November 24, 2024 • 28 mins
11/24/24
The Healthy Matters Podcast
S04_E03 - All About Gout!
Gout! It's kind of a funny word, but ask anyone who's got experience with it, and it is no joke! It's on the rise in the U.S., and although men are the more likely candidates, women and even some dogs(!) are also susceptible. But what is it exactly? Why is it so often found in our big toes? And, which dogs can actually get Gout?!
Many people who have experienced a Gout flare are quick to say it's the most painful thing they've experienced in their lives (...maybe second to childbirth). Since it deals with our joints, Gout typically falls under the field of Rheumatology, and in Episode 3, we'll sit down with Dr. Linh Ngo (DO, RhMSUS) to get a crash course on the subject. We'll go over the basics of what the condition is, ways people contract gout, as well as the most up-to-date diagnosis and treatment options to help get rid of it. There's a lot to learn here, so tune in to get wise on what's often referred to as "The Disease of Kings". Why is called that? Join us and find out!
Wanna see what Gout crystals look like under a microscope?
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:19):
Hey everybody, and welcome to episode three of
season four of the HealthyMatters podcast. I am David
Hilden , and today I am joinedby a colleague of mine at
Hennepin Healthcare. Dr. Lynn?
No , he is a rheumatologist andyes, I'll try to get him to
explain what that is in alittle bit. But today our main
topic is gout, and so you maybehave had gout or you know,
somebody who has gout, butwe're gonna dive deep into what
(00:42):
it is and what can be doneabout it. Dr . No thanks for
being here. Thanks
Speaker 3 (00:46):
For having me.
Speaker 2 (00:47):
Great to have you on the show, Landon. First of all,
just lay down the basics. Whatis gout?
Speaker 3 (00:52):
Yeah, gout is a , uh, very old standing disease.
It was originally known as the, uh, disease of kings. And one
of the things that we know nowis that everyone seems to be a
king. The prevalence of gouthas done nothing but gone up
over the last five decades.
Current estimates, we have justabout 12 million people in the
United States with gout. Andgout is a disease that can be
(01:14):
terrifying for a lot of peoplewho suffer with it because
unexpected sudden attacks ofgout are extremely painful. For
some they say it's the worstpain in their life, and then
for some they say it's theirsecond biggest pain in their
life after childbirth. And sotrying to emphasize a little
bit more awareness about it andhow to take care of it is kind
of on our to-do list.
Speaker 2 (01:35):
I have heard that a couple things that I've heard
that it is the disease of kingsZika's , like in Tudor,
England, Henry the eighth , orsomebody had it, or something
like that.
Speaker 3 (01:43):
Yeah, and it , um, we can get to that in a little
bit too, but it has to do alittle bit with the , uh, idea
behind , uh, diet and , uh,gout. Because in the time of
when the kings of England whosuffered from gout, they had
very rich foods, rich inalcohol and meat, things that
were not accessible to thecommon folk. And so we wouldn't
(02:04):
see that so much in the commonfolks versus the , uh, royalty
or the aristocrats. Andnowadays we are kind of seeing
that pretty much across theboard with everyone. We all eat
Speaker 2 (02:13):
Like Elizabethan king's. Okay, so what is it?
What, what is happening in thebody?
Speaker 3 (02:18):
So gout is simply put a problem with uric acid.
Uric acid is something thatwe're all born with. We all are
supposed to have it. Um, theproblem is that too much of a
good thing is a bad thing,essentially, is what it comes
down to. Um , when we have toomuch uric acid for a long
period of time, we startrunning into these gout
attacks. Now, gout is not justgout attacks , uh, that's the
(02:40):
worst of it, but long termthough, gout is also what we
think of joint destruction aswell, gouty arthropathy. And so
we want to think of stoppinggout, not just so much to stop
the attacks, but also toprevent long-term damage to
joints. So when people haveelevated uric acid levels for a
while, five plus years, theystart forming these crystals.
(03:03):
And these crystals seem benignenough, they're microscopic.
You can't see 'em with yournaked eye into your soft
tissues. That means underneathyour skin and your joints,
muscles, et cetera . And yourimmune system eventually finds
one of these things and says,Hey, you don't really belong
here. And incites a verystrong, powerful reaction akin
to you, you know, twisting yourtoe, dubbing your toe, dropping
(03:24):
something heavy on it, andthere it is. Uh , it gets very
red, hot, swollen, painful, itcomes on very suddenly. Most
people describe it coming outtathe middle of the night. I use
the example of the toe becausethat's the area that a lot of
people first get into goutattack, but it's not the only
one. People can get it reallyany joint. But lower
extremities, the dependentareas seem to be more affected
(03:46):
.
Speaker 2 (03:46):
I have heard this about the toe and I've seen it
over the last 20 some years.
That's where people get it alot, but it doesn't have to be
just your big toe. But do weknow why it is so commonly this
painful inflammation of yourbig toe? I mean, why not the
fourth toe? Why? Why isit the big toe?
Speaker 3 (04:02):
Good, good question.
I think it actually has to dowith a little bit more
mechanics. So first gravity,gravity pulls things down, and
so your foot is gonna have ahigher concentration of uric
acid throughout the day. And soif it were to collect and
crystallize and form thesecrystals, it's gonna probably
go from low and then work itsway up. The other thing too is
that your big toe is also thearea that we put a lot of
(04:24):
stress through. So when you'retaking a step or stepping
upstairs or anything like that,that area seems to bear a lot
more burden, a little bit morestress than say for example,
your fourth toe. And so thatmight be another area that
seems to attract more immunepresence because of that.
Speaker 2 (04:39):
In all my years of treating patients, I've never
really thought, why is it thebig toe? So thanks for at least
exploring that one with me. Butit can be other joints as well.
These crystals can go in , thisinflammation can happen in any
joint.
Speaker 3 (04:50):
Absolutely. For example, the very first attack
for the very unfortunate cansometimes be in the ankle. And
the bigger the joint for anattack, the more of the pain
is. So one of the worst placesto get an attack would be like,
for example, the knee orperhaps the elbow. That's when
we see people in the hospital.
They'll come into the hospitalbecause the pain is so severe
(05:10):
and nothing , um, wrong withdoing that because , uh, the
pain is quite bad. And so oneof the things that people are
afraid of is that maybe theyhave an infection in that joint
because the pain is unreal.
Speaker 2 (05:22):
Why is the pain so bad? I have heard people say,
especially when it's like inyour lower extremities, in your
ankle or your big toe, that theweight of the bed linens hurts.
It's just that painful. Yes.
Why does it hurt so dang much?
Speaker 3 (05:36):
That is a really good question. And that has to
do with the level ofinflammation that's involved
with it. So of the things thatcause that level of
inflammation, infection of thejoint is the other one that's
up there. And when people getgout flares and at the peak of
their attack, what'll happen isthat there's so much immune
presence in that area to clearthese crystals out, that your
(05:59):
immune system essentially can'ttell the difference. If it's
really fighting gout crystalsversus an infection or a
bacteria present inside of yourjoint, it acts the exact same
way and that's why the pain isso high. So
Speaker 2 (06:10):
How would , how would a patient know they've
got this swollen, big toe orankle or knee or elbow, it's
really swollen, it's painful,it might be red. How do they
know that that's gout versussomething else? What should
they know and what should theydo? I
Speaker 3 (06:24):
Guess I think first is the , the level of pain. Um,
the pain is gonna be unreal.
And then when they look at ittoo, it's gonna look very,
very, very, very differentcompared to what it looked
like, for example, 12 hoursprior. So when you look at your
affected joint and you seethat, hey, I can't even get a
sock on anymore, it won't fit,or it's too tight or it's too
uncomfortable, I can't even getmy shoe on. Same thing that
(06:47):
usually stands to reason thatperhaps that this is more of a
inflammatory process and thatmakes gout a little bit more
likely. And again, this is fora lot of folks, the worst pain
that they've ever felt. So
Speaker 2 (06:57):
I have heard on other people say what you said
earlier , uh, just a fewminutes ago, that , uh, for
people who have delivered achild, that might be some of
the most severe pain or themost severe pain they've ever
experienced. I think gout is aclose second. Yep . So if you
have not had the honor and theprivilege of delivering a
child, you don't want to getgout. Let's just put it that
way. Um , is it the same asarthritis?
Speaker 3 (07:18):
Um, no. So gout and gout attacks are inflammation
in a nutshell. It's a veryquick response of your immune
system to clear what it thinksis an infection. Essentially,
arthritis is a long standingprogressive. You can kind of
think of it as an aging processof your joints akin to getting
gray hair. You get iteventually. You can't do much
(07:40):
about it. It's slow to go, butit doesn't really bother you
that fast that quickly. Youjust kind of notice it a little
bit more day by day.
Speaker 2 (07:48):
Gout, you know, it, you were fine yesterday. You're
not today. Before I get intotreatments, which we're gonna
do after the break, I wouldlike to do a little bit about
prevalence and what causes itand what are some of the risk
factors for getting gout. And Imentioned earlier that you're a
rheumatologist very briefly.
What
Speaker 3 (08:04):
Is that? So a rheumatologist at the basics,
the , uh, named rheumatologistessentially means that we take
care of people with joints.
However, I would say thatdefinition of the profession
has really evolved over thelast 50 years. And because the
understanding of autoimmunedisease has changed in the last
50 years now, we recognize thatpeople who used to suffer with
(08:25):
things like psoriasis and thenswollen knees or swollen joints
out of the blue, they have anunderlying autoimmune disease.
And that's what rheumatologistsreally focus on. Now we focus
on treating underlying systemicautoimmune diseases like
psoriatic arthritis, rheumatoidarthritis, and lupus. Those are
(08:45):
probably the most well-knownones. Yeah.
Speaker 2 (08:47):
People don't often know what a rheumatologist says
. It's not just your arthritis.
I think it's one of the mostcomplex specialties in our
department of medicine.
Rheumatology is part of theDepartment of Internal Medicine
and Hennepin Healthcare, andthey deal with some of the most
complex , uh, systemicconditions. So , um, thank you
for that. Okay. The prevalenceof gout, you said 12 million
people said on the rise, andwhy is it so many? Yeah,
Speaker 3 (09:09):
So , uh, I would say about just about a decade ago,
the uh, number was probablysitting around 8 million , uh,
US Americans. Uh oh . And nowit's right around probably
about 12.1. And that data's alittle bit behind because the
best data that we can get isabout four years old. So yes,
the rate of gout in the UnitedStates is increasing. And the
(09:30):
reason why it has to do with alittle bit of our, our health,
our overall health gout is alittle bit more complex than
just what we eat. It also hasto do with our overall health.
It ties in with our body size,our body shape weight, it ties
in with our other medicalconditions, diabetes, heart
disease, medications that wetake as well. And then finally,
(09:51):
of course, it does tie in withour food, our diet and what's
available , uh, now isdifferent than what it was 10,
15 years ago. So you
Speaker 2 (09:59):
Talk about uric acid, I don't think most people
know what foods have uric acid.
I bet it's in a lot of things.
Yeah. Should we go there?
Should we talk a little bitabout diet and it's, its role
in gout?
Speaker 3 (10:10):
So people really do talk a lot about food and gout.
The first thing that you'd findwhen you Google gout nowadays
is, you know, recommendationsfrom everybody about what sort
of foods you should and shouldnot eat. And the answers out
there are really diverse. Butif you look at experts in the
field who have done research init, it really comes down to a
simplified list. It's all thegood stuff. Yes, it is against
(10:33):
, uh, again , um, the diseaseof kings . So , uh, for
example, red meat. Uh, red meatis a , uh, big instigator. It
increases the level of uricacid in your body if you
consume it a lot considerably.
Seafood, for example, thingswith a shell on it. So it's
gonna be the lobster, thecrayfish, the crab , the
shrimp, all the rich seafood.
(10:55):
In other words, that's gonna bean instigator. Alcohol of any
variety definitely increasesuric acid. And something that
we don't emphasize enough isthe products in the United
States that have a little bitmore sugar in them, they
typically carry a little bitmore of high fructose corn
syrup. High fructose corn syruphas also been linked with
higher levels of , uh, uricacid elevation as well. And so
(11:17):
whenever you pick up a regularsoda juice or something like
that, and that usually is gonnabe the thing. So
Speaker 2 (11:22):
You just think of that giant banquet table in a
castle in 16th century England,everything on there,
Speaker 3 (11:29):
Pretty much. Yeah.
Speaker 2 (11:30):
Uh , but what you said is so important is the ,
about the , the stuff that wehave now, I'm still trying to
find the redeeming quality ofhigh fructose corn syrup. It is
, uh, um, with all apologies tothe businesses and the
industries that rely on it, andthe lovely taste of that. It's
not good for you.
Speaker 3 (11:47):
No, not really.
Speaker 2 (11:48):
It just isn't. Yep .
Speaker 3 (11:50):
So
Speaker 2 (11:50):
Do men get it as much as women, women more than
men? Is it it not, not, notdifferentiating.
Speaker 3 (11:55):
Uh, that answer's a little bit more complex. So up
to a certain age, men do getgout a lot more than women. So
for most people, I would saybetween the ages of 20, all the
way to just about 60, it seemsto be men much more than women.
And then after 60, it seems toeven out. And the reason has to
do with the differences in ourphysiology. Women have more
(12:19):
estrogen secretion and presencein their body up until the age
of about 45, and then in whichmenopause occurs, and then the
estrogen levels drop off. Now,estrogen is something that
protects people from havingvery high uric acid. Estrogen
tells our kidneys toessentially take out all the
extra uric acid in our bodies.
(12:39):
And so for most women, it'sreally hard for them to get
gout as long as they haveestrogen premenopausal for men.
However, androgenstestosterone, as soon as
puberty hits the uric acidresponds in kind. So as
testosterone increases, uricacid increases as well. And we
don't really have anotherhormone in our body that kind
of offsets that. And so men area little bit more susceptible
(13:02):
because of that. At
Speaker 2 (13:03):
Least as until you hit menopause women. That's
right . And then you kind ofcatch up. That's fascinating. I
don't think I knew that, thatthat that complex , um, role of
the mm-hmm . ofthese hormones that which is
what estrogen and testosteroneand like are. Um, thank you for
that. What about familyhistory? Is it genetic?
Speaker 3 (13:18):
Yes, absolutely. So , um, one way you can kind of
see that now is the change inthe demographic of the United
States. Prior to about 2018 ,uh, the demographic group who
had the most gout in the UnitedStates were definitely African
American men. Um, after 2018,data now supports Asian
American men. Um, and that hasto do a lot with genetics. It
(13:39):
means that yes, there's familyhistory, so if your mom, dad,
brother, sister has gout, riskgoes up a little bit more. But
it also goes to the question ofhow do you get gout? It's not
just through food. Food is partof the equation for sure, but
the other part is just who youare, your DNA , if you will.
And so for some people, we havea predilection to hold onto
(14:01):
uric acid more, and that'sdefinitely more true of Asian
Americans. And then we alsohave certain people that just
simply make more uric acid intheir body. They take whatever
you give them in terms of foodand they crank out uric acid.
So that's how you can getlittle bit more higher levels
of uric acid. That
Speaker 2 (14:19):
Leads to my next question is how do you diagnose
it? Are we checking uric acidlevels or are we looking for
the pretty crystals? Andlisteners? I have seen gout
crystals under a microscope.
They're
Speaker 3 (14:28):
Beautiful. Yes.
They're , they're
Speaker 2 (14:29):
These yellow kind of pretty things.
Speaker 3 (14:31):
Yeah. If you have bad enough gout, it looks like
Christmas. When you look at a ,uh, uh, somebody saw takes me
Speaker 2 (14:38):
Back tissue , me skull takes me back to when
they made the colorblind melook at things in the
microscope. And everythinglooked about same color, but
gout didn't. Yep . It was thesebeautiful crystals. Yep .
They're not so beautiful whenthey're in your big toe.
Speaker 3 (14:49):
No . Uh, patients are not impressed with , uh,
the appearance of the crystalswhen they're suffering from the
attack. So
Speaker 2 (14:54):
How do you diagnose gout then?
Speaker 3 (14:55):
So , uh, diagnosing gout, this is actually really
helpful for patients to know.
Uh, so that's part of how theyrecognize if they have gout. So
we define gout as somethingcalled monoarticular, meaning
that it's usually just oneplace that starts off with an
attack. So if you have oneswollen joint out of the blue,
sudden onset, meaning that ithappened to say, for example,
(15:15):
overnight, no trauma oranything like that beforehand,
you can't explain why it'shappening. And it's very, very
rapid. So within about 12 hoursof feeling a little twinge in
that joint, it goes to beingvery swollen, very red, very
painful, very warm, all within12 hours. So it's a very rapid
thing. So if you're kind ofseeing that, that is very
(15:37):
helpful. And then finally,knowing a little bit more about
your personal history, ifyou're somebody that struggles
from high blood pressure andyou take high blood pressure
medicines, those medicinesoftentimes are linked to having
higher levels of uric acid. Youshouldn't stop taking them, but
you should be more aware that,hey, I am a little bit higher
risk of it. You look at yourbody weight, if you notice
(16:00):
that, hey, my BMI is somethingthat I do wanna work on a
little bit because it's on thehigher end, that does put you
at higher risk. And of coursefamily history, if you know
that your father struggled withgout or your brother struggled
with gout, that makes it alittle bit more likely too .
Rheumatologists used the exactsame clues to help diagnose
gout. Back in the old days, wesaid that the only thing that
(16:21):
you could do to diagnose goutwas to take fluid outta
someone's joint. Look at it inthe microscope. That is not
true anymore. Nowadays, thestory of what we're talking
about right now, the elementsof history and the person's ,
uh, medical history is just ashelpful. So if we know these
elements and they check yes,true, we can diagnose people
with gout just by using thestory alone. If we wanted to
(16:45):
get fluid from the joint, wecan definitely do that. We have
many ways to do that now. It'sstill not the most fun process
in the world. Yep ..
Yeah. And then we also haveways now to , uh, look at the
joint underneath the skin aswell, without having to take
fluid. We can use , uh,something called ultrasound.
Ultrasound has very distinctfeatures when people have gout
(17:05):
and a gout flare. And then wealso have something called dual
energy ct. Dual energy CT isnewer to us, and we do have it
here and it allows us tovisualize and reconstruct, for
example , uh, foot and kind ofmap out and draw the diagram of
the skeleton of the foot, allthe bones, and it will actually
draw out the crystalsthemselves on the surface of
(17:27):
the bones. So you can get anidea of how many crystals there
are there too. And how big aproblem it really is.
Speaker 2 (17:32):
We've come a long way from King Henry vii .
Absolutely. So we're learningabout gout with Dr No
rheumatologist at HennepinHealthcare in downtown
Minneapolis, and never fearfolks. Help is on the way.
We're gonna talk abouttreatments and what you maybe
can do to reduce your risk ofgetting out and what you should
do if you do have it. So stickaround, we'll take a quick
break and then we'll be rightback.
Speaker 4 (17:56):
When Hennepin Healthcare says we are here for
life, they mean here for you,your life, and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the West Metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(18:18):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (18:34):
And we're back talking about gout with Dr.
Lynn. No . Okay. So Lynn ,we've, we've talked about the
prevalence and what it is andhow painful it can be. Now
let's talk about what can bedone about it. So is there a
cure for it? Is there atreatment for it? What do you
do?
Speaker 3 (18:48):
Uh, that answer is there's definitely treatment
for it, and it almost is acure. So let me emphasize that
a second. It's almost a cure.
The way you take care of goutis simple. You know, it's
caused by high uric acid. Thetreatment is to lower the uric
acid. You could do it via acombination of waste .
Medications are probably themost effective. We have a
couple of different ones in theUnited States, and then also
(19:10):
the things that we can do inour day-to-day life, that can
also decrease the amount ofuric acid in our body as well.
Those two things right thereessentially will treat and
prevent gout attacks for theremainder of most people's
lives if they're, they'refocused on it. So let's
Speaker 2 (19:24):
Talk about the first one, reducing uric acid. These
are medicines that you takeevery day?
Speaker 3 (19:28):
Yes. So we have a few different medications that
you do need to take every dayand you wanna be consistent
with it. And the key things Iwould impart is that it's not a
one size fit all typemedications. These are
medications that are tailoredto the individual. So what you
do is very simple. You startsomebody at the lowest dose
humanly possible of a medicine.
You check their uric acid in afew weeks. If it's higher than
(19:49):
where you want it, you increasethe dose and you keep ongoing
until you get to your goal, thegoal for that patient. And once
they get to that numericalgoal, that uric acid their G
attack , stop and that's it.
Yeah . Yeah.
Speaker 2 (20:01):
That's, it's actually, they're really
effective these medications tolower uric acid. So that's the
first thing. What aboutavoiding the amount of uric
acid you put in your body? Wetalked about some foods earlier
that, that we've already goneover, but what do you tell
patients about about theirdiet? Because you can't just
say, don't eat any of that.
Speaker 3 (20:19):
Right? We do like to, at least here, we like to
emphasize quality of life. Wewanna try to encourage
adherence because if I tellsomebody, I know you love
steak, but you can never, ever,ever have it again for the rest
of your 60 years on this earth,they're just gonna leave.
They're not
Speaker 2 (20:35):
Gonna leave state .
They're gonna leave theirrheumatologist. Yeah,
Speaker 3 (20:37):
They're gonna leave me. Yeah. And so I tell them,
Hey, be reasonable. Do it inmoderation with these
medications. You can have thisstuff, but you won't be able to
have it as much as perhapsyou'd like. And that's usually
enough where the patient says,okay, I see value in this
medication. And then I also seethat you're trying to help me
keep my quality of life too. Ienjoy this, this is part of me.
(21:00):
And so we don't emphasize, Hey,you need to cut out anything.
We really try to say everythingin moderation. So
Speaker 2 (21:07):
That is sort of how to reduce future attacks of
acute gout with what you eatand maybe take a , a uric acid
lowering medication. What aboutduring an acute attack during
that agonizingly painful fewdays?
Speaker 3 (21:20):
Yeah. What ,
Speaker 2 (21:20):
What do we do about that?
Speaker 3 (21:22):
If you know you have gout and you're experiencing
the beginning of a new attack,the best thing that you could
do for yourself is take ananti-inflammatory. A lot of
doctors will prescribe patientsa variety of different things
from a medication calledprednisone to colchicine or
very popular endeth is theother one as well. But really
(21:44):
any anti-inflammatory willwork, whether it's ibuprofen or
naproxen. You just gotta makesure you take enough of it and
take it early enough. You wannatake it in that first 12 hours
of feeling the , uh, onset andattack. And if you can do that,
you can save yourself severaldays of agony. Sounds
Speaker 2 (22:00):
Good. That's treatment. I do wanna talk
about some of the longer termeffects of gout on the human
body. Other than just the acuteattacks. Are there effects of
high uric acid levels? In otherwords, if you don't lower your
uric acid levels, you get theseacute attacks, but is , are
there other effects on yourbody long term ?
Speaker 3 (22:20):
Absolutely. So we have seen that uric acid being
too high in the body for a longtime has been linked with
increased kidney disease andincreased risk of kidney
disease. So for people whoalready have it, and we now see
their uric acid elevated, we'remore motivated than ever to
help them lower that uric acidbecause we don't really want
(22:42):
people to progress towards
Speaker 2 (22:43):
Dialysis. Right.
Kidney disease, something to beavoided. So people should take
it seriously, not only becauseit's an agonizing week of your
life when you have an acuteattack, but also because there
aren't long term effects ofhaving high uric acid levels
forevermore in yourbloodstream. Is there anything
non medicinal? I I, I'mthinking of this question that
I'm asking you, and I treatgout all the time, or at least
(23:04):
I treat the initial stuff. Iusually send them to a guy like
you who knows what they'redoing more. But I'm trying to
think of , are there nonmedicinal things you can do
other than what you eat? Yeah,
Speaker 3 (23:13):
Absolutely. Being healthy. I mean, gout and uric
acid is really tied to howhealthy we are. Usually that's
the case. And so if we loseweight, our uric acid comes
down. If our blood sugars arebetter, our uric acid comes
down. If our blood pressure isbetter, our uric acid comes
down. And so when you take careof yourself overall in making
(23:36):
your body healthier, your uricacid tends to respond. So
Speaker 2 (23:39):
It's, it's sort of like a , a theme that happens
on this podcast is I bring aspecialist in to talk about a
specific condition and it , itis actually a theme. Healthy
life choices are reallyimportant. Absolutely. They
just really are important. I, Ilove that actually about this
is that regardless of whattopic I'm talking about, I get
a , an expert in a topic andthey say, you know, you need to
(24:00):
eat right and, and exercise andbe healthy and not smoke and
all those things.
Speaker 3 (24:04):
Absolutely. I mean, we emphasize that in our
clinic. We tell our patients,if you're trying to find a diet
rather than trying to findthings to avoid, why don't you
look for things that you shouldeat more of? Uh , Mediterranean
diet is excellent. The dashdiet is excellent too, but
Mediterranean diet has beenassociated with lower levels of
uric acid across the board. Andso if you just wanted to make a
(24:26):
simple change when you look upMediterranean diet and recipes
and whatnot, that's a reallygood place to start.
Speaker 2 (24:32):
That's why I wanna move to Myorca . Okay. Now ,
um, before I let you go, isthere any future research or is
there, are there any futuretreatments for gout that, or ,
or diagnostics that excite you?
Um,
Speaker 3 (24:43):
Very rarely. We have situations where gout is very,
very challenging to control.
And the medications that wecurrently have simply don't fit
the bill. And when thathappens, we are currently left
with a scenario where we haveto give bad news to patients.
And I really don't love doingthat. And so I'm excited about
some new , uh, therapies on thehorizon that allow us to give
(25:07):
medicines , uh, called uricasethat just destroy uric acid. In
a nutshell, it's an enzyme thatwe , uh, as humans have a gene
to encode, but it's a vestigialgene, meaning that it's a gene
that no longer is activethrough time. Humans have lost
the ability to use it. Mostother mammals in the world
(25:28):
still use that gene so theydon't get gout. So when you
make uric case this enzyme toany uric acid in your body,
it's immediately destroyed. Andso this is now something that
we're currently looking atusing to give people to get rid
of all the uric acid present inthe body.
Speaker 2 (25:46):
That just gets to the root of the problem. Then
it , it isn't trying to excreteit out of your body, just
destroy it in your body. Sothat's why my dog doesn't get
gout, you know, ,certain
Speaker 3 (25:56):
Dogs, certain
Speaker 2 (25:57):
Dogs do some get it?
Yes.
Speaker 3 (25:58):
Oh, dalmatians,
Speaker 2 (26:00):
Dalmatians. Get gout. Okay. If you've listened
to this far in the podcast, wehave just given you a bar
trivia answer for the ages. Theone breed of dogs that gets
gout is dalmatians. Yep . Myblack labs safe maybe. Yep .
We're talking with Dr. Lin .
Know about gout. He's arheumatologist at Hennepin
Healthcare. And Lynn , if Icould ask you to leave our
(26:20):
listeners with the main pointsthat they should know, what
would you like listeners toremember about gout?
Speaker 3 (26:26):
I always tell my patients, if you could take
three things away from thisvisit today. Um , number one, I
want you to know that uricacid, you have too much of it.
You were born with it, it'sokay, not your fault, you just
have too much of it and it'sgiving you a problem. Number
two , there are ways to get ridof your uric acid. And number
three , the
Speaker 2 (26:42):
Uric acid can be removed by either medication or
lifestyle modification. Irecommend both Great tips,
listeners, if you arestruggling with gout or you
think you might be, or you knowsomeone it is and you're
wondering where to get help, Ihope you have learned something
from this show, as have I, andI hope you'll seek medical
attention. If the case may be,if you happen to be in downtown
Minneapolis, we haveoutstanding rheumatologists at
(27:05):
Hennepin Healthcare. Dr . Nothanks for being here today.
It's a pleasure. Thank you.
It's been great having you onthe show today. Listeners, I
hope you'll tune in for ournext episode in two weeks time,
and in the meantime, be healthyand be well.
Speaker 1 (27:18):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk .
There's also a link in the shownotes. The Healthy Matters
(27:40):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:02):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:19):
Hey everybody, and welcome to episode three of
season four of the HealthyMatters podcast. I am David
Hilden , and today I am joinedby a colleague of mine at
Hennepin Healthcare. Dr. Lynn?
No , he is a rheumatologist andyes, I'll try to get him to
explain what that is in alittle bit. But today our main
topic is gout, and so you maybehave had gout or you know,
somebody who has gout, butwe're gonna dive deep into what
(00:42):
it is and what can be doneabout it. Dr . No thanks for
being here. Thanks
Speaker 3 (00:46):
For having me.
Speaker 2 (00:47):
Great to have you on the show, Landon. First of all,
just lay down the basics. Whatis gout?
Speaker 3 (00:52):
Yeah, gout is a , uh, very old standing disease.
It was originally known as the, uh, disease of kings. And one
of the things that we know nowis that everyone seems to be a
king. The prevalence of gouthas done nothing but gone up
over the last five decades.
Current estimates, we have justabout 12 million people in the
United States with gout. Andgout is a disease that can be
(01:14):
terrifying for a lot of peoplewho suffer with it because
unexpected sudden attacks ofgout are extremely painful. For
some they say it's the worstpain in their life, and then
for some they say it's theirsecond biggest pain in their
life after childbirth. And sotrying to emphasize a little
bit more awareness about it andhow to take care of it is kind
of on our to-do list.
Speaker 2 (01:35):
I have heard that a couple things that I've heard
that it is the disease of kingsZika's , like in Tudor,
England, Henry the eighth , orsomebody had it, or something
like that.
Speaker 3 (01:43):
Yeah, and it , um, we can get to that in a little
bit too, but it has to do alittle bit with the , uh, idea
behind , uh, diet and , uh,gout. Because in the time of
when the kings of England whosuffered from gout, they had
very rich foods, rich inalcohol and meat, things that
were not accessible to thecommon folk. And so we wouldn't
(02:04):
see that so much in the commonfolks versus the , uh, royalty
or the aristocrats. Andnowadays we are kind of seeing
that pretty much across theboard with everyone. We all eat
Speaker 2 (02:13):
Like Elizabethan king's. Okay, so what is it?
What, what is happening in thebody?
Speaker 3 (02:18):
So gout is simply put a problem with uric acid.
Uric acid is something thatwe're all born with. We all are
supposed to have it. Um, theproblem is that too much of a
good thing is a bad thing,essentially, is what it comes
down to. Um , when we have toomuch uric acid for a long
period of time, we startrunning into these gout
attacks. Now, gout is not justgout attacks , uh, that's the
(02:40):
worst of it, but long termthough, gout is also what we
think of joint destruction aswell, gouty arthropathy. And so
we want to think of stoppinggout, not just so much to stop
the attacks, but also toprevent long-term damage to
joints. So when people haveelevated uric acid levels for a
while, five plus years, theystart forming these crystals.
(03:03):
And these crystals seem benignenough, they're microscopic.
You can't see 'em with yournaked eye into your soft
tissues. That means underneathyour skin and your joints,
muscles, et cetera . And yourimmune system eventually finds
one of these things and says,Hey, you don't really belong
here. And incites a verystrong, powerful reaction akin
to you, you know, twisting yourtoe, dubbing your toe, dropping
(03:24):
something heavy on it, andthere it is. Uh , it gets very
red, hot, swollen, painful, itcomes on very suddenly. Most
people describe it coming outtathe middle of the night. I use
the example of the toe becausethat's the area that a lot of
people first get into goutattack, but it's not the only
one. People can get it reallyany joint. But lower
extremities, the dependentareas seem to be more affected
(03:46):
.
Speaker 2 (03:46):
I have heard this about the toe and I've seen it
over the last 20 some years.
That's where people get it alot, but it doesn't have to be
just your big toe. But do weknow why it is so commonly this
painful inflammation of yourbig toe? I mean, why not the
fourth toe? Why
Speaker 3 (04:02):
Good, good question.
I think it actually has to dowith a little bit more
mechanics. So first gravity,gravity pulls things down, and
so your foot is gonna have ahigher concentration of uric
acid throughout the day. And soif it were to collect and
crystallize and form thesecrystals, it's gonna probably
go from low and then work itsway up. The other thing too is
that your big toe is also thearea that we put a lot of
(04:24):
stress through. So when you'retaking a step or stepping
upstairs or anything like that,that area seems to bear a lot
more burden, a little bit morestress than say for example,
your fourth toe. And so thatmight be another area that
seems to attract more immunepresence because of that.
Speaker 2 (04:39):
In all my years of treating patients, I've never
really thought, why is it thebig toe? So thanks for at least
exploring that one with me. Butit can be other joints as well.
These crystals can go in , thisinflammation can happen in any
joint.
Speaker 3 (04:50):
Absolutely. For example, the very first attack
for the very unfortunate cansometimes be in the ankle. And
the bigger the joint for anattack, the more of the pain
is. So one of the worst placesto get an attack would be like,
for example, the knee orperhaps the elbow. That's when
we see people in the hospital.
They'll come into the hospitalbecause the pain is so severe
(05:10):
and nothing , um, wrong withdoing that because , uh, the
pain is quite bad. And so oneof the things that people are
afraid of is that maybe theyhave an infection in that joint
because the pain is unreal.
Speaker 2 (05:22):
Why is the pain so bad? I have heard people say,
especially when it's like inyour lower extremities, in your
ankle or your big toe, that theweight of the bed linens hurts.
It's just that painful. Yes.
Why does it hurt so dang much?
Speaker 3 (05:36):
That is a really good question. And that has to
do with the level ofinflammation that's involved
with it. So of the things thatcause that level of
inflammation, infection of thejoint is the other one that's
up there. And when people getgout flares and at the peak of
their attack, what'll happen isthat there's so much immune
presence in that area to clearthese crystals out, that your
(05:59):
immune system essentially can'ttell the difference. If it's
really fighting gout crystalsversus an infection or a
bacteria present inside of yourjoint, it acts the exact same
way and that's why the pain isso high. So
Speaker 2 (06:10):
How would , how would a patient know they've
got this swollen, big toe orankle or knee or elbow, it's
really swollen, it's painful,it might be red. How do they
know that that's gout versussomething else? What should
they know and what should theydo? I
Speaker 3 (06:24):
Guess I think first is the , the level of pain. Um,
the pain is gonna be unreal.
And then when they look at ittoo, it's gonna look very,
very, very, very differentcompared to what it looked
like, for example, 12 hoursprior. So when you look at your
affected joint and you seethat, hey, I can't even get a
sock on anymore, it won't fit,or it's too tight or it's too
uncomfortable, I can't even getmy shoe on. Same thing that
(06:47):
usually stands to reason thatperhaps that this is more of a
inflammatory process and thatmakes gout a little bit more
likely. And again, this is fora lot of folks, the worst pain
that they've ever felt. So
Speaker 2 (06:57):
I have heard on other people say what you said
earlier , uh, just a fewminutes ago, that , uh, for
people who have delivered achild, that might be some of
the most severe pain or themost severe pain they've ever
experienced. I think gout is aclose second. Yep . So if you
have not had the honor and theprivilege of delivering a
child, you don't want to getgout. Let's just put it that
way. Um , is it the same asarthritis?
Speaker 3 (07:18):
Um, no. So gout and gout attacks are inflammation
in a nutshell. It's a veryquick response of your immune
system to clear what it thinksis an infection. Essentially,
arthritis is a long standingprogressive. You can kind of
think of it as an aging processof your joints akin to getting
gray hair. You get iteventually. You can't do much
(07:40):
about it. It's slow to go, butit doesn't really bother you
that fast that quickly. Youjust kind of notice it a little
bit more day by day.
Speaker 2 (07:48):
Gout, you know, it, you were fine yesterday. You're
not today. Before I get intotreatments, which we're gonna
do after the break, I wouldlike to do a little bit about
prevalence and what causes itand what are some of the risk
factors for getting gout. And Imentioned earlier that you're a
rheumatologist very briefly.
What
Speaker 3 (08:04):
Is that? So a rheumatologist at the basics,
the , uh, named rheumatologistessentially means that we take
care of people with joints.
However, I would say thatdefinition of the profession
has really evolved over thelast 50 years. And because the
understanding of autoimmunedisease has changed in the last
50 years now, we recognize thatpeople who used to suffer with
(08:25):
things like psoriasis and thenswollen knees or swollen joints
out of the blue, they have anunderlying autoimmune disease.
And that's what rheumatologistsreally focus on. Now we focus
on treating underlying systemicautoimmune diseases like
psoriatic arthritis, rheumatoidarthritis, and lupus. Those are
(08:45):
probably the most well-knownones. Yeah.
Speaker 2 (08:47):
People don't often know what a rheumatologist says
. It's not just your arthritis.
I think it's one of the mostcomplex specialties in our
department of medicine.
Rheumatology is part of theDepartment of Internal Medicine
and Hennepin Healthcare, andthey deal with some of the most
complex , uh, systemicconditions. So , um, thank you
for that. Okay. The prevalenceof gout, you said 12 million
people said on the rise, andwhy is it so many? Yeah,
Speaker 3 (09:09):
So , uh, I would say about just about a decade ago,
the uh, number was probablysitting around 8 million , uh,
US Americans. Uh oh . And nowit's right around probably
about 12.1. And that data's alittle bit behind because the
best data that we can get isabout four years old. So yes,
the rate of gout in the UnitedStates is increasing. And the
(09:30):
reason why it has to do with alittle bit of our, our health,
our overall health gout is alittle bit more complex than
just what we eat. It also hasto do with our overall health.
It ties in with our body size,our body shape weight, it ties
in with our other medicalconditions, diabetes, heart
disease, medications that wetake as well. And then finally,
(09:51):
of course, it does tie in withour food, our diet and what's
available , uh, now isdifferent than what it was 10,
15 years ago. So you
Speaker 2 (09:59):
Talk about uric acid, I don't think most people
know what foods have uric acid.
I bet it's in a lot of things.
Yeah. Should we go there?
Should we talk a little bitabout diet and it's, its role
in gout?
Speaker 3 (10:10):
So people really do talk a lot about food and gout.
The first thing that you'd findwhen you Google gout nowadays
is, you know, recommendationsfrom everybody about what sort
of foods you should and shouldnot eat. And the answers out
there are really diverse. Butif you look at experts in the
field who have done research init, it really comes down to a
simplified list. It's all thegood stuff. Yes, it is against
(10:33):
, uh, again , um, the diseaseof kings
example, red meat. Uh, red meatis a , uh, big instigator. It
increases the level of uricacid in your body if you
consume it a lot considerably.
Seafood, for example, thingswith a shell on it. So it's
gonna be the lobster, thecrayfish, the crab , the
shrimp, all the rich seafood.
(10:55):
In other words, that's gonna bean instigator. Alcohol of any
variety definitely increasesuric acid. And something that
we don't emphasize enough isthe products in the United
States that have a little bitmore sugar in them, they
typically carry a little bitmore of high fructose corn
syrup. High fructose corn syruphas also been linked with
higher levels of , uh, uricacid elevation as well. And so
(11:17):
whenever you pick up a regularsoda juice or something like
that, and that usually is gonnabe the thing. So
Speaker 2 (11:22):
You just think of that giant banquet table in a
castle in 16th century England,everything on there,
Speaker 3 (11:29):
Pretty much. Yeah.
Speaker 2 (11:30):
Uh , but what you said is so important is the ,
about the , the stuff that wehave now, I'm still trying to
find the redeeming quality ofhigh fructose corn syrup. It is
, uh, um, with all apologies tothe businesses and the
industries that rely on it, andthe lovely taste of that. It's
not good for you.
Speaker 3 (11:47):
No, not really.
Speaker 2 (11:48):
It just isn't. Yep .
Speaker 3 (11:50):
So
Speaker 2 (11:50):
Do men get it as much as women, women more than
men? Is it it not, not, notdifferentiating.
Speaker 3 (11:55):
Uh, that answer's a little bit more complex. So up
to a certain age, men do getgout a lot more than women. So
for most people, I would saybetween the ages of 20, all the
way to just about 60, it seemsto be men much more than women.
And then after 60, it seems toeven out. And the reason has to
do with the differences in ourphysiology. Women have more
(12:19):
estrogen secretion and presencein their body up until the age
of about 45, and then in whichmenopause occurs, and then the
estrogen levels drop off. Now,estrogen is something that
protects people from havingvery high uric acid. Estrogen
tells our kidneys toessentially take out all the
extra uric acid in our bodies.
(12:39):
And so for most women, it'sreally hard for them to get
gout as long as they haveestrogen premenopausal for men.
However, androgenstestosterone, as soon as
puberty hits the uric acidresponds in kind. So as
testosterone increases, uricacid increases as well. And we
don't really have anotherhormone in our body that kind
of offsets that. And so men area little bit more susceptible
(13:02):
because of that. At
Speaker 2 (13:03):
Least as until you hit menopause women. That's
right . And then you kind ofcatch up. That's fascinating. I
don't think I knew that, thatthat that complex , um, role of
the mm-hmm .
what estrogen and testosteroneand like are. Um, thank you for
that. What about familyhistory? Is it genetic?
Speaker 3 (13:18):
Yes, absolutely. So , um, one way you can kind of
see that now is the change inthe demographic of the United
States. Prior to about 2018 ,uh, the demographic group who
had the most gout in the UnitedStates were definitely African
American men. Um, after 2018,data now supports Asian
American men. Um, and that hasto do a lot with genetics. It
(13:39):
means that yes, there's familyhistory, so if your mom, dad,
brother, sister has gout, riskgoes up a little bit more. But
it also goes to the question ofhow do you get gout? It's not
just through food. Food is partof the equation for sure, but
the other part is just who youare, your DNA , if you will.
And so for some people, we havea predilection to hold onto
(14:01):
uric acid more, and that'sdefinitely more true of Asian
Americans. And then we alsohave certain people that just
simply make more uric acid intheir body. They take whatever
you give them in terms of foodand they crank out uric acid.
So that's how you can getlittle bit more higher levels
of uric acid. That
Speaker 2 (14:19):
Leads to my next question is how do you diagnose
it? Are we checking uric acidlevels or are we looking for
the pretty crystals? Andlisteners? I have seen gout
crystals under a microscope.
They're
Speaker 3 (14:28):
Beautiful. Yes.
They're , they're
Speaker 2 (14:29):
These yellow kind of pretty things.
Speaker 3 (14:31):
Yeah. If you have bad enough gout, it looks like
Christmas. When you look at a ,uh, uh, somebody saw takes me
Speaker 2 (14:38):
Back tissue , me skull takes me back to when
they made the colorblind melook at things in the
microscope. And everythinglooked about same color, but
gout didn't. Yep . It was thesebeautiful crystals. Yep .
They're not so beautiful whenthey're in your big toe.
Speaker 3 (14:49):
No . Uh, patients are not impressed with , uh,
the appearance of the crystalswhen they're suffering from the
attack. So
Speaker 2 (14:54):
How do you diagnose gout then?
Speaker 3 (14:55):
So , uh, diagnosing gout, this is actually really
helpful for patients to know.
Uh, so that's part of how theyrecognize if they have gout. So
we define gout as somethingcalled monoarticular, meaning
that it's usually just oneplace that starts off with an
attack. So if you have oneswollen joint out of the blue,
sudden onset, meaning that ithappened to say, for example,
(15:15):
overnight, no trauma oranything like that beforehand,
you can't explain why it'shappening. And it's very, very
rapid. So within about 12 hoursof feeling a little twinge in
that joint, it goes to beingvery swollen, very red, very
painful, very warm, all within12 hours. So it's a very rapid
thing. So if you're kind ofseeing that, that is very
(15:37):
helpful. And then finally,knowing a little bit more about
your personal history, ifyou're somebody that struggles
from high blood pressure andyou take high blood pressure
medicines, those medicinesoftentimes are linked to having
higher levels of uric acid. Youshouldn't stop taking them, but
you should be more aware that,hey, I am a little bit higher
risk of it. You look at yourbody weight, if you notice
(16:00):
that, hey, my BMI is somethingthat I do wanna work on a
little bit because it's on thehigher end, that does put you
at higher risk. And of coursefamily history, if you know
that your father struggled withgout or your brother struggled
with gout, that makes it alittle bit more likely too .
Rheumatologists used the exactsame clues to help diagnose
gout. Back in the old days, wesaid that the only thing that
(16:21):
you could do to diagnose goutwas to take fluid outta
someone's joint. Look at it inthe microscope. That is not
true anymore. Nowadays, thestory of what we're talking
about right now, the elementsof history and the person's ,
uh, medical history is just ashelpful. So if we know these
elements and they check yes,true, we can diagnose people
with gout just by using thestory alone. If we wanted to
(16:45):
get fluid from the joint, wecan definitely do that. We have
many ways to do that now. It'sstill not the most fun process
in the world. Yep .
Yeah. And then we also haveways now to , uh, look at the
joint underneath the skin aswell, without having to take
fluid. We can use , uh,something called ultrasound.
Ultrasound has very distinctfeatures when people have gout
(17:05):
and a gout flare. And then wealso have something called dual
energy ct. Dual energy CT isnewer to us, and we do have it
here and it allows us tovisualize and reconstruct, for
example , uh, foot and kind ofmap out and draw the diagram of
the skeleton of the foot, allthe bones, and it will actually
draw out the crystalsthemselves on the surface of
(17:27):
the bones. So you can get anidea of how many crystals there
are there too. And how big aproblem it really is.
Speaker 2 (17:32):
We've come a long way from King Henry vii .
Absolutely. So we're learningabout gout with Dr No
rheumatologist at HennepinHealthcare in downtown
Minneapolis, and never fearfolks. Help is on the way.
We're gonna talk abouttreatments and what you maybe
can do to reduce your risk ofgetting out and what you should
do if you do have it. So stickaround, we'll take a quick
break and then we'll be rightback.
Speaker 4 (17:56):
When Hennepin Healthcare says we are here for
life, they mean here for you,your life, and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the West Metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(18:18):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (18:34):
And we're back talking about gout with Dr.
Lynn. No . Okay. So Lynn ,we've, we've talked about the
prevalence and what it is andhow painful it can be. Now
let's talk about what can bedone about it. So is there a
cure for it? Is there atreatment for it? What do you
do?
Speaker 3 (18:48):
Uh, that answer is there's definitely treatment
for it, and it almost is acure. So let me emphasize that
a second. It's almost a cure.
The way you take care of goutis simple. You know, it's
caused by high uric acid. Thetreatment is to lower the uric
acid. You could do it via acombination of waste .
Medications are probably themost effective. We have a
couple of different ones in theUnited States, and then also
(19:10):
the things that we can do inour day-to-day life, that can
also decrease the amount ofuric acid in our body as well.
Those two things right thereessentially will treat and
prevent gout attacks for theremainder of most people's
lives if they're, they'refocused on it. So let's
Speaker 2 (19:24):
Talk about the first one, reducing uric acid. These
are medicines that you takeevery day?
Speaker 3 (19:28):
Yes. So we have a few different medications that
you do need to take every dayand you wanna be consistent
with it. And the key things Iwould impart is that it's not a
one size fit all typemedications. These are
medications that are tailoredto the individual. So what you
do is very simple. You startsomebody at the lowest dose
humanly possible of a medicine.
You check their uric acid in afew weeks. If it's higher than
(19:49):
where you want it, you increasethe dose and you keep ongoing
until you get to your goal, thegoal for that patient. And once
they get to that numericalgoal, that uric acid their G
attack , stop and that's it.
Yeah . Yeah.
Speaker 2 (20:01):
That's, it's actually, they're really
effective these medications tolower uric acid. So that's the
first thing. What aboutavoiding the amount of uric
acid you put in your body? Wetalked about some foods earlier
that, that we've already goneover, but what do you tell
patients about about theirdiet? Because you can't just
say, don't eat any of that.
Speaker 3 (20:19):
Right? We do like to, at least here, we like to
emphasize quality of life. Wewanna try to encourage
adherence because if I tellsomebody, I know you love
steak, but you can never, ever,ever have it again for the rest
of your 60 years on this earth,they're just gonna leave.
They're not
Speaker 2 (20:35):
Gonna leave state .
They're gonna leave theirrheumatologist. Yeah,
Speaker 3 (20:37):
They're gonna leave me. Yeah. And so I tell them,
Hey, be reasonable. Do it inmoderation with these
medications. You can have thisstuff, but you won't be able to
have it as much as perhapsyou'd like. And that's usually
enough where the patient says,okay, I see value in this
medication. And then I also seethat you're trying to help me
keep my quality of life too. Ienjoy this, this is part of me.
(21:00):
And so we don't emphasize, Hey,you need to cut out anything.
We really try to say everythingin moderation. So
Speaker 2 (21:07):
That is sort of how to reduce future attacks of
acute gout with what you eatand maybe take a , a uric acid
lowering medication. What aboutduring an acute attack during
that agonizingly painful fewdays?
Speaker 3 (21:20):
Yeah. What ,
Speaker 2 (21:20):
What do we do about that?
Speaker 3 (21:22):
If you know you have gout and you're experiencing
the beginning of a new attack,the best thing that you could
do for yourself is take ananti-inflammatory. A lot of
doctors will prescribe patientsa variety of different things
from a medication calledprednisone to colchicine or
very popular endeth is theother one as well. But really
(21:44):
any anti-inflammatory willwork, whether it's ibuprofen or
naproxen. You just gotta makesure you take enough of it and
take it early enough. You wannatake it in that first 12 hours
of feeling the , uh, onset andattack. And if you can do that,
you can save yourself severaldays of agony. Sounds
Speaker 2 (22:00):
Good. That's treatment. I do wanna talk
about some of the longer termeffects of gout on the human
body. Other than just the acuteattacks. Are there effects of
high uric acid levels? In otherwords, if you don't lower your
uric acid levels, you get theseacute attacks, but is , are
there other effects on yourbody long term ?
Speaker 3 (22:20):
Absolutely. So we have seen that uric acid being
too high in the body for a longtime has been linked with
increased kidney disease andincreased risk of kidney
disease. So for people whoalready have it, and we now see
their uric acid elevated, we'remore motivated than ever to
help them lower that uric acidbecause we don't really want
(22:42):
people to progress towards
Speaker 2 (22:43):
Dialysis. Right.
Kidney disease, something to beavoided. So people should take
it seriously, not only becauseit's an agonizing week of your
life when you have an acuteattack, but also because there
aren't long term effects ofhaving high uric acid levels
forevermore in yourbloodstream. Is there anything
non medicinal? I I, I'mthinking of this question that
I'm asking you, and I treatgout all the time, or at least
(23:04):
I treat the initial stuff. Iusually send them to a guy like
you who knows what they'redoing more. But I'm trying to
think of , are there nonmedicinal things you can do
other than what you eat? Yeah,
Speaker 3 (23:13):
Absolutely. Being healthy. I mean, gout and uric
acid is really tied to howhealthy we are. Usually that's
the case. And so if we loseweight, our uric acid comes
down. If our blood sugars arebetter, our uric acid comes
down. If our blood pressure isbetter, our uric acid comes
down. And so when you take careof yourself overall in making
(23:36):
your body healthier, your uricacid tends to respond. So
Speaker 2 (23:39):
It's, it's sort of like a , a theme that happens
on this podcast is I bring aspecialist in to talk about a
specific condition and it , itis actually a theme. Healthy
life choices are reallyimportant. Absolutely. They
just really are important. I, Ilove that actually about this
is that regardless of whattopic I'm talking about, I get
a , an expert in a topic andthey say, you know, you need to
(24:00):
eat right and, and exercise andbe healthy and not smoke and
all those things.
Speaker 3 (24:04):
Absolutely. I mean, we emphasize that in our
clinic. We tell our patients,if you're trying to find a diet
rather than trying to findthings to avoid, why don't you
look for things that you shouldeat more of? Uh , Mediterranean
diet is excellent. The dashdiet is excellent too, but
Mediterranean diet has beenassociated with lower levels of
uric acid across the board. Andso if you just wanted to make a
(24:26):
simple change when you look upMediterranean diet and recipes
and whatnot, that's a reallygood place to start.
Speaker 2 (24:32):
That's why I wanna move to Myorca . Okay. Now ,
um, before I let you go, isthere any future research or is
there, are there any futuretreatments for gout that, or ,
or diagnostics that excite you?
Um,
Speaker 3 (24:43):
Very rarely. We have situations where gout is very,
very challenging to control.
And the medications that wecurrently have simply don't fit
the bill. And when thathappens, we are currently left
with a scenario where we haveto give bad news to patients.
And I really don't love doingthat. And so I'm excited about
some new , uh, therapies on thehorizon that allow us to give
(25:07):
medicines , uh, called uricasethat just destroy uric acid. In
a nutshell, it's an enzyme thatwe , uh, as humans have a gene
to encode, but it's a vestigialgene, meaning that it's a gene
that no longer is activethrough time. Humans have lost
the ability to use it. Mostother mammals in the world
(25:28):
still use that gene so theydon't get gout. So when you
make uric case this enzyme toany uric acid in your body,
it's immediately destroyed. Andso this is now something that
we're currently looking atusing to give people to get rid
of all the uric acid present inthe body.
Speaker 2 (25:46):
That just gets to the root of the problem. Then
it , it isn't trying to excreteit out of your body, just
destroy it in your body. Sothat's why my dog doesn't get
gout, you know,
Speaker 3 (25:56):
Dogs, certain
Speaker 2 (25:57):
Dogs do some get it?
Yes.
Speaker 3 (25:58):
Oh, dalmatians,
Speaker 2 (26:00):
Dalmatians. Get gout. Okay. If you've listened
to this far in the podcast, wehave just given you a bar
trivia answer for the ages. Theone breed of dogs that gets
gout is dalmatians. Yep . Myblack labs safe maybe. Yep .
We're talking with Dr. Lin .
Know about gout. He's arheumatologist at Hennepin
Healthcare. And Lynn , if Icould ask you to leave our
(26:20):
listeners with the main pointsthat they should know, what
would you like listeners toremember about gout?
Speaker 3 (26:26):
I always tell my patients, if you could take
three things away from thisvisit today. Um , number one, I
want you to know that uricacid, you have too much of it.
You were born with it, it'sokay, not your fault, you just
have too much of it and it'sgiving you a problem. Number
two , there are ways to get ridof your uric acid. And number
three , the
Speaker 2 (26:42):
Uric acid can be removed by either medication or
lifestyle modification. Irecommend both Great tips,
listeners, if you arestruggling with gout or you
think you might be, or you knowsomeone it is and you're
wondering where to get help, Ihope you have learned something
from this show, as have I, andI hope you'll seek medical
attention. If the case may be,if you happen to be in downtown
Minneapolis, we haveoutstanding rheumatologists at
(27:05):
Hennepin Healthcare. Dr . Nothanks for being here today.
It's a pleasure. Thank you.
It's been great having you onthe show today. Listeners, I
hope you'll tune in for ournext episode in two weeks time,
and in the meantime, be healthyand be well.
Speaker 1 (27:18):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk .
There's also a link in the shownotes. The Healthy Matters
(27:40):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:02):
time, be healthy and be well.
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