Dr Bryan Betty: Gout and the study finding it's primarily caused by genetics

A painful form of arthritis, gout is the second most common form affecting New Zealanders.  

A major international study involving around 2.6 million people, has revealed that genetics are a major cause, not lifestyle choices.  

Dr Bryan Betty joined Jack Tame to run through the study, what gout looks like, and how it impacts people. 

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Episode Transcript

Speaker 1 (00:07):
You're listening to the Saturday Morning with Jack Team podcast
from News Talks AB.

Speaker 2 (00:12):
Doctor Brian Behe is with us this morning and he
is focusing on gout and there's some really interesting new data, Brian.
A major international study with more than two and a
half million people, led by the University of Otago researchers
has found that gout is a chronic illness for which
genetics are a major cause. This is a bit of
a surprise, right.

Speaker 3 (00:34):
Well, look, we've always suspected that was the case. You know,
traditionally often people have thought of gout as you think
of the English King who sort of overweighth drinking port
legs venison and has laid up with gout and suffers
from gout. So this lifestyle issue has always been this
factor that's run around that you can modify gout by
reducing or changing your lifestyle or what you do. What

(00:57):
this study actually says, and it was a large study
with about two and a half million people, has said, well, look,
primarily what's going on is your genes caused the problem
that causing you to have too much uric acid in
your blood. And actually lifestyle changes, although they are important
in stopping c gout attacks. They don't lower your uric
acid level, so they can't cure the gout. So that's

(01:20):
the big, big shift. So moving away from saying lifestyle
as reason garcurves and yeah, pretty important.

Speaker 2 (01:27):
Okay, so let's just go back to basis. Remind us
what is gout?

Speaker 3 (01:32):
Yeah, so gout is when we've got too much of
the stuff called uric acid flowing around in our blood streams.
The body produces uric acid as part of its metabolism,
and we also invest uric acid through certain foods. Now,
if you have too much of it, what can actually
happen is the uric acid can deposit little salts in joints.

(01:53):
So what happens is the uric acid goes into a joint,
and typically where we see it is the joint that's
at the base of the big toe, and suddenly these
crystals form in the joint. The body reacts to that
immune response, and sudden you get this very very painful, swollen,
red joint that's really really debilitating and it just pops

(02:15):
out of the blue. Yeah, and then we have to
treat it. So look really really really awful when it occurs,
and for anyone who's had gout, they know exactly what
I'm talking about. And yeah, a very nasty, nasty condition.

Speaker 2 (02:26):
When you get it, it sounds like super painful. I
know a few people have had it and they just
talk of their like it. It's really shocking how painful
it actually is. Like even if you just have a
tiny bit of cloth, you know, like on a on
a joint or something, or like putting on a sock,
if you have gout in your big toe is absolutely
off agonizing.

Speaker 3 (02:45):
Yeah, look look at it. And then so people come
into the surgery with cute gout attacks and they limp
up into the room and they can't put their foot down,
and they can't wear a shoe, and they talk about
it at night. They can't put sheets on the toe because
or the joint because it's just so so painful. So yeah,
very very unpleasant and unforgettable. If you have a gout attack,
you'll remember it for life.

Speaker 1 (03:06):
Yeah.

Speaker 2 (03:07):
Stuff, it's tough. Okay. So for those of us who
know that there is a bit of gut in the family,
are there lifestyle causes that can trigger it? Like, are
there things that I'm going to need to look out for,
because I'm going to warn you right now, Brian, ours
is a family that likes ice cream, It likes cheese,
it likes seafood, it likes all of those all other
good things.

Speaker 3 (03:27):
Look, look, look, it's important to have a healthy lifestyle,
so we've got to say that. But up from what
the study is saying to us, Look, if you're predisposed
to gout because your uric acid is too high, regardless
of what you do with your lifestyle, you know, you
stop those things and actually give us uric acid. So
that's basically red meat things like shellfish, alcohol, sugary drinks,

(03:53):
like like our carbonated sugary drinks. They can give us
more uric acid and cause the gout to occur. But
the fact of the matter is, if you get rid
of all those things and stop all those things, if
you've got to underline predespicion to out, lower your uric
acid to a level that you won't get the gout.
So yeah, you can, you can change, you can modify
those life those factors which can trigger gout, but they

(04:16):
won't reduce your overall uric acid and they won't reduce
your risk over time of getting out. So that's the
big difference.

Speaker 2 (04:24):
Why does it affect more men than women.

Speaker 3 (04:26):
Yeah, look, that's a good question. So really what the
study is pointing to it's biological factors. So again it's
the genetics men versus women that that tend to produce
a higher uric acid and also in some cases kidney
disease itself because uric acid has got rid of through
the kidneys can actually produce this kidney this condition. The

(04:46):
other important, really important thing to note is that Mari
and Pacifica peoples have four to six times the rate
of gout, So it is particularly prevalent across New Zealand.
And because again driven by this genetic sort of predisposition
to gout that we see.

Speaker 2 (05:07):
So what do you do about it?

Speaker 3 (05:10):
Yes, So look, I mean, look, there's no doubt that
if you predispose the gout and you have a big
feed of oisters or something, often that's what triggers the
out because you put extra uric acid into an underlying
high level and it will precipitate the gout. So look,
just avoiding certain foods will lessen the frequency of gout attacks,
but it won't get rid of the gout. So look,
for most people, you need to take medication to lower

(05:33):
your uric acid level. That's a medication that's commonly called alipurinol.
You need to take it once a day essentially once
you're on it, and you need to take it for life.
And what alipurinol does very effectively is lower the underlying
level of the uric acid and reduces your chances of
getting the gout, prevents the gout. So look, at most cases,
to be honest, Jack, it comes down to medication.

Speaker 2 (05:57):
Yeah, okay, hey, thanks for your tom, Brian. We really
appreciate it. As ever, we'll put all of Brian's tips
and information there on the News Talks You'd be website.

Speaker 1 (06:05):
For more from Saturday Day Morning with Jack Tame. Listen
live to News Talks at b from nine am Saturday,
or follow the podcast on iHeartRadio