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Obesity and Gout

Gout is a type of arthritis caused by the build up of uric acid in various joints around the body, with most cases being recorded around the big toe. (1) (2) Uric acid is a compound made of various elements (carbon, nitrogen, oxygen and hydrogen) and is formed in the body through various means that are related to genetics, dietary problems as well as rapid weight loss. (3) Obesity, inadequate diet and alcohol have all been related to being factors that can cause hyperuricemia (abnormally high levels of uric acid in the blood). (4) The insulin resistance (and subsequent obesity) that comes hand in hand with diabetes has also been sometimes identified as having a close relationship with gout. (5) When the bloodstream has high concentrations of uric acid in it, uric crystal structures are deposited around various joints in the bodies, which cause the arthritic pains that have been described as throbbing, crushing and excruciating. (6)

The prevalence of gout

As human populations have increased worldwide, it only seems natural that according to the according to the National Health and Nutrition Examination Survey III (NHANES III) “gout prevalence has approximately doubled over the last two decades, now affecting over 5 000 000 Americans.” (7) It also seems that men are affected more frequently than women. (8) But it would be dismissive to claim that the rise in gout is merely a result of population explosion and various factors have been identified as the reasons for the increase in victims, such as “increases in longevity, use of diuretics and low-dose aspirin, obesity, end-stage renal disease, hypertension and metabolic syndrome.” (9)

The relationship between obesity and gout

Obesity has become a serious public health problem and has often been considered a disease, but the truth is that obesity is just a symptom of a much worse condition known as metabolic syndrome. (10) (11) Obesity is defined as having a body mass index of greater than 30, and has also been associated with a number of diseases and conditions such as hypertension, hyperlipidemia, coronary artery disease and hyperuricemia. (12) The most significant of these to the study of gout is the last one, hyperuricemia and there have been quite a few studies that have linked metabolic syndrome to an increased risk of gout. (13)

One of these, published in 2004 in the journal Arthritis & Rheumatism, states that the prevalence of gout appears to be increasing because of “changes in diet, increases in longevity, hypertension, metabolic syndrome, and advanced renal disease, and the broad use of diuretics in clinical practice.” (14) An earlier study conducted at the Centers for Disease Control in Atlanta also concluded that “metabolic syndrome is highly prevalent.” (15) Another large and important study concluded that “the metabolic syndrome typically affects 20–30% of middle-aged adults in the U.S.” (16)

Hypertension and its relationship to gout

Hypertension, one of the symptoms of metabolic syndrome, is a medical condition characterized by very high blood pressure. Approximately 90–95% of hypertensive patients suffer from the condition due to barely identifiable causes, but many doctors and researchers claim that the main ones are a sedentary lifestyle, smoking, alcohol, visceral obesity and general obesity. (17) Some of the relevant procedures for dealing with hypertension related to obesity and gout are weight reduction as well as regular aerobic exercise, the reduction or even elimination of sugar (and all other foods that are transformed into sugar such as carbohydrates) from the diet, a reduction of sodium (salt) and an increase in potassium, quitting smoking and alcohol consumption as well as reducing stress. (18) Dietary changes, physical exercise and weight loss are the first things to be done when fighting hypertension that can cause gout.

Treatment of gout

The first treatment for gout is always medicinal, because the pain is so unbearable. A variety of drugs are used, such as NSAIDs, Colchicine, steroids, Pegloticase, and Prophylaxis. Ice can also be applied to the affected area for 20-30 minutes a day to ease the pain. Lowering uric acid levels through a diuretic process and changes in diet will need to be applied for long-term removal of uric acid from the blood and removal of the disease. (19) (20)

Gout and alcohol use also linked to obesity

Gout has also been traditionally linked to excessive alcohol use and obesity. Most alcohol (with the notable exception of wine), contains high levels of carbohydrates, which are converted into sugar by the metabolism. This is particularly true for beer, which is largely made of grains such as barley and rye. The high carbohydrate content in many alcoholic drinks translates to sugar in the bloodstream, which is converted into fat deposits and leads to obesity. Obesity and gout have also been shown to be linked, so heavy alcohol drinkers are more likely to suffer from gout at some point in their lives as well, unless they take steps to reduce their weight. (21) (22)

Uric acid, gout and obesity

Science has also shown that uric acid levels can significantly decrease as weight is lost. (23) This has been demonstrated to be intimately related to insulin levels in the bloodstream and the metabolic syndrome in general. (24) One of the most indicative symptoms of the metabolic syndrome is obesity. While one factor for the development in the blood of high levels of uric acid is the vast quantities of insulin created by the pancreas circulating throughout the cardio-vascular system, it needs to be addressed that there is a cause for the high levels of insulin in the first place. This is intricately linked to the excess body-fat, which is now considered an organ in the body that has grown way out of proportion and is releasing too much hormones into the bloodstream that imbalance the entire metabolic system, causing the excess of insulin. (25)

The ultimate cause of high levels of uric acid in the blood, however, seem to be fructose and a number of studies are beginning to investigate this possibility. (26) If the causes of obesity and then metabolic syndrome turn out to be highly-related to sugar intake (in all its forms), then significant developments can be made in the field of nutritional science in order to better determine the optimal dietary intake, physical exercise needs and lifestyle changes needed for maximum longevity and health.