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Gout - The Disease And Diet (Part I) By Mumtaz Khalid Ismail
More Links Clinical features of Gout Precipitating factors of Gout Uric acid and its metabolism Uric acid source
Gout is a chronic metabolic disorder occurred due to the abnormal uric acid metabolism. It is a hereditary disease and is mainly occurring in males. The incidence of the disease among female is only about 5-10 percent. Women become more susceptible after menopause. Even though gout can develop in young age the mean age of onset is around 45 years for male and around 55 years in female. People suffer from this disease are generally non-vegetarians even though some time this disease is seen also among the vegetarians. In India gout appeals to be relatively uncommon disease may be due to hereditary factors or due to the dietary habit.
Gout may be primary or secondary. Primary gout is due to the abnormality of uric acid production and metabolism and secondary gout results from excess uric acid production due to excessive break down of cell nuclei occurring in other diseases such as leukaemia, pernicious anaemia, haemolytic anaemia and polycythaemia (increased red cells). Raised serum uric acid and deposition of urate (uric acid salt) in the cartilage and joint surfaces are the characteristics of gout. There are recurrent attacks of pain and swelling of the joints. Joints that are more prone to trauma are most liable to be involved.
Most of the time clinical gout starts with recurrent attacks of gouty arthritis. Initially starts as acute pain and swelling of metatarsophalangeal joint of the great toe. Later inflammation spreads to heel, ankle, other small joints of feet and knee. Other joints involved are small joints of hand, elbow and spinal joints. This resolves and may have recurrent attacks. About 10 to 12 years after initial attack chronic tophaceous gout develops. Urate crystals get ( tophi ) deposited in different parts of the body including joints. Joint destruction occurs and becomes more prone to infection. The resolution at this stage is incomplete.
The incidences of renal disease in gouty patients are very high. Kidney gets involved resulting in renal stone formation and failure. Monosodium urate monohydrate and uric acid crystals are precipitated in the collecting ducts of kidney. Due to increase excretion these products and resultant damage of the kidney gouty patients commonly suffer from renal stones. The stones are mostly of uric acid with oxalate and phosphate. The kidney function deterioration may be due to associated high blood pressure, diabetes, primary kidney disease, urinary obstruction, change in kidney blood vessels and generally not directly due to gout. Chronic raised uric acid by itself does not appear to impair kidney tissues but certainly predisposes an individual to kidney stone formation in some cases. The other reason for high incidence of kidney impairment associated with gout may be due to excessive and prolonged use of pain relieving drugs that are potentially toxic to kidney.
- Trauma
- Alcoholic excess
- Over eating
- Infection
- Surgery
- Starvation
- Ketoacidosis
- Strenuous physical exercises
- Emotional strain
Cellular material of both plant and animal origin contains nucleoproteins. Glandular organs such as liver, pancreas and kidney are among the richest sources of uric acids. Meat and the embryo or germ of grains and legumes together with the growing parts of young plants also furnish uric acids in appreciable amounts. During digestion nucleoproteins are first split into protein and nucleic acid. Further cleavages of nucleic acid leads to several products. One of the major metabolic products is purine. This purine latter oxidised to uric acid probably by the liver.
The body can also synthesise purines from the simplest carbon and nitrogen compounds such as carbondioxide, acetic acid and glycine. Thus any substance from which these materials originate namely carbohydrate, fat and proteins, gives rise to a considerable production of uric acid. Even in the fasting state there is a constant production of uric acid from the products of cellular break down.
Body derives uric acid from two sources. It may be from out side source - exogenous source or from inside - endogenous source. The diet with a high purine and nucleic acid content such as fish, meat, liver, kidney, pancreases etc are the exogenous source of uric acid. A person who eats animal food gets about 200 - 500 mg of uric acid per day. The endogenous purines derived from the breakdown of nuclieo protein or by synthesis are converted into uric acid. About 300 - 600mg uric acid per day derived from these endogenous sources even for a normal person on purine free diet. This uric acid is excreted in the urine of a normal adult. Normal adults consuming a diet rich in meat excrete in urine about 1gm of uric acid per day. The level of serum uric acid in normal subject is about 3-6mg per 100 ml.
...to be continued
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