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Update August, 2019

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Doctor's Consultation  by Dr. Iain Corness


Gout – is it just diet?

Gout is far more prevalent than you would imagine. This week I am looking at the diet for those with gout, and there are some famous sufferers out there, and in history. If you have gout, then you join with Henry VIII, Benjamin Franklin and Thomas Jefferson. It is indicated in around five percent of all cases of arthritis and is present in around three to five percent of the population, with males outnumbering women around nine to one. Afro-Americans and many Asian races also have higher incidence than Caucasians.

Gout is in its simplest fashion, a recurrent form of arthritis, and which generally affects just one joint – most commonly the joint in the big toe. This arthritis, or inflammation, occurs in association with high uric acid levels in the blood.

It is a condition that is still being researched, and there is still no complete agreement on the preventive treatment for this condition.

The higher the concentration of serum uric acid (SUA), the more likely you are to get an acute attack. The ‘normal’ range for SUA is taken as less than 0.42 mmol/L (called ‘milli moles’ per liter), but if your concentration is 0.54 mmol/L then you are five times more likely to get gout.

Basically what happens is, that with high concentrations of uric acid it crystallizes out into the joint, leaving very sharp, needle-like crystals crunching inside the articular surface of the joint. Very painful!

The typical gout sufferer is male in his 50’s, overweight, with high blood pressure, carnivorous and consumes large quantities of alcohol. Is that you? Or could it be almost be anyone in a pub near you!

Gout affects almost four million men in the USA. It has long been thought that purine-rich foods and a high protein intake are risk factors, and sufferers are advised to avoid meats, seafood, purine-rich vegetables, and animal protein. But this advice was based more on the theory of how excess blood uric acid can occur, rather than actual clinical studies.

One of the newer studies began on over 50,000 men from health professions in 1986. Food-frequency questionnaires were sent out at baseline, and again in 1990 and 1994. Weight, medications, and medical conditions were recorded every two years.

The participants were assigned to groups according to the total intake of meat, their consumption of seafood, purine-rich vegetables, dairy products, low-fat dairy products, total protein, and animal protein.

During the study, there were 730 new cases of gout during the 12 years of follow-up. Most of them were aged 55 to 64.

When total meat consumption was analyzed, the risk of acquiring gout was 1.41 times greater in the high meat eaters; in other words, eating more meat was a risk factor for gout. Similarly, high seafood eaters were 1.51 times as likely to develop gout. (Grass should be fairly safe I believe!)

In contrast, gout was less common in those taking more dairy products. Men who drank two glasses a day of skimmed milk, or ate a serving of low-fat yogurt more than twice a week, halved their risk of developing gout.

In this study at least, purine-rich vegetables, and total protein had no influence on the chances of getting gout.

This large study confirmed that a diet high in meat and seafood increases the likelihood that a susceptible person will develop gout. It also showed that milk proteins increase the excretion of uric acid in the urine.

So, to avoid developing gout, try to limit your intake of meat (beef, pork, lamb, and offal) and seafood, while increasing your intake of low-fat dairy products (skim milk, yogurt).

This is all very important, as the long term outlook is not good for the unrepentant gout sufferer. Constant high levels can lead to uric acid ‘stones’ being deposited in the kidneys (producing renal problems) and even discharging lumps (called ‘tophi’) around joints, on the forearms and even on the outer ears. Really a most bleak and depressing future, and not one I’d like to have.

Note too, that it is low-fat milk that is being proposed, as high fat milk introduces the cholesterol problems again! It really is a fine line that we must all tread!

Six years! The road to wearing a stethoscope!

To become a doctor many years ago, was a long road. I remember as an undergraduate looking at Med 6 students and thinking “They’re all old men.”

My road began many moons ago, though not quite as long ago as when JC played for Bethlehem United, but before Bic biros became commonplace and long before cling film and mobile phones. I had done very well in my scholastic life, partly through natural talent (said he modestly) and partly through un-natural pressure from my late father, who was a teacher at the school where I finished my secondary school education. Being a student where your father was on the staff was the pits? Dreadful!

I was unsure what career path to take, as all I wanted to do was go motor racing, so I was taken to an institute which would show those careers for which I was most suited. After innumerable tests, written and oral, my father and I were summonsed to hear my future direction. “He can do anything he wants to,” said the counselor to my father, as if I wasn’t in the room, thus losing my attention and respect immediately. We had traipsed in and out for these tests and I could do whatever I wanted to. Great! But I didn’t know what that was, as they don’t have trial career offers. “Let’s see if you should be an accountant. Pick up this pen and try pushing it…”

So it was home again and parental pushing. I had done well in maths and physics, so engineering was proposed. However, my late mother had been a nurse and I had enjoyed books like George Saba’s ‘Guerrilla Surgeon’, so I did have an interest in medicine as a career. I also worked out that if I became an engineer, I couldn’t be a doctor in my spare time, but if I became a doctor, I could fiddle about in engineering in my spare time (apologies to any engineer reading this)!

So it was Queensland University in Brisbane for six long years. Since those days, the more enlightened universities have made Medicine a post-graduate course and shortened it to four years. This way, the profession gets young people who really ‘want’ to do medicine, and nonsense subjects such as Botany are dropped from the curriculum (apologies to all botanists reading this, but I have not used one jot of botanical information in 50 years of being a doctor, but I do know the difference between a carrot and a banana).

My individualism brought me unstuck a couple of times. In those days, the consultants were given god-like personae. I had always considered that to become a deity, it should be given to you, not assumed and then lorded over lesser mortals. I was standing in the Medical School foyer when Dr Konrad Hirschfeld (Australia’s answer to Sir Lancelot Spratt – remember those movies?) barged in, a small portly man with a cigar. I did not move out of his way quickly enough and I was on the receiving end of “Don’t you know who I am, boy?” “Yes sir,” I replied, “But do you know who I am?” Individualism was not fostered in those days!

When we were first issued with ID cards, I read the reverse side which stated “This card must be carried at all times when on university property, and must be shown to any university staff member on demand.” I objected to the “must be” and the “on demand”, so I tore mine up. Very shortly I was summonsed to the Dean’s office. “Why did you tear up your ID card?” he asked. “Because I know who I am,” was my reply.

I ended up sitting my medical finals in the Royal Colleges of Physicians and Surgeons in London in 1966, after I had again upset the establishment in Australia (another long story of individualism and not really relevant today). Six years and 12,000 miles after I had commenced my medical course I rang my father reverse charges from London. Would he accept a call from “Dr.” Iain Corness? He did, and Dr. Iain Corness, with a shiny silver badge, was let loose on an unsuspecting British public!

HEADLINES [click on headline to view story]

Gout – is it just diet?

Six years! The road to wearing a stethoscope!