Gout: The Disease of Kings… and Everyone Else (Part 1)

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You might be thinking that it’s a little bit odd to be writing about gout on a diabetes Web site. What could the two conditions possibly have in common, you ask? Surprisingly (or perhaps not), quite a bit.

Gout is a type of chronic, progressive arthritis that occurs when high levels of uric acid get deposited as crystals around the joints and sometimes, in soft tissue. The uric acid crystals cause an inflammatory type of arthritis that leads to pain (often very intense), redness, and swelling. The most commonly affected joint is the big toe, but the ankle, heels, knees, wrists, fingers, and elbows may be, as well. Left untreated, uric acid crystals can form hardened lumps in the joints and in tissues, leading to joint destruction, kidney damage, and kidney stones.

Gout has been termed the “disease of kings” because it used to be that royalty and other wealthy folks were afflicted (after dining on too much rich food and drink). Even Saint Gregory the Great suffered from this painful condition. However, gout doesn’t discriminate: According to the National Health and Nutrition Examination Survey 2007–2008, almost 4% of adult Americans have had gout at some point. Men suffer more than women (6% of men versus 2% of women). And gout is on the increase.

Gout and Diabetes
Linking gout with diabetes isn’t anything new. In fact, the possibility of a connection was established in the late 18th century. But it doesn’t take a rocket scientist to make sense of this connection: As overweight and obesity increase, so does the prevalence of Type 2 diabetes and gout. People with gout and people with Type 2 diabetes share some common risk factors:

• Being overweight or obese (for the most part)
• Not getting enough physical activity
• High uric acid levels
• Insulin resistance
• High blood pressure
• Decreased circulation

Triggers for Gout
High levels of uric acid (called hyperuricemia) are the main culprit behind the development of gout. Uric acid is formed from the breakdown of cells in the body and also from purines (substances found in food). Normally, the kidneys can handle uric acid and they excrete excess amounts in the urine. When too much uric acid is formed and it builds up in the blood, the time is ripe for gout to set in. Not everyone with high uric acid levels gets gout, however. But there are certain triggers, or risks:

• Genetics (yes, gout can run in the family)
• Alcohol use
• Joint injury
• High triglyceride (blood fat) levels
• Diuretics (“water pills”)
• Cyclosporine (an antirejection medicine)
• Chemotherapy
• Radiation therapy
• Surgery or a sudden illness
• A high intake of red meat, shellfish, or organ meats (such as liver)
• A high intake of fructose from sweetened soft drinks
• Crash dieting
• Starting on uric acid-lowering medicine

Of course, none of the above is a guarantee that you’ll be hit with gout, but if you do have gout, it’s helpful to pay close attention to what your triggers are so that you can take steps as much as possible to avoid or limit them. You may not know what your uric acid level is, so you might ask your doctor to check this. It can be measured with a simple blood test. Reference ranges for uric acid can vary from lab to lab, but in general, for men, a normal uric acid level is between 3.4 and 7.0 mg/dl; for women, 2.4 to 6.0 mg/dl.

High uric acid levels may be a result of kidney disease, liver disease, cancer or cancer treatment, alcoholism, starvation, hypothyroidism, obesity, and taking certain medicines. And to make matters more confusing, people with high uric acid levels don’t necessarily get gout. But it’s certainly a risk factor. You should also know that, in one study, men with high uric acid levels had a 19% higher risk of developing diabetes than men with normal levels. High uric acid levels also up your risk for heart attack and heart disease.

So, we’ve established that uric levels can be a trigger for gout if they get too high, and that Type 2 diabetes and gout are intertwined. Next week, we’ll look at what you can do to prevent gout and how to treat it if it does occur.

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