Arvind Naveen is one among the thousands of teens who dreams of becoming the next Cristiano Ronaldo in the soccer frenzied coastal city of Kozhikode in the state of Kerala. However, in late 2020, during one of his weekend football practice sessions, Arvind started experiencing an on and off pain in his ankles, which was initially thought to be some sort of muscle or ligament injury. The pandemic restrictions had also scrambled his daily dietary and lifestyle routines. He had gained a couple of kilos and was inching close to 65 kg. Traditional home remedies were tried on him and were initially effective. However, the pain relapsed after a couple of weeks and he was taken to a doctor and diagnosed with gout.
What is gout?
“I initially thought that the pain would be related to a sports injury, but then his test report reflected high levels of uric acid,” says Amritha Naveen, Arvind’s mother.
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According to the Centers for Disease Control and Prevention (CDC), hyperuricemia (elevated uric acid level) triggers gout and overweight people, especially those with exceedingly high body mass index (BMI) are at higher risk. It is also pointed out that gout often flares up with extreme pain and swelling. However, it will subside into remission after a couple of days with lifestyle management. Medical intervention is needed only if required.
Arvind was not prescribed any medication but was asked to adopt a healthy diet and stop having red meat, sea food and aerated sugar drinks.
“I excluded animal proteins (apart from occasional chicken) from his diet and switched to green vegetables and fruits at home. He lost around six kilos and his uric acid level decreased,” explains Amritha. She also added that Arvind’s uric acid level during a recent check was well within the normal range of around 6 mg/dL.
Role of purine and uric acid in gout
Dr Garima Aggarwal, consultant nephrologist and renal transplant physician, Manipal Hospital, Bengaluru, explains that uric acid is produced when the body breaks down substances called purines formed during the breakdown and synthesis of our cells. She also adds that purine (also known as nuclear bases) is one of the cellular components which is involved in cell formation and other cellular reactions.
“Our cells contain nuclear material which gets metabolised during cellular formation or breakdown to form purine. About 70 percent of the purine in our body comes from this process,” she adds.
The remaining 30 percent comes from our diet, mainly from red or organ meat, very sweet drinks, alcohol and all kinds of sea food including scallops and lobster. The liver breaks down this purine into uric acid which is then expelled from the body. If the uric acid levels are high along with inflammation, then the kidney will not be able to process and expel it through urine which leads to the formation of uric acid crystals (monosodium urate crystals). These crystals cause painful swelling in our lower limb joints.
Connection between body weight, uric acid and gout
According to Bengaluru based diabetologist Dr Ashwitha Shruti Dass, the higher the BMI, the more are the chances of a person developing gout. “Most of the time, people affected with gout are overweight and have a habit of eating red meat and highly processed foods,” she explains. There could also be some genetic reasons, she adds.
Multiple research studies have also confirmed the association between excess body weight and increased gout risk. Dr Dass also says that gout usually affects the lower limbs.
Dr Aggarwal further adds that there is a linear correlation between BMI and increased uric acid levels.
“There are some studies which say that for every 5-point increase in BMI above 25, there is a 55 percent higher risk of having elevated uric acid level. “That’s how high the correlation is,” explains Dr Aggarwal.
Overweight people are vulnerable
Excess visceral fat deposition (especially around the abdomen) due to insulin resistance and systemic inflammation is very high in overweight people.
Insulin resistance: Dr Belinda George, endocrinologist and associate professor, St John’s Medical College Hospital, Bengaluru, says that according to research, insulin resistance coexists with obesity. She says that when insulin is not able to breakdown glucose and ensure energy expenditure, it gets internally deposited as visceral fat. She also adds that this will hamper uric acid removal by the kidney leading to elevated uric acid levels.
Systemic inflammation: This is the common thread connecting obesity, type two diabetes and hypertension. Chronic low-grade inflammation (occurring at the cellular level) which alters cellular functioning is attributed as the reason for insulin resistance.
“All these changes, starting from insulin resistance result in metabolic syndrome and people with this syndrome are likely to have elevated uric acid levels,” explains Dr George. She further adds that uric acid is also produced during fat metabolism.
Managing uric acid through diet
Eating habits of overweight people have a bearing on their purine levels.
Apart from high-protein red meat, people who consume refined foods, saturated fats and sugars are more likely to have high uric acid levels.
“Obese people who have a high-purine diet consisting of protein and artificial sugar are more likely to be affected by gout and other metabolic disorders,” explains Dr Aggarwal.
How to keep uric acid under check?
Normal blood uric acid level ranges between 3.5 to 7.2 mg/dL. Most experts don’t advise medication unless the affected person has other comorbidities. Dr Aggarwal says that a healthy person diagnosed with high uric acid level should try to control it with diet and an active lifestyle for about two to six months and then opt for medication only if required.
A few ways of keeping uric acid under check include:
- Maintaining a healthy diet and an active lifestyle.
- Keeping an eye on protein intake and avoiding red and lean meat along with sea food.
- Avoiding alcohol consumption.
- Adopting Mediterranean or DASH Diet with less purine and more vegetable and plant proteins.
- Avoiding refined carbohydrates and having complex fibre-rich foods.
Takeaways
- There is a direct link between gout and obesity. Overweight and obese individuals are at higher risk of developing gout which is a painful variant of inflammatory arthritis.
- Medication is usually not required if high uric acid levels are brought down through diet and lifestyle alterations.
- Protein-rich food items should be either avoided or consumed in moderation in order to control high uric acid levels.
