Gout in Women, and How Menopause Fits into the Picture

When one thinks of gout an image of an older grumpy man (perhaps going through andropause) with a throbbing painful swollen big red toe and a bottle of red wine immediately jumps to mind.  As far back as Hippocrates time – gout was known as the “disease of the Kings”. It was also noted then that premenopausal women and prepubescent men were not afflicted by the disease. (1,3)

Yet gout is one of the most common inflammatory arthritides. An arthritide is characterised by pain, swelling, stiffness and often inflammation of the joints. It is associated with high levels of uric acid and is caused by crystals being deposited in and around joints. It is believed that lowering uric acid levels through small changes in the diet may help reduce the incidence of gout attacks. Gout is approximately twice as common in men, but the risk does increase with age in both sexes. (2,4,5)

It is thought that oestrogen may help the kidneys remove uric acid, therefore when oestrogen levels begin to drop in menopause, blood uric acid levels may begin to increase. In a study involving over 7,000 women, the relationship between menopause, post menopause and uric acid levels was investigated, and it was concluded that menopause is associated with high serum uric acid levels. (6)

Gout has increased in recent years both in prevalence and frequency. A number of epidemiological studies have identified the risk factors which include: genetic predisposition, excessive alcohol consumption, a purine-rich diet and metabolic syndrome. (4)

Let’s focus on the lifestyle risk factors that are within our control and look at what you can do to prevent the onset of gout.

Chronic gout is difficult to treat and strict adherence to lifestyle and dietary changes is necessary.

Exercise and activity have been shown to be strong preventers of gout, together with maintaining a healthy, ideal weight. (3)

Reduce animal derived purine rich foods:

Which foods are high in purines? A purine is a type of chemical compound found in many foods, some having higher concentrations than others, and a higher consumption of these foods has been shown to increase the risk of gout. Animal derived purines include mainly organ meats, meats, and seafood. Purine rich vegetables however don’t seem to have the same impact. According to Choi et al, a moderate intake of purine rich vegetables such as peas, lentils, spinach and mushrooms does not appear to increase gout. Though, when it comes to meat, the risk has been shown to be increased by 21% for each meat serving. (3,9,10)

Avoid alcohol:

Alcohol consumption has been associated with higher uric acid levels, as it interferes with the body’s ability to eliminate uric acid. Beer, in particular, increases the risk more than other alcohol beverages and should be avoided. (3)

Some foods to INCLUDE in your diet:

Cherries – including cherries in your diet has been seen to be an effective “anti-gout remedy” as studies have shown a decrease in uric acid plasma levels within hours of eating fresh cherries. (8)

Fresh fruit and vegetables – it has been shown that vitamin C intake is strongly associated with a lower risk of gout and therefore a diet rich in Vitamin C whole foods such as capsicum, kiwi, berries, mangoes, strawberries and broccoli may be hugely beneficial in the prevention of gout. (3,7)

Low fat dairy foods – clinical studies have shown that there is an association between a low fat dairy diet and a decrease in the risk of gout. Choose sensibly though – for example a low fat organic biodynamic Greek yoghurt without additives or sugar is a good option. (3,9)

There is a lot you can do to prevent gout.

• Achieve your healthy ideal weight – lose weight if you need to.
• Exercise – be active.
• Reduce animal derived purine rich foods like meat and seafood.
• Avoid alcohol and soft drinks.
• Avoid trans fats, white refined carbohydrates and sugar.
• Eat more fruit and vegetables (high in Vitamin C).
• Eat more cherries.
• Make sensible healthy low fat dairy choices.
• Keep well hydrated.

Practice LIFESTYLE medicine in the prevention of chronic disease.

Feel free to contact us to chat about your diet and the changes you can make to it to ensure long term health.

References

1. Star VL, Hochberg MC. Prevention and management of gout. Drugs, 1993, 45(2), 212-222.
2. arthritis australia.com.au/information sheet.
3. Hechtman L, 2012, Clinical Naturopathic Medicine, Elsevier Australia, pages 556 -558
4. Roddy E, Zhang W & Doherty M, 2007, The changing epidemiology of gout, Nature Clinical Practice Rheumatology, Vol 3, pages 443-449
5. Perry ME & Sturrock RD, 2007, Gout is a risk factor for cardiovascular disease, The Practitioner.
6. Choi HK, Hak AE. Menopause, postmenopausal hormone use and serum acid levels in US women – The third national Health and Nutrition Examination Survey. Research article, 2008 online at http://arthritis-research.com/content/10/5/R116
7. Choi HK, Gao X & Curham G, 2009, Vitamin C intake and the risk of gout in men, Arch Intern Med, vol 169:5,502-507.
8. Jacob RA, Spinozzi GM, Simon VA et al. Consumption of Cherries lowers plasma urate in healthy women. J Nutr 2003; 133: 1826-9
9. Choi HK, Atkinson K, Karlson E et al. Purine rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004:350: 1093-103
10. Zang Y et al, 2012, Purine-rich foods intake and recurrent gout attacks, NIH; 71(9): 1448-1453