Gout- a very ouchy problem!

I hadn’t ever expected to blog about gout, but a few things have pushed it to the forefront of my attention lately.

One- I discovered that a friend my age has it quite badly and two: I didn’t realize this is just one of the many forms of arthritis (there are more than 100- yikes!)!

Having decided to inform myself, I found it was a timely topic- The Lancet has just had a leading article on it and most of it is pretty readable for an educated person, not just for medicos. Here’s a link to the Abstract, but you’ll have to use your connections in the business or a science library to read the whole caboodle:
Richette P and Bardin T (2010) Gout. Lancet. Jan 23;375(9711):318-28.

The docs have provided a beaut explanation of the current state of gout knowledge and how to treat it and relieve the symptoms. Sufferers are [rightly] much more vocal about the symptoms themselves- gout hurts to high heaven wherever you get it! [Insert loud groans and screams here]. It certainly laid low my friend on several recent occasions when he would far rather have been out enjoying himself. It also seems to make him and others quite depressed- which I guess can also be the result of taking a lot of pain killers.

All I knew before researching this topic was that some crystals accumulated in the joints somehow; that they were sharp, and that they maybe scratched the bones and thus hurt a lot! Apparently, that’s almost true, except for the fact that gout is really a form of arthritis, (meaning inflammation of joints: Greek ‘arthro’= joint and ‘itis’= inflammation), and that the crystals irritate the joint linings which makes them swell up and produce pain- it’s not the physical scratching from some great chunky quartz-type crystals, but tiny little pointy things in spaces they shouldn’t be. Here’s a pic from the internet:

Monosodium urate crystals

The traditional spot for gout to show up is in the big toe- here’s a diagram to show where the crystals deposit.

Now I know why I saw a lot of old guys with the toe cut out of their shoes when I was a little kid growing up in a country town! The pain is felt all over the toe and really gets bad if your shoe rubs the end of it.

Unfortunately, gout can cause arthritis in most joints- my friend has it in the knees, for instance. What can add to the pain and discomfort is the occurrence of swelling and heat around the joint such that ice packs are very welcome, as well as pain killers and anti-inflammatories (like aspirin).

I wondered where the crystals came from or why they accumulated in the joint spaces, rather than in the kidneys (like other crystals I’d heard about, eg. kidney “stones”). Well the uric acid crystals actually come from processing proteins we eat- I won’t explain the whole process as you can look it up. The folklore about gout being caused by a diet that is “too rich” and “having too much to drink” is not all true.

Most gout has some inherited component- it “runs in families” and researchers are identifying some possible target genes. It is a metabolic problem where the usual pathways though and out of the body for the urate crystals are disrupted or diverted. Instead of all the extra uric acid we don’t need getting ferried out through the kidneys, too much of it hangs around in the blood permanently. With ageing, the concentration is more difficult for the body to cope with and the crystals percolate out of the blood and into the tissues, accumulating in the joint spaces where they hurt. Also, if it isn't treated properly you could end up with permanently damaged joints and need joint replacements. Alternately, if you become dependent on steroids to control the symptoms, you get all sorts of nasty side effects which wreck other aspects of your health! Bad scene- better to change your diet!

Most of the foods that contain the protein that causes uric acid build-up are also nice tasty, popular foods like: red meat, shellfish, other popular fish, roe/caviar, asparagus, cauliflower, mushrooms, peas, beans and lentils; plus there is the traditional culprit alcohol.

So if you know someone with gout, don’t make fun of them, as gout is definitely NOT a fun thing! Be sympathetic when they have an attack and either help them out with rest and ice packs or leave them alone for a day or two to get over it. By all means encourage people to seek expert care, as there is a lot more treatment available these days than when those old men cut the toes out of their shoes!

Where can I claim my reward?

As a sufferer from depression and pretty much unemployed for 2.5 years, I have been feeling a terrible lack of opportunity to be rewarded- either with money or something else I favour. People tell me (and I have started telling myself) not to WANT things. I really do have what I NEED for basic sustenance- sufficient food, a roof over my head, clothing, warmth, a partner, sex, 3 cats and friends. But despite telling myself to concentrate on how lucky I am (ie. think Haitian kids, one of whom I sponsor through World Vision), I have this terribly human trait of WANTING stuff/experiences/different stuff. Well now the people in the labs, those white-coated loonies of popular folklore, have discovered that our brains need enough of a particular substance to actually FEEL rewarded by anything. Not surprisingly, this substance is serotonin, the stuff that your neurons like to bathe in regularly, so you don't feel depressed. These guys (along with a host of others) found that serotonin was the vital part of the brain's REWARD system.

Now, how can we get more rewards? Do things and eat foods that increase the free-floating serotonin levels in the brain. There is a lot of bullshit, "natural", nutrition and New Age claptrap around, but the truth seems to be that foods containing plenty of tryptophan (trip-to-fane) are the go. These are mostly tasty proteiny things like, lean red meat, turkey, chicken, nuts, cheese, beans and pulses (eg. lentils, chick peas). As part of a normal diet, we need to consume these with a little carbohydrate (which is hard to avoid, given the composition of most food)- the more complex ans slower to burn in our systems, the better. So- no added sugar, but good complex carbohydrates such as in vegetables, grainy breads and some fruits. Traditionally they say chocolate and bananas increase serotonin, but they're better with some protein as part of a meal, not an EXTRA snack on the side! Appropriate fats are good too- mono-unsaturated oils like olive oil, omega 3 and 6 oils like fish oil/some nut oils, and recently some authorities have recommended pure cold-pressed coconut oil (which I find good). There seems to be little about dietary coconut oil, except as an antioxidant- by which the scientists mean that the components of coconut oil roam around our blood stream "scavenging" those things called "free radicals" which seem to age us and may play a role in the beginning of cancer. So even if the virgin coconut oil is not yet proven to help with depression and reward experiences, the mere thought that it's doing you good may help anyway!

Now, I'm no medical authority, so don't call me to account for this one, but there were recent reports that a pediatrician (children's doctor) in the USA was treating her prematurely dementing husband with coconut oil and getting promising results. There is nothing in the conventional medical literature as yet, but I'm waiting with interest.

However, leaders in the field of cognition in ageing caution that there is no clear or longterm proof of the worthwhile use of various oils and other substances in slowing brain decline.

Light REALLY DOES make migraines worse

As an ex-migraine sufferer I was interested to see this article in the latest Nature magazine which demonstrated that light definitely makes migraine headaches worse. I always felt that it did and would always try to stay away from bright light when I had a migraine, but some people thought it was just a function of screwing up my eyes in the light making my head muscles tense up more. Plenty of migraine sufferers out there can now declare they're not as neurotic as their friends think!

The researchers in the Nature article compared blind people with migraines with normal-sighted people also suffering regular migraines, who had been matched on age, age of onset (most started around age 17 to 18, give or take several years), occurrence of an aura and other medical factors. They found that only the blind people with an intact optic nerve had their migraine exacerbated by light, along with the seeing people. The blind people whose optic nerves were still Okay (ie. they could transmit information to the brain about light vs. dark, but not about lines, shapes and colours) had their migraines made worse whereas the blind people without optic nerves and/or no eyeballs did not.

The authors give really detailed information for the knowledgeable about the nerve pathways involved, but I won't go into any of that. I think the fact that the study appeared in such a prestigious scientific publication is good evidence that the research is quite sound and migraineurs can be assured they're not crying wolf!

Doing Health Policy in Australia

Doing Health Policy in Australia
This sounds good- I wonder if I can get hold of a copy?