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Gout & Health

  1. What is gout?
  2. Are other illnesses associated with the development of gout?
  3. Can losing weight help my gout?
  4. Which foods should be avoided?
  5. How much protein do you need?
  6. Are there any foods that are good for gout?
  7. Eating healthily is key
  8. Beware sweetened foods and beverages
  9. Can I drink alcohol?
  10. Are some types of alcohol better than others?
  11. What about reduced alcohol beer?
  12. Is there a link between gout and binge drinking?
  13. Should I drink lots of water?

What is gout?

Gout is a type of arthritis. It is caused by having too much of the chemical, uric acid, in your bloodstream. Uric acid is the waste product created when the body breaks down purines (a type of protein found in many foods and all of your cells). Increased levels of uric acid in your blood may occur if, for example, your kidneys cannot efficiently remove it, you have a rare genetic abnormality, or because your diet and lifestyle increase the amount of uric acid that you produce. If levels of uric acid are high for prolonged periods, needle-like crystals can start to form in your tissues, resulting in swollen, painful joints. Your diet plays an important role in both causing gout and reducing the likelihood of suffering further painful attacks of gout. If you already suffer from gout, eating a diet that is rich in purines can result in a five-fold increase in gout attacks.

Are other illnesses associated with the development of gout?

Elevated uric acid is seen in many other conditions, and people who have gout may also have raised cholesterol, raised triglycerides (a type of fat in your blood), high blood pressure and poor glucose tolerance. This may make it more likely that you have (or will develop) type 2 diabetes, metabolic syndrome and kidney disease. In addition, approximately half of all gout sufferers are overweight. 

Central obesity (carrying weight around your middle) also increases certain inflammatory substances in your blood. This can further exacerbate gout attacks, as well as putting you at risk of developing heart disease, diabetes and metabolic syndrome. For further information on gout and related illnesses, download: All About Gout and other health problems from www.ukgoutsociety.org 

Can losing weight help my gout? 

Losing weight alone can reduce blood uric acid levels, and the number of acute attacks suffered. Weight loss will also help to reduce the stress on weight-bearing joints e.g. hips, knees, ankles and feet. However, it is important to avoid any type of crash dieting, as going without food for long periods and rapid loss of weight can increase uric acid levels and trigger painful gout attacks. A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely and maintain a healthy weight. 

Which foods should be avoided? 

As uric acid is made in the body from the breakdown of purines that come from your diet, it is advisable to reduce the amounts of foods that you eat that are high purines. 

High purine foods include: (avoid) 

  • Offal – liver and kidneys, heart and sweetbreads 
  • Game – pheasant, rabbit, venison 
  • Oily fish – anchovies, herring, mackerel, sardines, sprats, whitebait, trout 
  • Seafood – especially mussels, crab, shrimps and other shellfish, fishroe, caviar • Meat and Yeast Extracts – Marmite, Bovril, commercial gravy as well as beer 

Moderate purine foods (eat in moderation) 

  • Meat – beef, lamb chicken, pork 
  • Poultry – chicken and duck 
  • Dried peas, beans and legumes – baked beans, kidney beans, soya beans and peas etc. • Mushrooms and mycoprotein (Quorn™) 
  • Some vegetables – asparagus, cauliflower, spinach 
  • Wholegrains – bran, oatbran,wholemeal bread

Low purine foods 

  • Dairy – milk, cheese, yoghurt, butter 
  • Eggs 
  • Bread and cereals – (except wholegrain) 
  • Pasta and noodles 
  • Fruit and vegetables (see moderate purine list) 

How much protein do you need? 

Generally you need about 1g of protein per kg of body weight (70kg man only requires 70g of protein daily), unless you on a protein restricted diet e.g., some people with kidney disease may need to restrict their intake. 

Here are some examples of protein content of food: 

  • 100g (3.5oz) chicken breast contains 22g protein 
  • 100g cod fillet contains 21g protein 
  • Large egg contains 6g 
  • 30g (1oz) hard cheese contains 8g protein 
  • 30g cottage cheese contains 14g protein 
  • 30g almonds contain 5g protein 

Protein is very important part of your diet, it used for growth and repair, as well as an energy source. Not only that, but eating sufficient protein improves satiety (how full you feel) as well as blood sugar control. 

However, as its important to use high purine/moderate protein foods with caution, then you are best to combine both animal and vegetarian sources of protein. Studies have shown that vegetarian diets that are high in purines (e.g. from lentils etc.) are much less likely to lead to gout. 

In addition, red meat is a very good source of iron and is easily absorbed by the body. Other foods such as eggs and pulses contain iron, but in a form that the body finds hard to absorb. However, the absorption of iron can be improved if you also eat vitamin C – rich foods in the same meal e.g., add green and red peppers to scrambled eggs. 

Some people find that certain foods such as strawberries, oranges, tomatoes and nuts will trigger their gout even though they are not high in purines. Although there is no clear evidence to suggest why this happens, it is probably best to avoid them if you have had this experience. 

Are there any foods that are good for gout? 

Studies have shown that men whose diet is higher in vitamin C are less likely to develop gout. Also, taking additional vitamin C as a dietary supplement (500 to 1500mg/day) can reduce blood uric acid levels.This is achieved by helping to remove uric acid from the body via the kidneys. If you’re considering supplementing your diet, always discuss this with your doctor as vitamin C can (rarely) interact with prescribed medications. High doses of vitamin C can also cause loose stools in some people. 

Sour cherries or sour cherry juice have been used as a natural remedy for gout – and scientific research has shown that a certain type of cherry can reduce blood uric acid levels as well as reduce the inflammation that occurs with gout.

Eating healthily is key 

Eating a balanced diet is important for everyone. A healthy diet helps to control weight and provides all the necessary nutrients needed for maintaining good health. A variety of foods from the four main food groups should be eaten every day, this means: 

  • Plenty of fruit and vegetables – it’s very important to achieve at least 5-a-day, as fruit and vegetables provide fibre, vitamins, minerals and phytonutrients essential for good health 
  • Plenty of bread, other cereals and potatoes – try to eat some whole grains, and use the skin on potatoes to ensure you get the vitamins, mineral and fibre you need 
  • Moderate amounts of meat, fish and alternatives – avoid eating large portions – beware restaurants often serve 8oz of meat for a main 
  • Moderate amounts of dairy products – the recommended amount is three portions of dairy products daily e.g. 200 ml glass of milk, a pot of yoghurt and a 30 mg (matchbox-sized) piece of hard cheese 
  • Reduce or eliminate highly processed foods and drinks (see below) 

Beware sweetened foods and beverages 

Foods and drinks sweetened with fructose (often seen labelled as glucose-fructose syrup or corn syrup), as well as sweetened soft drinks, increase the risk of developing gout, as well as the number gout attacks. 

Sweetened soft drinks, and many commercial fruit juices (especially those from concentrate), are a poor substitute for fruit, as they do not contain any fibre, and are effectively ‘empty- calories’. 

Also be careful buying jams and sweetened condiments. Many manufacturers are now using glucose fructose syrup (also known as high fructose corn syrup), as it is cheaper than cane or beet sugar. 

Diets that are high in refined (easily digested) carbohydrates for example, white bread, white pasta, white rice, biscuits and cakes, also increase the risk of developing type 2 diabetes, and are linked to obesity 

Therefore, try to avoid sweetened soft drinks, and reduce the amount of sugar in your diet other than fresh fruit. 

Can I drink alcohol? 

Drinking alcohol can increase your risk of developing gout and can bring on a sudden attack if you are already a gout sufferer. Alcohol can raise the level of uric acid in the blood in a number of ways and so trigger a gout attack. Many beers contain large quantities of purines from the fermenting process and alcohol stimulates the production of uric acid by the liver. More importantly, however, alcohol is converted in the body to lactic acid which interferes with the removal of uric acid from the body by the kidneys. 

While it is certainly possible for people with gout to remain well without becoming teetotal, reduction in alcohol consumption is very important particularly if you are drinking more than the recommended healthy limit of 21 units per week for men or 14 units per week for women.

1 unit of alcohol is provided by: 

  • ½ pint of standard strength (3-4% alcohol by volume) beer, lager or cider 
  • 125ml glass of wine (11%, 100ml glass of stronger wine) 
  • Single measure of spirits (25ml) 
  • Single measure of sherry or fortified wine (50ml)

Are some types of alcohol better than others? 

A study has shown that the risk of developing gout is greater in even moderate regular beer drinkers than in those who drink equivalent amounts of alcohol in the form of spirits or wine. Gout was two and a half times more frequent in men who drink two bottles of beer a day while two glasses of wine daily was not associated with an increased risk of developing gout. 

What about reduced alcohol beer? 

We are not aware of any specific studies with low alcohol beers but it seems probable that they are less likely to cause gout. 

Is there a link between gout and binge drinking? 

Some people say that their gout attacks follow quickly after a heavy drinking session. Indeed, it is well established that binge drinking may trigger attacks in people who suffer with gout, even when they are taking medicines to prevent them. 

Should I drink lots of water? 

Yes, drinking fluids reduces the likelihood of crystals forming in the kidneys. As a general rule, drinking 8 large glasses of fluids a day (1.5 litres) is recommended. All drinks, except alcohol, count towards your fluid intake, including caffeine-containing drinks such as tea and coffee. Caffeine can act as a mild diuretic, which means it causes you to pass urine more often. However, regular tea and coffee drinkers develop a natural tolerance to caffeine and will only experience mild dehydration if they consume more than their usual amount. Caffeine itself may have no direct influence on the risk of developing gout, as research has shown that coffee intake, but not tea, may in some people be associated with slightly lower blood levels of uric acid than those drinking the same volumes of tea

This leaflet is not a substitute for professional medical advice and should be used in conjunction with verbal information and treatment given at London Bridge Sports Medicine. 

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.