"Even if you have gout, it is possible to lead a relatively normal life, if you avoid the factors that trigger gout attacks, and keep your uric acid level within the target advised by your doctor! 

So, in that sense yes, you can at least control gout," shares Dr Ng Lee Beng, Senior Consultant from the Department of Family Medicine Continuing Care at Singapore General Hospital (SGH), a member of the SingHealth group,

 Foods to avoid (to prevent gout attacks)

Avoid completely or eat less of these foods that are likely to trigger a gout attack:

  • Common sweet drinks containing high fructose corn syrup and

  • Foods rich in purine such as 
    - Organ meat (liver and kidney),
    - Red meat (lamb and beef),
    - Seafood such as shellfish (mussels, crab, shrimp, lobster) and oily     fish (anchovies, sardines, mackeral), and

  • Alcohol especially beer

"The two main pieces of advice I often give gout patients are: Avoid indulging in sweet drinks and rich food, especially organ meats, seafood and alcohol. Also, keep well hydrated daily! Drink lots of water (at least 8 to 12 cups) especially during exercise and in hot weather," Dr Ng said.

 Foods to eat

As a person suffering from gout, you may wonder if there are certain safe foods that you can consume more frequently or in larger amounts. 

Rather than think this way, Dr Ng advocates the following when it comes to diet:

Observe a balanced healthy diet to maintain a healthy weight.

A healthy balanced diet consists of:

  • Carbs: Consume more complex carbs (like oats and brown rice) rather than processed food. Avoid white bread, cake, candy and sweet drinks.

  • Fats: Cut down on saturated fats from red meats, fatty poultry and high-fat dairy products.

  • Water: Drink 8 to 12 cups of water a day

  • Protein: Eat plant-based protein from beans and nuts, or eat lean meat, poultry fish and low fat dairy products

  • Vegetables and fruits: Eat more from this group.
    Please note: High-purine vegetables do not cause gout

"The (HPB) My Healthy Plate is a good guide to follow. Eat a quarter plate of complex carbs like oats and brown rice. Avoid refined carbohydrates. Also, eat half a plate of all kinds of vegetables. Lastly, fill the last quarter of your plate with plant-based or low-fat protein. This can include bean curd, tempeh and dhal," Dr Ng advised.

"Many also have the misconception that nuts and beans, especially soya products, cause gouts.

"Many research studies have shown consistently that vegetables, soya products, nuts and beans do not cause gout," clarified Dr Ng.

In fact, eating more of these foods will help you feel full longer, and leave less stomach space to be filled with foods and drinks that trigger gout.

Can exercise prevent gout attacks?

"Yes, exercising regularly can help prevent a gout attack. Aim to have at least 150 to 300 minutes of moderate-intensity activity a week. Moderate intensity exercises such as brisk walking, cycling or swimming is good. Adding on strength exercises at least twice a week to that will be a healthy holistic long-term option," Dr Ng shared.

Gout attack / gout flare: What to do

Gout is a condition that can cause sudden, excruciating pain and swelling in the affected joints, particularly in the big toe. Such an episode is called a gout attack or gout flare.

For quick relief, the trick is to:

Seek treatment immediately! Taking medication that reduces inflammation within 24 hours is effective! You can also rest and ice the affected joint until the gout pain resolves by itself.

The choice of anti-inflammatory medication depends on the severity, number of joints involved and associated medical conditions. Such medication include:

Non-drug methods to reduce gout pain include

  • Rest the joint – Gout is self-limiting and will settle in a few days without treatment, if you can bear the pain.

  • Ice the inflamed joint

  • Avoid the drinks and foods that trigger the attack

Following a gout attack, it is vital to bring down your uric acid level through lifestyle measures and medication, so as to minimise the chance and severity of future gout attacks.

If your uric acid is high over a prolonged period, it causes chronic gout leading to:

  • Gout Tophi, which are nodules formed by uric acid deposits over the fingers, elbows, ears or heels, which can be disfiguring

  • Progression of flares: Gout attacks become more often and can affect other joints such as the ankles and knees.

  • Over time, this can lead to permanent damage such as cartilage and bone erosion, resulting in joint damage, deformity and functional disability

  • Build up of uric acid can also lead to kidney stones, kidney damage and kidney failure.
    Kidney disease, which reduces urine secretion, in turn worsens the gout condition as uric acid, which is expelled from the body in urine, starts accumulating when its excretion goes down.

7 Tips to prevent gout attacks and lower gout risk

The same tips that help to lower risk of getting future gout attacks also apply to those who do not have gout at all and want to lower their risk:   

  1. Adopt a healthy balanced diet – Consume complex carbs, lots of fruit and vegetables and preferably plant-based, or at least low-fat animal proteins.

  2. Drink plenty of water at least 8 to 12 cups.

  3. Exercise at least 30 minutes daily (for example, brisk walking, cycling, swimming)

  4. Take medication, if prescribed, do not stop on your own!

  5. Check uric acid level regularly and maintain below the level advised by your doctor
    - Target serum urate: <350mg/dl
    - Tophaceous gout: <300mg/dl

  6. Maintain a healthy body weight

  7. Avoid drinking alcohol and smoking

What causes gout?

Gout is an inflammatory condition of the joints which occurs when there is excess uric acid in the body.

Uric acid is a waste product produced in the breakdown of purine, which is part of human tissues and is also found in a lot of high protein food.

A gout attack or gout flare occurs when there is an abrupt change in uric acid level. 

High uric acid level occurs when too much uric acid is produced and not excreted fast enough by the body. This can occur after taking a meal high in purine content or after drinking sweet drinks or excess alcohol, especially beer.

The accumulated uric acid forms crystals which are deposited in parts of the body, particularly in joints. As the body regards uric acid crystals as an outsider, this leads to an inflammatory response.

The result is a joint that is very painful, swollen, hot, warm and red. The big toe is most commonly affected.

A gout attack can also occur when uric acid level suddenly goes down, for example when treatment is just started, however this is more uncommon.

What are the risk factors for gout?

Gout is hereditary so having family members that suffer from it increases your own risk. Other risk factors for gout include:

  • Consuming a diet high in organ meat, red meat, shellfish and oily fishes, drinking a lot of drinks sweetened with fructose, and alcohol, especially beer

  • Age: Men over the age of 45 and post-menopausal women have increased risk

  • Gender: Males have increased risk compared to females

  • Ethnicity: Certain ethnicities such as Hispanics have a higher risk

  • Being obese increases risk of gout

  • Having chronic conditions such as high cholesterol, Type 2 Diabetes Mellitus and kidney disease

  • Certain medication such as diuretics and immunosuppressants used by transplant patients

  • Having a high uric acid level
    - Target serum urate: <350mg/dl
    - Tophaceous gout: <300mg/dl

Gout: How to treat

There are two classes of medication used to treat gout:

  1. The first group is to reduce the pain and swelling of acute gout and 

  2. The second group is to lower the uric acid level to prevent the next flare

"The choice of medication depends on the severity of the gouty attack, how many joints involved, the uric acid level and what other medical conditions you may be having.

Consultation with your doctor is needed to choose the medication that best suits you at that point in time," Dr Ng explained.

Gout and chronic conditions: Is there a link?

"There is a definite link between gout, diabetes, high blood pressure (hypertension) and high cholesterol as all these conditions can have a common starting point: a diet that contains high levels of saturated fat and fructose (sugar). Such a diet results in the production of various products in the liver that give rise to this constellation of diseases," affirmed Dr Ng

Fructose is broken down in the liver to form uric acid which causes gout, at the expense of the liver producing a more useful substance that could have helped to keep blood pressure down, so blood pressure goes up. 

"Fructose also pushes the formation of cholesterol and triglyceride which result in fatty liver. Fatty liver in turn is related to insulin resistance where the body's ability to control sugar level goes down. 

So yes, gout is part of the group of chronic diseases directly caused by a suboptimal diet that is high in processed food and drinks containing fructose," Dr Ng explained.

Ref: H24

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