidney and thus too much uric acid in the blood.

+ In a 12-year study that followed eating habits and gout incidence in large number of men it was found that eating food rich in purine, such as meat and seafood, was associated with high risk of gout, whereas a higher level of consumption of dairy products was associated with a reduced risk. Moderate intake of purine-rich vegetables or protein was not associated with an elevated risk of gout.

+ The risk of getting gout increases when one is male, overweight and over the age of 40, or when one has certain blood disorders like leukemia or take certain hypertensive medications.

+ Women are less prone to getting gout as its female hormone estrogen provides protective effect by blocking the anion exchange transporter in the kidney, causing more uric acid to be excreted in the urine, and thus lower the level of uric acid in the blood. However, during menopause, excessive uric acid can find its way to the soft tissues of the ears, hands and feet. The worst scenario is deposition in the kidneys, leading to blockage and failure.

+ Other causes - A defect in excretion of uric acid can also occur due to medications, eg. diuretics, low dose aspirin or alcohol. Defective uric acid excretion also occurs when the kidneys are functioning poorly.

Food High or Low in Purines

Data in US shows the average daily diet for an adult contains approximately 600-1000 mg of purines. A low-purine diet is recommended for about a week to decrease their total daily purine intake to 100-150 milligrams.

Meat and fish appear to have high total purine content, where as cereal foods contain low purine content. Generally, there seems to exist a positive correlation between protein and purine content in diet.

Suitable Foods - Fresh fruits and vegetables, nuts (except peanuts), milk and milk products, white bread, white rice and plain noodles.

Foods to be taken in moderation - Meat, fish, eggs, poultry, scallop, lobster, mussel, oyster, crayfish, sunflower seeds, dry lentils, chickpeas, peanuts, peas, oatmeal, dried fruits, banana, jackfruit, spinach, capsicium, sweetcorn, cauliflower, chives, parsley, bean sprouts, leeks, broccoli

Foods highest in purine – AVOID

• Yeast extracts (e.g. Marmite)
• Animal organs such as liver, kidney, heart, brains
• Small fish, e.g. sprat, ikan billis, sardine, herring
• Trout, tuna, canned fish
• Fish roe
• Dried mushrooms
• Broths, meat stocks eg. chicken essence, gravies, stock cubes
• Soy bean and related products e.g. beancurd, bean paste, soya bean milk

Does cooking helps to reduce purine content?

Some of the purines were freed up into the cooking water and became lost from the food. If the water in which the food was boiled got discarded after cooking, purine risk can be reduced to a good extent.

Other considerations

· Eat balanced meals that include a variety of food.

· Decrease the amount of fat and oil used in your meals as the items will increase uric acid production.

· Get most of your energy from starchy foods.

· Use sugar in moderation especially if you are overweight.

· Avoid alcohol as it increases uric acid production.

· Maintain your ideal body weight and be more active as far as possible. Do not follow a crash diet even if you are very overweight, as it can bring on an attack of gout. Avoid a high protein diet to lose weight as this may trigger or aggravate a gout attack.

· Drink 2 – 3 litres (10 – 15 glasses) of water daily to dilute the uric acid.

· Do simple movements to prevent stiffness but do not over exercise or strain the affected joint.

. Go for regular medical checkup that include a test to measure uric acid level or an analysis of the joint fluids to detect uric acid crystals.

. Vitamins that can help:

- A sufferer with inadequate intake of Vitamin B5 produces high amounts of uric acid.

- A lack of Vitamin A worsens gout condition.

- Vitamin E deficiency causes damage to the nuclei of cells that produce uric acid, causing more uric acid to form.

Other comments

In the case of a patient undergoing chemo treatment, uric acid is often released in extreme amounts, resulting in gouty arthritis.

Proper dietary management with or without medications is essential to avoid further attacks and prevent complications.

Source: www.dietaryfiberfood.com/purine-food.php; http://www.whfoods.com/genpage.php?tname=george&dbid=51

VIVA Corner

+ To counteract the high uric acid level problem, conscious attempt should be made to turn the high acidity in the blood to high alkalinity. VIVA Green Barley serves this purpose well if considerable amount is taken during the detoxification period of a week or so.

+ VIVAGuard with its powerful antioxidants can help to scavenge free radicals and control the uric acid level in the kidney.

+ Vivashield has best combination of Vitamin A, C, E and selenium to eliminate free radicals and prevent further gout attacks.

+ VIVA Omega 3 acts as a blood cleanser and reduces any inflammation.