March 19, 2025 • 34 mins
Can post-menopausal women be at risk for a condition traditionally seen as a male disease? Join Dr. Holly Thacker in the Sunflower House as she breaks the myth and sheds light on how gout and high uric acid levels can significantly affect women. Discover the crucial role of estrogen in protecting against gout and how its decline post-menopause can lead to painful symptoms. Dr. Thacker dives into the science of purines, dietary influences, genetic, and lifestyle factors, and why women often face misdiagnoses.
Transform your understanding of gout management with Dr. Thacker's comprehensive prevention strategies. Learn how to make smarter dietary choices, recognizing the impact of alcohol, certain medications, and high-purine foods. Dr. Thacker identifies foods to avoid and those that can help manage the condition, emphasizing the importance of hydration and a balanced diet.
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Speaker 1 (00:06):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new pod on everythinggout and high uric acid.
(00:28):
So I became interested in thiswhen I had some patients in my
menopause clinic being diagnosedwith gout.
And it's interesting becauseit's classically much more
commonly a disease of males,because it's classically much
more commonly a disease of malesand it's interesting to look at
(00:49):
some of the sex differences.
And since we cover so much onspeaking of women's health in
terms of being strong, beinghealthy and being in charge on
diet and nutrition, there'sdefinitely dietary factors that
influence this condition, whichcan be very painful, and the
(01:12):
classic kind of presentation ofgout was, you know, decades and
decades ago, termed a very richperson's disease, because only
very wealthy people could affordvery rich foods, rich in meat,
purines and seafood.
(01:32):
So what are purines?
Well, they're substances foundin certain foods and our bodies
turn purine into uric acid, andhigh levels of uric acid, or
what's called hyperuricemia, cancause gout, which is a form of
(01:54):
very painful inflammatoryarthritis.
So you might ask well, whatcauses the uric acid level to go
up, and at least one in fivepeople have elevated uric acid
levels, and it's a waste product.
When your body breaks downpurines that are in drinks and
(02:15):
foods, most of the time the uricacid just dissolves in the
blood and passes through thekidneys and leaves your body in
the urine.
But hyperuricemia occurs if toomuch uric acid stays inside
your body.
And if you've got too much ofthese uric acid they can clump
(02:39):
together and form very sharppokey crystals and these
crystals can settle right in thejoints and really be painful.
They can also build up in yourkidneys and form uric acid,
kidney stones, and if youhaven't listened to our earlier
podcast on everything kidneystone, that's a good one to
(03:03):
listen to.
People say kidney stones aremore painful than childbearing
and at least usually at the endof labor you get the prize of a
beautiful baby.
But most people are not toohappy to have a kidney stone,
although they are usually gladif they pass it.
And if you do pass a kidneystone, save it if you can, so it
(03:32):
can be chemically analyzed.
So temporarily having anincrease in your uric acid level
doesn't mean you have gout, andmany people with elevated uric
acid levels never get gout andthey may not ever get kidney
stones.
So what is gout?
Well, it's a very painful acuteinflammatory arthritis and
chronically, if the goutcrystals continue to be
(03:56):
deposited, there can be not justpain and inflammation but
actually joint damage.
So about 5% of people have goutand it's much more common in
males than females.
Especially, it's much morecommon in males under the age of
60.
But with, like a lot of thingsafter age 60, when women go
(04:20):
through menopause and loseestrogen, sometimes they catch
up to men or at least start toapproach higher incidence of
some of these other conditions,whether it's heart disease,
sleep apnea.
There's a lot of things that itseems like premenopausal women
have some protection.
(04:41):
Just like gout is very rare inpregnancy, usually there's some
genetic defects or kidney issuesand obviously anyone that has
kidney impairment may havetrouble clearing the uric acid.
So in general we don't usuallysee gout in young women before
(05:05):
the age of menopause and it'sthought that estrogen does
protect because it may helpflush the uric acid out of the
kidneys.
And women who have much shorterreproductive spans in their
life late menarche, earlymenopause seem to maybe have a
higher risk, and some studieshave shown that menopausal
(05:30):
hormone therapy may actuallyhelp reduce gout.
But there was one study inKorea of a million women that
looked at lots of differentfactors and found very tiny
increases in gout in women onhormonal contraceptive pills and
(05:53):
menopausal hormone therapy.
So there is some differences instudies.
Now, certainly, the higher thebody mass index, obesity seems
to make pretty much everycondition worse.
And again, the caricature ofsomeone with gout was usually a
(06:16):
wealthy, quite overweight manwho enjoyed rich foods and lots
of alcohol, and certainly manyalcohols, like hard liquor and
beer, increase purines.
Now, according to the ArthritisFoundation, where we got some of
(06:38):
this information from, womentend to develop gout in several
joints very slowly andinsidiously, whereas men get the
more classic pedagra, which ispain in that big toe joint that
can strike in the middle of thenight.
(06:59):
Just even the light touch ofbed covers tend to cause just
terrible pain, whereas women mayget it in their hands and their
knees and their wrist, the endsof their finger, where they
might already have someosteoarthritis, and
osteoarthritis is the mostcommon arthritis affecting the
(07:21):
vast majority of people startingat age 30.
Sometimes you get it in the bigtoe where you have a little
bunion or maybe more on yourdominant hand compared to the
non-dominant hand Trauma, sportsinjuries.
Certainly there's geneticcomponents and we have a lot of
information on osteoarthritis onour speakingofwomenshealthcom
(07:45):
site and upcoming podcast.
We also had a great podcast onjoint supplements for joint pain
and preparing for jointreplacement.
So a lot of times gout in thehands are misdiagnosed and
that's where I have seen it insome of my patients.
(08:05):
It's kind of reminiscent of howmyocardial infarctions, heart
attack in women, may bemisdiagnosed because they're not
classic.
Like an elephant sitting on mychest, it might just be
shortness of breath, I can't doas much activity or housework,
or I might be nauseated orfatigued and I definitely would
(08:29):
go back and listen to seasonone's podcast on gender matters
in terms of heart disease inwomen and the manifestations.
So, getting back to thesymptoms of gout, as I mentioned
, classically it's the big toe,but it doesn't have to be the
big toe.
(08:50):
It could be the knees or theankles or the small joints in
the feet or hands, wrists oreven elbows.
A lot of times they can occur atnight when someone's a little
dehydrated.
They can occur for severalweeks.
Usually the most intense,unbearable pain is in the first
(09:11):
24 hours and it's not mild,irritating pain.
It's pretty intense.
There can be redness,discoloration, swelling,
tenderness to even a light touch.
Some people say they feel liketheir joint is on fire or
they're being stabbed with apoker stick.
(09:31):
So gout can affect anyone.
But the risks include beingoverweight, having too much body
fat, congestive heart failure,kidney failure, type 2 diabetes,
and we have a podcast ondiabetes.
(09:53):
How to be less sweet.
We have information ongestational diabetes, which is a
risk for adult onset diabetes,as well as sleep apnea,
hypertension.
I have a podcast talking aboutcholesterol and calcium and
hypertension and how.
Almost every day in clinic Ihave discussions with women who
(10:15):
say oh, my blood pressure'salways been great, everybody's
blood pressure's always greatuntil it isn't Just like I've
had women tell me well, in thepast my uric acid levels were
always good and now they're not.
So it is good to know yourhistory.
It's good to keep copies ofyour lab results and,
interestingly, uric acid used tobe on a lot of multi-channel
(10:42):
chemistries when you would go inand have like a chem 20, you
know 20 different lab tests ofchemistries in your blood work.
But now it usually needs to beordered specifically.
So some people don't even knowwhat their uric acid level is.
Kidney disease and one in fourpeople over age 65 have some
(11:05):
kidney impairment.
Just like we reach maximal bonedensity at age 30, you kind of
have your peak renal function atthat age and then there's a
slow decline with age andcertainly obesity and
hypertension and medicationsthat can damage the kidney or go
through the kidney can impairkidney function.
(11:28):
Different types of blood cancer, malignancies that are very
where there's a lot of cellturnover there can be higher
uric acid levels.
Family history if you're ableto know your medical history of
(11:49):
your biological relatives withthanksgiving, I think is a good
time when you might meet up withyour family or other holidays
or birthdays or other maybecultural or family celebrations.
It is kind of good to getupdates on your family history
(12:14):
and those that eat a lot ofanimal proteins, especially
animal fish, flesh, animalorgans, as well as shellfish and
any foods that contain organmeats and those are very rich in
nutrients like iron.
Our very first podcast onseason one was all about iron
and certainly zinc and iron arefrequent deficiencies in women.
(12:35):
There has been somewhat of acarnivore craze, with people
just eating meat, which you haveto be very careful because not
just of the high purines butalso because of maybe lack of
electrolytes, and so any strictdiet or unusual diet really
should be monitored, of course,by your healthcare clinician.
(12:59):
Now, drinking alcohol regularlyis also a risk.
Alcohol regularly is also arisk, particularly beers and
hard liquor.
If you're on a diureticmedication like water pills,
that can reduce your uric acidexcretion.
Also, low dose aspirin incontrast to high dose aspirin,
(13:22):
which might promote more uricacid excretion.
No-transcript.
So you might ask well, how can Iprevent getting an elevated
uric acid level and gout?
You have some control over this.
(13:45):
You don't have control overyour genes, that's for sure, but
you do have control over thefoodstuffs that you put in your
mouth and what foods you have inyour diet.
And what foods you have in yourdiet.
So the foods that are very highin purines and we have a nice
list of this onspeakingofwomenshealthcom.
If you go on the website and onthe mobile version, in the
(14:07):
upper right hand corner is alittle magnifying glass just put
in purine or gout.
So organ meats like liver andkidney and sweetbreads and
brains and tripe Again very richin nutrients.
But if you have high uric acidit's not something that you
might want to eat regularly.
(14:29):
Now red meat which has a lot ofiron and zinc and protein and
nutrients bacon, beef, pork andlamb.
And if you haven't read thecolumn on food freedom and
banned foods in other countriesthat are available in our food
(14:50):
supply, I was shocked to learnthat 100 countries ban American
pork because of stuff that isadded to the feed of pork that
other countries consider toxic.
Now, game meats, specialtieslike goose and veal venison pate
(15:13):
, they all contain very highlevels of purines.
Turkey, especially theprocessed deli.
Turkey Seafood oh, seafood'sone of my favorite foods and
it's rich in omega-3.
And so many patients that I gettheir levels of omega-3, maybe
(15:35):
because their cholesterol levelsare abnormal or they have
inflammation or joint pain ordepression.
I'm really shocked to find outthe imbalance of the hard,
healthy fats that so many of thepeople that I see even many of
them very health conscious have,and so seafood is a wonderful
(15:56):
source of omega-3, but alsopurines.
So tuna, anchovies, sardines,mackerel, herring, scallops,
trout, mussels, codfish, haddock, just to name a few.
So gravies and meat sauces aswell.
(16:20):
And, as I mentioned, beer andhard liquor.
Now for women, I always tellthem there's no reason you need
to drink alcohol quote for hearthealth.
I mean.
That is a common misconception.
There is no medical reason todrink alcohol.
Now, people that are socialalcohol drinkers in some studies
(16:42):
might have less heart disease,but it may be markers for other
things socialization, exercise.
I love to golf and you know weall joke about the 19th hole is
the watering hole.
Obviously, lots of celebrationshave alcohol, but 20% of women
can become alcoholic.
(17:02):
It's a toxic substance to thebrain and the liver and it's
also lots of calories and itdoes interfere with sleep.
If you haven't heard some ofour great podcast on sleep,
that's really good to go back tolisten to.
So alcohol specifically preventsyour kidneys from eliminating
(17:26):
uric acid, pulling it back,reabsorbing it back into the
body where it can accumulate.
So if you're predisposed togout and it's a special occasion
and you know you might have adrink and you're predisposed to
gout, and it's a specialoccasion and you know you might
have a drink and you'repredisposed to gout, I have seen
some physicians recommendtaking colchicine.
(17:47):
Colchicine is an old medicine,naturally derived.
It affects tubular spindles andit's very good at treating
inflammation and pain and itreduces the inflammation caused
by those crystals of uric acidthat build up when one has gout.
(18:09):
Now, one thing that I think youcan totally eliminate from your
diet safely, because obviously,in general, meat has so much
nutrition and protein that wewould not say just for most
people to ever eliminate meat.
Alcohol, of course, issomething that is not a
(18:32):
necessary nutritional item, thatis for sure.
But the one thing that we canabsolutely say to eliminate is
sugary drinks and junky sweetsand anything with high fructose
corn syrup.
So a lot of table sugar isactually made up of half
(18:53):
fructose, which is fruit sugar,and fruit sugar breaks down into
uric acid and any food or drinkthat has a high sugar content
can trigger gout.
So I don't think there's reallyany reason to be drinking
(19:28):
sugary drinks and I would readlabels and not purchase things
that have high fructose cornsyrup and a lot of that's in
prepackaged foods, processedsnacks, cheaper foods and, if
you haven't read the column onfood freedom and banned foods in
(19:49):
other countries, justresearching that, I learned so
much Now.
Yeast and yeast extract also isrich in purines.
So what about foods that arelow in purines and a lot of
these are really healthy foodsand can help eliminate the
(20:10):
burden of uric acid in yourblood, and foods that are low in
purine can help improvesymptoms of gout and kidney
stones and just general healthand well-being.
Vegetables, certain fruits,like cherries Cherries are
excellent, whole grain breadsand rice.
(20:32):
Eggs.
And eggs are really rich incholine, good for your brain and
they're a very excellent sourceof protein, and they've been
really demonized too long.
Good old water.
Coffee, black coffee, I thinkis a good way to start your day
if you're not too sensitive tocaffeine, and I say black coffee
(20:55):
because I think it's good, asadults in general, to
intermittently fast.
Black coffee because I thinkit's good as adults in general
to intermittently fast.
If you're not a coffee person,green tea as well.
And as I'm an osteoporosisdoctor, I'm always happy to see
(21:15):
low-fat cheese and dairyproducts and milk on the list
because those are really richsources of calcium.
Those are really rich sourcesof calcium.
So in that respect, there aresome foods I think that you can
enjoy and think about whenyou're planning, you know, your
diet for the week, to make surethat you're having some low
(21:37):
purine foods and not just highpurine foods.
It's interesting that some ofthe foods that are high in
histamines are also foods thatare high in purines and some
people are sensitive tohistamine and can get hives, and
(21:58):
I see a lot more hives andsensitive skin in postmenopausal
women.
So some of the foods that aresuper high in histamine include
a lot of alcoholic beverages,including red wine.
Fermented foods which fermentedfoods are great for your gut,
microbiome, like sauerkraut andcomiche and miso, but they are
(22:22):
high in histamine.
And then the good old meatslike bacon and sausage and
salami and pork, especiallypre-processed meats, as well as
fish, mackerel, tuna, sardinesand herring.
And the high histamine dairyare primarily aged cheese and
(22:43):
yogurt.
And then strawberries are veryhigh in histamine and the
so-called tropical fruits likepineapple, banana and papaya.
So not everyone has histamineintolerance, that's for sure.
But, uh, some people definitelydo and have diarrhea and
(23:04):
bloating and sneezing andflushing and low blood pressure,
uh, even swelling or, um,swelling of the lips and tongue,
which can be, uh, very serious,and anaphylaxis, very serious
in anaphylaxis.
So, getting back to gout, andyou've been listening to the
(23:25):
Speaking of Women's Healthpodcast.
I'm your host, dr Holly Thacker, and we're in the Sunflower
House talking all things purineand gout.
So a healthcare clinician candiagnose gout primarily by a
physical exam, by asking aboutsymptoms and affected joints,
but it's not include a uric acidblood test, and the most
(24:03):
definitive diagnostic test wouldbe to draw fluid out of a joint
and look under the microscopeto see the uric acid crystals.
So how is gout treated?
Well, the pain has to bemanaged, as well as the
inflammation, and then,long-term, the diet and the
weight and, potentially, goutmedications.
(24:25):
So medications likenon-steroidal anti-inflammatory
agents, like over-the-counteribuprofen, naproxen, aspirin.
Those medicines can affectkidney function and also the
stomach, and those that haveaspirin allergy or stomach
(24:46):
ulcers or kidney impairmentwould definitely need to talk to
their physician before takingthose agents, many of them,
which are over the countercounter.
Now, colchicine is a it's aprescription medicine and it can
(25:07):
be very effective in the acuteattack, and it can if you take
it right away at the first signof it.
It can be very, very helpful.
And one of the biggest sideeffects, though, of colchicine
is diarrhea and abdominal cramps, and it's a very old natural
medication.
(25:27):
It's used also in cases ofpericarditis and other
autoimmune inflammatoryconditions.
Now, corticosteroids likeprednisone are prescription
medications that are very strong.
It's usually taken by mouth.
Sometimes it can be injecteddirectly into the joint, usually
(25:48):
by a rheumatologist or yourfamily physician.
Long-term to like reduce theburden of uric acid on your body
.
Besides diet and working to getyour weight to the normal body
weight, there are medicines likeallopurinol which have been
used for a long time to loweruric acid, and there's some
(26:09):
other ones fabuxostat andpeglotocase and then there's one
probenicid which increases uricacid secretions.
Sometimes I've suggestedchanges in the diuretic regimen.
We use a lot of low-dosediuretics to treat hypertension
and in the osteoporosis field Iuse very low doses of
(26:35):
hydrochlorothiazide, not even inblood pressure doses, but just
to prevent too much calciumexcretion in the urine.
We do this in the cases ofkidney stones caused by
hypercalciuria, as well as womenwho have osteoporosis and
negative calcium balancenegative calcium balance Now,
(27:03):
most of the time.
Your healthcare team wouldsuggest following a low purine
diet and consuming less foodsrich in high purine, and you
might be encouraged to eat foodsor drink things like maybe
you're not a coffee or teadrinker, maybe you do need to be
prompted to drink more water inyour diet.
Um, maybe, uh, some great uhcherries.
(27:28):
You might be encouraged todrink cherry juice or tart
cherry extract capsules, orfrozen cherries.
If they're not in season, youmight ask well, can gout be
cured?
You'll get much less painfulattacks if you work with your
(27:57):
healthcare team to findtreatments that manage your
symptoms as well as lower youruric acid levels, and so the
thing that is under your controlis getting rid of those sugary
drinks, the high fructose cornsyrup and super duper rich, high
purine foods or at leastminimize them, maybe, and pair
them with fruit and vegetablesand low fat dairy.
(28:20):
Getting regular exercise andstrengthening up your muscles
around your joints can help, andanyone that is medically
overweight or obese, especiallycentral organ body weight,
should definitely be workingwith their healthcare team to
(28:44):
get their weight down.
Now what can you expect if youhave gout?
The flares can happen morefrequently if you're not being
managed, and some peopleparadoxically, actually get more
severe or frequent attacksright after starting a new
(29:05):
treatment because the uric acidin their body is more in a flux,
and most people with gouteventually find a combination of
treatments and lifestyle tweaksto manage their symptoms and
reduce how often they get goutattacks.
Gout is very treatable, andpeople who can lower their uric
(29:26):
acid below 6 mg per deciliterare much less likely to have
acute attacks are much lesslikely to have acute attacks.
Now women have asked me well,should I take hormone therapy or
not take hormone therapyrelated to gout, and that
doesn't usually weigh into ourrisk benefit equation Um.
(29:48):
Untreated gout, though, can leadto permanent joint damage, and
if you have a buildup of uricacid in the joints and soft
tissue, it's called a tophus,and it can actually erode
through the skin.
And some people with gout candevelop severe joint deformities
, the tophi, which is actualuric acid crystals in the joints
(30:12):
and around the soft tissue,painful kidney stones and a
higher rate of heart disease.
So you want to plan formanaging a gout attack.
So if you start to get a goutattack, you've got to stop
alcohol, stop sweet drinks thatare sugary and any high fructose
(30:33):
corn syrup.
You want to drink plenty ofwater and you want to elevate
your affected joint above thelevel of your heart as you're
able to, icing the joint withcold compresses for 15 to 20
minutes, with at least a 20minute break, doing this a few
times a day.
You want to avoid stress on thejoint from intense physical
(30:56):
activity and you want to seekmedical attention if this is the
first attack, if it hasn't beendiagnosed, if you think there
might be infection, if the jointis red and swollen, because
gout shares many symptoms withserious infections that might
need to be treated withantibacterial agents right away.
(31:21):
So when you're meeting with yourphysician, if you're having
more frequent attacks or moresevere than they used to be, you
want to find out is this gout?
Is it another type of arthritis?
What can you do to preventfuture attacks?
What medication might be used?
You know, assuming you've triedto optimize your diet as much
(31:43):
as possible.
Some questions that you mightwant to ask are what are the
first signs of having gout?
It's usually sudden, withoutwarning, and it's very intense
pain and they can developovernight and you might notice
the symptoms in the morning andit's common to go.
(32:04):
It's common to go from nosymptoms to severe symptoms all
at once during an attack andit's important to get an exam to
make sure there's nothing elsegoing on and that you don't have
an acute infection.
If you've already beendiagnosed and you've got your
prescription medications, youmight be instructed to start on
(32:25):
colchicine, and you do need along-term plan because you want
to protect your kidneys and,depending on your kidney
function and your uric acidlevel, that your physician will
take into account in terms ofdetermining what might be the
best treatment to reduce youruric acid load and burden.
(32:47):
It's also good, I think, tokeep track and have a journal.
Some people will journal whatthey eat or what their
activities are, and that can behelpful.
So I hope that this podcast onall things gout and uric acid
and some of the gender-baseddifferences has been helpful to
(33:09):
you or your family.
I want to thank you for tuningin for another episode.
We're so grateful for yoursupport.
Please consider sharing it withfriends or family or leaving us
a five-star rating, and if youdon't subscribe to the podcast,
you can follow or subscribe forfree.
(33:29):
We're on Apple Podcasts,spotify TuneIn, wherever you
listen to your podcast.
Thanks again for listening andwe will see you next time in the
Sunflower House.
Be strong, be healthy and be incharge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new pod on everythinggout and high uric acid.
(00:28):
So I became interested in thiswhen I had some patients in my
menopause clinic being diagnosedwith gout.
And it's interesting becauseit's classically much more
commonly a disease of males,because it's classically much
more commonly a disease of malesand it's interesting to look at
(00:49):
some of the sex differences.
And since we cover so much onspeaking of women's health in
terms of being strong, beinghealthy and being in charge on
diet and nutrition, there'sdefinitely dietary factors that
influence this condition, whichcan be very painful, and the
(01:12):
classic kind of presentation ofgout was, you know, decades and
decades ago, termed a very richperson's disease, because only
very wealthy people could affordvery rich foods, rich in meat,
purines and seafood.
(01:32):
So what are purines?
Well, they're substances foundin certain foods and our bodies
turn purine into uric acid, andhigh levels of uric acid, or
what's called hyperuricemia, cancause gout, which is a form of
(01:54):
very painful inflammatoryarthritis.
So you might ask well, whatcauses the uric acid level to go
up, and at least one in fivepeople have elevated uric acid
levels, and it's a waste product.
When your body breaks downpurines that are in drinks and
(02:15):
foods, most of the time the uricacid just dissolves in the
blood and passes through thekidneys and leaves your body in
the urine.
But hyperuricemia occurs if toomuch uric acid stays inside
your body.
And if you've got too much ofthese uric acid they can clump
(02:39):
together and form very sharppokey crystals and these
crystals can settle right in thejoints and really be painful.
They can also build up in yourkidneys and form uric acid,
kidney stones, and if youhaven't listened to our earlier
podcast on everything kidneystone, that's a good one to
(03:03):
listen to.
People say kidney stones aremore painful than childbearing
and at least usually at the endof labor you get the prize of a
beautiful baby.
But most people are not toohappy to have a kidney stone,
although they are usually gladif they pass it.
And if you do pass a kidneystone, save it if you can, so it
(03:32):
can be chemically analyzed.
So temporarily having anincrease in your uric acid level
doesn't mean you have gout, andmany people with elevated uric
acid levels never get gout andthey may not ever get kidney
stones.
So what is gout?
Well, it's a very painful acuteinflammatory arthritis and
chronically, if the goutcrystals continue to be
(03:56):
deposited, there can be not justpain and inflammation but
actually joint damage.
So about 5% of people have goutand it's much more common in
males than females.
Especially, it's much morecommon in males under the age of
60.
But with, like a lot of thingsafter age 60, when women go
(04:20):
through menopause and loseestrogen, sometimes they catch
up to men or at least start toapproach higher incidence of
some of these other conditions,whether it's heart disease,
sleep apnea.
There's a lot of things that itseems like premenopausal women
have some protection.
(04:41):
Just like gout is very rare inpregnancy, usually there's some
genetic defects or kidney issuesand obviously anyone that has
kidney impairment may havetrouble clearing the uric acid.
So in general we don't usuallysee gout in young women before
(05:05):
the age of menopause and it'sthought that estrogen does
protect because it may helpflush the uric acid out of the
kidneys.
And women who have much shorterreproductive spans in their
life late menarche, earlymenopause seem to maybe have a
higher risk, and some studieshave shown that menopausal
(05:30):
hormone therapy may actuallyhelp reduce gout.
But there was one study inKorea of a million women that
looked at lots of differentfactors and found very tiny
increases in gout in women onhormonal contraceptive pills and
(05:53):
menopausal hormone therapy.
So there is some differences instudies.
Now, certainly, the higher thebody mass index, obesity seems
to make pretty much everycondition worse.
And again, the caricature ofsomeone with gout was usually a
(06:16):
wealthy, quite overweight manwho enjoyed rich foods and lots
of alcohol, and certainly manyalcohols, like hard liquor and
beer, increase purines.
Now, according to the ArthritisFoundation, where we got some of
(06:38):
this information from, womentend to develop gout in several
joints very slowly andinsidiously, whereas men get the
more classic pedagra, which ispain in that big toe joint that
can strike in the middle of thenight.
(06:59):
Just even the light touch ofbed covers tend to cause just
terrible pain, whereas women mayget it in their hands and their
knees and their wrist, the endsof their finger, where they
might already have someosteoarthritis, and
osteoarthritis is the mostcommon arthritis affecting the
(07:21):
vast majority of people startingat age 30.
Sometimes you get it in the bigtoe where you have a little
bunion or maybe more on yourdominant hand compared to the
non-dominant hand Trauma, sportsinjuries.
Certainly there's geneticcomponents and we have a lot of
information on osteoarthritis onour speakingofwomenshealthcom
(07:45):
site and upcoming podcast.
We also had a great podcast onjoint supplements for joint pain
and preparing for jointreplacement.
So a lot of times gout in thehands are misdiagnosed and
that's where I have seen it insome of my patients.
(08:05):
It's kind of reminiscent of howmyocardial infarctions, heart
attack in women, may bemisdiagnosed because they're not
classic.
Like an elephant sitting on mychest, it might just be
shortness of breath, I can't doas much activity or housework,
or I might be nauseated orfatigued and I definitely would
(08:29):
go back and listen to seasonone's podcast on gender matters
in terms of heart disease inwomen and the manifestations.
So, getting back to thesymptoms of gout, as I mentioned
, classically it's the big toe,but it doesn't have to be the
big toe.
(08:50):
It could be the knees or theankles or the small joints in
the feet or hands, wrists oreven elbows.
A lot of times they can occur atnight when someone's a little
dehydrated.
They can occur for severalweeks.
Usually the most intense,unbearable pain is in the first
(09:11):
24 hours and it's not mild,irritating pain.
It's pretty intense.
There can be redness,discoloration, swelling,
tenderness to even a light touch.
Some people say they feel liketheir joint is on fire or
they're being stabbed with apoker stick.
(09:31):
So gout can affect anyone.
But the risks include beingoverweight, having too much body
fat, congestive heart failure,kidney failure, type 2 diabetes,
and we have a podcast ondiabetes.
(09:53):
How to be less sweet.
We have information ongestational diabetes, which is a
risk for adult onset diabetes,as well as sleep apnea,
hypertension.
I have a podcast talking aboutcholesterol and calcium and
hypertension and how.
Almost every day in clinic Ihave discussions with women who
(10:15):
say oh, my blood pressure'salways been great, everybody's
blood pressure's always greatuntil it isn't Just like I've
had women tell me well, in thepast my uric acid levels were
always good and now they're not.
So it is good to know yourhistory.
It's good to keep copies ofyour lab results and,
interestingly, uric acid used tobe on a lot of multi-channel
(10:42):
chemistries when you would go inand have like a chem 20, you
know 20 different lab tests ofchemistries in your blood work.
But now it usually needs to beordered specifically.
So some people don't even knowwhat their uric acid level is.
Kidney disease and one in fourpeople over age 65 have some
(11:05):
kidney impairment.
Just like we reach maximal bonedensity at age 30, you kind of
have your peak renal function atthat age and then there's a
slow decline with age andcertainly obesity and
hypertension and medicationsthat can damage the kidney or go
through the kidney can impairkidney function.
(11:28):
Different types of blood cancer, malignancies that are very
where there's a lot of cellturnover there can be higher
uric acid levels.
Family history if you're ableto know your medical history of
(11:49):
your biological relatives withthanksgiving, I think is a good
time when you might meet up withyour family or other holidays
or birthdays or other maybecultural or family celebrations.
It is kind of good to getupdates on your family history
(12:14):
and those that eat a lot ofanimal proteins, especially
animal fish, flesh, animalorgans, as well as shellfish and
any foods that contain organmeats and those are very rich in
nutrients like iron.
Our very first podcast onseason one was all about iron
and certainly zinc and iron arefrequent deficiencies in women.
(12:35):
There has been somewhat of acarnivore craze, with people
just eating meat, which you haveto be very careful because not
just of the high purines butalso because of maybe lack of
electrolytes, and so any strictdiet or unusual diet really
should be monitored, of course,by your healthcare clinician.
(12:59):
Now, drinking alcohol regularlyis also a risk.
Alcohol regularly is also arisk, particularly beers and
hard liquor.
If you're on a diureticmedication like water pills,
that can reduce your uric acidexcretion.
Also, low dose aspirin incontrast to high dose aspirin,
(13:22):
which might promote more uricacid excretion.
No-transcript.
So you might ask well, how can Iprevent getting an elevated
uric acid level and gout?
You have some control over this.
(13:45):
You don't have control overyour genes, that's for sure, but
you do have control over thefoodstuffs that you put in your
mouth and what foods you have inyour diet.
And what foods you have in yourdiet.
So the foods that are very highin purines and we have a nice
list of this onspeakingofwomenshealthcom.
If you go on the website and onthe mobile version, in the
(14:07):
upper right hand corner is alittle magnifying glass just put
in purine or gout.
So organ meats like liver andkidney and sweetbreads and
brains and tripe Again very richin nutrients.
But if you have high uric acidit's not something that you
might want to eat regularly.
(14:29):
Now red meat which has a lot ofiron and zinc and protein and
nutrients bacon, beef, pork andlamb.
And if you haven't read thecolumn on food freedom and
banned foods in other countriesthat are available in our food
(14:50):
supply, I was shocked to learnthat 100 countries ban American
pork because of stuff that isadded to the feed of pork that
other countries consider toxic.
Now, game meats, specialtieslike goose and veal venison pate
(15:13):
, they all contain very highlevels of purines.
Turkey, especially theprocessed deli.
Turkey Seafood oh, seafood'sone of my favorite foods and
it's rich in omega-3.
And so many patients that I gettheir levels of omega-3, maybe
(15:35):
because their cholesterol levelsare abnormal or they have
inflammation or joint pain ordepression.
I'm really shocked to find outthe imbalance of the hard,
healthy fats that so many of thepeople that I see even many of
them very health conscious have,and so seafood is a wonderful
(15:56):
source of omega-3, but alsopurines.
So tuna, anchovies, sardines,mackerel, herring, scallops,
trout, mussels, codfish, haddock, just to name a few.
So gravies and meat sauces aswell.
(16:20):
And, as I mentioned, beer andhard liquor.
Now for women, I always tellthem there's no reason you need
to drink alcohol quote for hearthealth.
I mean.
That is a common misconception.
There is no medical reason todrink alcohol.
Now, people that are socialalcohol drinkers in some studies
(16:42):
might have less heart disease,but it may be markers for other
things socialization, exercise.
I love to golf and you know weall joke about the 19th hole is
the watering hole.
Obviously, lots of celebrationshave alcohol, but 20% of women
can become alcoholic.
(17:02):
It's a toxic substance to thebrain and the liver and it's
also lots of calories and itdoes interfere with sleep.
If you haven't heard some ofour great podcast on sleep,
that's really good to go back tolisten to.
So alcohol specifically preventsyour kidneys from eliminating
(17:26):
uric acid, pulling it back,reabsorbing it back into the
body where it can accumulate.
So if you're predisposed togout and it's a special occasion
and you know you might have adrink and you're predisposed to
gout, and it's a specialoccasion and you know you might
have a drink and you'repredisposed to gout, I have seen
some physicians recommendtaking colchicine.
(17:47):
Colchicine is an old medicine,naturally derived.
It affects tubular spindles andit's very good at treating
inflammation and pain and itreduces the inflammation caused
by those crystals of uric acidthat build up when one has gout.
(18:09):
Now, one thing that I think youcan totally eliminate from your
diet safely, because obviously,in general, meat has so much
nutrition and protein that wewould not say just for most
people to ever eliminate meat.
Alcohol, of course, issomething that is not a
(18:32):
necessary nutritional item, thatis for sure.
But the one thing that we canabsolutely say to eliminate is
sugary drinks and junky sweetsand anything with high fructose
corn syrup.
So a lot of table sugar isactually made up of half
(18:53):
fructose, which is fruit sugar,and fruit sugar breaks down into
uric acid and any food or drinkthat has a high sugar content
can trigger gout.
So I don't think there's reallyany reason to be drinking
(19:28):
sugary drinks and I would readlabels and not purchase things
that have high fructose cornsyrup and a lot of that's in
prepackaged foods, processedsnacks, cheaper foods and, if
you haven't read the column onfood freedom and banned foods in
(19:49):
other countries, justresearching that, I learned so
much Now.
Yeast and yeast extract also isrich in purines.
So what about foods that arelow in purines and a lot of
these are really healthy foodsand can help eliminate the
(20:10):
burden of uric acid in yourblood, and foods that are low in
purine can help improvesymptoms of gout and kidney
stones and just general healthand well-being.
Vegetables, certain fruits,like cherries Cherries are
excellent, whole grain breadsand rice.
(20:32):
Eggs.
And eggs are really rich incholine, good for your brain and
they're a very excellent sourceof protein, and they've been
really demonized too long.
Good old water.
Coffee, black coffee, I thinkis a good way to start your day
if you're not too sensitive tocaffeine, and I say black coffee
(20:55):
because I think it's good, asadults in general, to
intermittently fast.
Black coffee because I thinkit's good as adults in general
to intermittently fast.
If you're not a coffee person,green tea as well.
And as I'm an osteoporosisdoctor, I'm always happy to see
(21:15):
low-fat cheese and dairyproducts and milk on the list
because those are really richsources of calcium.
Those are really rich sourcesof calcium.
So in that respect, there aresome foods I think that you can
enjoy and think about whenyou're planning, you know, your
diet for the week, to make surethat you're having some low
(21:37):
purine foods and not just highpurine foods.
It's interesting that some ofthe foods that are high in
histamines are also foods thatare high in purines and some
people are sensitive tohistamine and can get hives, and
(21:58):
I see a lot more hives andsensitive skin in postmenopausal
women.
So some of the foods that aresuper high in histamine include
a lot of alcoholic beverages,including red wine.
Fermented foods which fermentedfoods are great for your gut,
microbiome, like sauerkraut andcomiche and miso, but they are
(22:22):
high in histamine.
And then the good old meatslike bacon and sausage and
salami and pork, especiallypre-processed meats, as well as
fish, mackerel, tuna, sardinesand herring.
And the high histamine dairyare primarily aged cheese and
(22:43):
yogurt.
And then strawberries are veryhigh in histamine and the
so-called tropical fruits likepineapple, banana and papaya.
So not everyone has histamineintolerance, that's for sure.
But, uh, some people definitelydo and have diarrhea and
(23:04):
bloating and sneezing andflushing and low blood pressure,
uh, even swelling or, um,swelling of the lips and tongue,
which can be, uh, very serious,and anaphylaxis, very serious
in anaphylaxis.
So, getting back to gout, andyou've been listening to the
(23:25):
Speaking of Women's Healthpodcast.
I'm your host, dr Holly Thacker, and we're in the Sunflower
House talking all things purineand gout.
So a healthcare clinician candiagnose gout primarily by a
physical exam, by asking aboutsymptoms and affected joints,
but it's not include a uric acidblood test, and the most
(24:03):
definitive diagnostic test wouldbe to draw fluid out of a joint
and look under the microscopeto see the uric acid crystals.
So how is gout treated?
Well, the pain has to bemanaged, as well as the
inflammation, and then,long-term, the diet and the
weight and, potentially, goutmedications.
(24:25):
So medications likenon-steroidal anti-inflammatory
agents, like over-the-counteribuprofen, naproxen, aspirin.
Those medicines can affectkidney function and also the
stomach, and those that haveaspirin allergy or stomach
(24:46):
ulcers or kidney impairmentwould definitely need to talk to
their physician before takingthose agents, many of them,
which are over the countercounter.
Now, colchicine is a it's aprescription medicine and it can
(25:07):
be very effective in the acuteattack, and it can if you take
it right away at the first signof it.
It can be very, very helpful.
And one of the biggest sideeffects, though, of colchicine
is diarrhea and abdominal cramps, and it's a very old natural
medication.
(25:27):
It's used also in cases ofpericarditis and other
autoimmune inflammatoryconditions.
Now, corticosteroids likeprednisone are prescription
medications that are very strong.
It's usually taken by mouth.
Sometimes it can be injecteddirectly into the joint, usually
(25:48):
by a rheumatologist or yourfamily physician.
Long-term to like reduce theburden of uric acid on your body
.
Besides diet and working to getyour weight to the normal body
weight, there are medicines likeallopurinol which have been
used for a long time to loweruric acid, and there's some
(26:09):
other ones fabuxostat andpeglotocase and then there's one
probenicid which increases uricacid secretions.
Sometimes I've suggestedchanges in the diuretic regimen.
We use a lot of low-dosediuretics to treat hypertension
and in the osteoporosis field Iuse very low doses of
(26:35):
hydrochlorothiazide, not even inblood pressure doses, but just
to prevent too much calciumexcretion in the urine.
We do this in the cases ofkidney stones caused by
hypercalciuria, as well as womenwho have osteoporosis and
negative calcium balancenegative calcium balance Now,
(27:03):
most of the time.
Your healthcare team wouldsuggest following a low purine
diet and consuming less foodsrich in high purine, and you
might be encouraged to eat foodsor drink things like maybe
you're not a coffee or teadrinker, maybe you do need to be
prompted to drink more water inyour diet.
Um, maybe, uh, some great uhcherries.
(27:28):
You might be encouraged todrink cherry juice or tart
cherry extract capsules, orfrozen cherries.
If they're not in season, youmight ask well, can gout be
cured?
You'll get much less painfulattacks if you work with your
(27:57):
healthcare team to findtreatments that manage your
symptoms as well as lower youruric acid levels, and so the
thing that is under your controlis getting rid of those sugary
drinks, the high fructose cornsyrup and super duper rich, high
purine foods or at leastminimize them, maybe, and pair
them with fruit and vegetablesand low fat dairy.
(28:20):
Getting regular exercise andstrengthening up your muscles
around your joints can help, andanyone that is medically
overweight or obese, especiallycentral organ body weight,
should definitely be workingwith their healthcare team to
(28:44):
get their weight down.
Now what can you expect if youhave gout?
The flares can happen morefrequently if you're not being
managed, and some peopleparadoxically, actually get more
severe or frequent attacksright after starting a new
(29:05):
treatment because the uric acidin their body is more in a flux,
and most people with gouteventually find a combination of
treatments and lifestyle tweaksto manage their symptoms and
reduce how often they get goutattacks.
Gout is very treatable, andpeople who can lower their uric
(29:26):
acid below 6 mg per deciliterare much less likely to have
acute attacks are much lesslikely to have acute attacks.
Now women have asked me well,should I take hormone therapy or
not take hormone therapyrelated to gout, and that
doesn't usually weigh into ourrisk benefit equation Um.
(29:48):
Untreated gout, though, can leadto permanent joint damage, and
if you have a buildup of uricacid in the joints and soft
tissue, it's called a tophus,and it can actually erode
through the skin.
And some people with gout candevelop severe joint deformities
, the tophi, which is actualuric acid crystals in the joints
(30:12):
and around the soft tissue,painful kidney stones and a
higher rate of heart disease.
So you want to plan formanaging a gout attack.
So if you start to get a goutattack, you've got to stop
alcohol, stop sweet drinks thatare sugary and any high fructose
(30:33):
corn syrup.
You want to drink plenty ofwater and you want to elevate
your affected joint above thelevel of your heart as you're
able to, icing the joint withcold compresses for 15 to 20
minutes, with at least a 20minute break, doing this a few
times a day.
You want to avoid stress on thejoint from intense physical
(30:56):
activity and you want to seekmedical attention if this is the
first attack, if it hasn't beendiagnosed, if you think there
might be infection, if the jointis red and swollen, because
gout shares many symptoms withserious infections that might
need to be treated withantibacterial agents right away.
(31:21):
So when you're meeting with yourphysician, if you're having
more frequent attacks or moresevere than they used to be, you
want to find out is this gout?
Is it another type of arthritis?
What can you do to preventfuture attacks?
What medication might be used?
You know, assuming you've triedto optimize your diet as much
(31:43):
as possible.
Some questions that you mightwant to ask are what are the
first signs of having gout?
It's usually sudden, withoutwarning, and it's very intense
pain and they can developovernight and you might notice
the symptoms in the morning andit's common to go.
(32:04):
It's common to go from nosymptoms to severe symptoms all
at once during an attack andit's important to get an exam to
make sure there's nothing elsegoing on and that you don't have
an acute infection.
If you've already beendiagnosed and you've got your
prescription medications, youmight be instructed to start on
(32:25):
colchicine, and you do need along-term plan because you want
to protect your kidneys and,depending on your kidney
function and your uric acidlevel, that your physician will
take into account in terms ofdetermining what might be the
best treatment to reduce youruric acid load and burden.
(32:47):
It's also good, I think, tokeep track and have a journal.
Some people will journal whatthey eat or what their
activities are, and that can behelpful.
So I hope that this podcast onall things gout and uric acid
and some of the gender-baseddifferences has been helpful to
(33:09):
you or your family.
I want to thank you for tuningin for another episode.
We're so grateful for yoursupport.
Please consider sharing it withfriends or family or leaving us
a five-star rating, and if youdon't subscribe to the podcast,
you can follow or subscribe forfree.
(33:29):
We're on Apple Podcasts,spotify TuneIn, wherever you
listen to your podcast.
Thanks again for listening andwe will see you next time in the
Sunflower House.
Be strong, be healthy and be incharge.
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