Over the last few years I have noticed a substantial amount of men affected by gout; however it seems much less prevalent in women. I asked a few people and I really didn’t get a solid answer, so I did a little digging and found a really cool article published in the New England Journal of medicine in 2004 “Uric Acid and Diet — Insights into the Epidemic of Cardiovascular Disease"
Summary points:
· Gout has been described throughout history, as early as 4 B..C; originally thought to be a disease of the wealthy, affecting middle-aged men of wealthy upper class. It was associated with those that could afford the opportunity of overindulgence.
· “Humans are the only mammals which gout develops spontaneously.” This is thought to be because of mutations that occurred in the promoter region of the uricase gene. Uricase is the enzyme that converts uric acid to allatoin.
· This point addresses the men vs women factor: Estrogen stimulates urinary urate excretion, thus premenopausal women have lower serum uric acid levels.
· In the 1700’s it was proposed that a diet low in protein and high in dairy could decrease gout’s prevalence. Study in 2004 found gout was associated with diets high in meats and seafood and low in low-fat dairy. In fact they found an increase in risk of 21% per addition portion of meat per day. Populations with diets low in animal products and high in vegetables have a relatively low uric acid levels.
· Gout development is now following our current obesity trends. Higher populations of obesity have higher incidences of gout; even when these populations had lower rates throughout history, when obesity rates were lower (i.e. Maori of New Zealand).
· Recommend diets rich in fruits, vegetables and low-fat dairy foods (i.e. DASH diet)
So it seems that gout is following the obesity footsteps across the world, leaving behind the “wealthy” stereotype of the past and now affecting those at high risk of many other co-morbidities. Looks like it all comes back to a healthy diet…..
Johnson, R and Rideout B. Uric Acid and Diet--Insights into the epidemic of cardiovascular disease. N Engl J Med 2004; 350:1071-1073
Interesting info, Lindsey. It's interesting because we are starting to see a shift of a lot of the obesity related diseases to be diseases of lower socioeconomic status, potentially due to the obesigenic environment and the high cost of a number of healthy foods. The times, they are a-changin.
ReplyDeleteAlso, I thought the info on estrogen was useful, because I definitely tend to think of gout as only affecting men. Here, we see that estrogen helps eliminate uric acid, so premenopausal women typically don't experience gout. I wonder about pregnant women, or if gout takes a long time to manifest...?
Oh, and I like that they recommend the DASH diet... one of the only diets that seems pretty reasonable.