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Gout is undeservedly the subject of jokes but it shouldn’t be because of the serious nature of the condition and the considerable discomfort the sufferer finds him/herself in. Gout typically affects men over 40 and women over 50 but it can strike on other age groups as well. It is commonly associated with being overweight and with a tendency to diabetes and hypertension. The single most important cause of gout is of course hyperuricemia, and excess of uric acid formed by purine metabolism. However it is not the only cause, as it needs a low blood acidosis for the uric acid to precipitate and form crystals in the joints. Once this happens, the symptoms show suddenly and dramatically, typically in one of the big toes for 75% of cases, but also in the ankle, knee, wrist and fingers. The typical scenario is this: the big toe suddenly appears greatly swollen, inflamed and very sensitive to the slightest touch upon waking up in the morning, causing a great deal of pain and reduction of daily activities. Uric acid is normally excreted via urine, but a protein rich diet can overload the kidneys leading to an accumulation of uric acid until eventually will precipitate and form the crystals with the painful consequences. Red meat and sea food are widely regarded as the main culprits for uric acid build up because they are high in purines due to the vast number of mitochondria present in lean muscle tissue cells. Not just protein rich foods, but also alcohol consumption can lead to the same results, with beer being the usual trigger of a gout attack. It is possible to deal with the problem with different approaches. Firstly, by reducing the symptoms, like pain and swelling. Secondly, by preventing further attacks. Thirdly, by reducing uric acid. Non steroidal anti inflammatory drugs and colchicine are effective in reducing pain and swelling but they are what they are, drugs with all the unpleasant side effects. They cure the symptoms but not the root cause. Reducing the supply of purine and dissolving crystals back into the blood stream so they can be excreted in order to prevent them from happening again is a better approach. A complete overhaul of diet to reduce permanently uric acid is the best solution. It is best to do something about gout as soon as it shows up and before the onset of tophi or the gout become chronic. At that stage only surgery can remove tophi and correct joint deformity from arthritis. Diet should be void of meat, fish, alcohol and fructose while drinking plenty of water to facilitate dilution and excretion of uric acid. Protein supply should be left to dairy products only, milk and cheese, as they are low purine. No muscle tissue cells here, just amino acids, the building blocks of proteins. To sum it up a gout treatment is relatively easy to manage and the diet implementing it should not be boring or incomplete by any means.
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