Is Gout Prevention Possible?

Is Gout Prevention Possible?
You can't always control whether you get gout, but you can make diet and lifestyle changes to lessen your risk. Start taking gout prevention steps today. What can you do for gout prevention? "There are a number of risk factors for gout, some of them modifiable, some of them less modifiable," says Daniel Solomon, MD, MPH, associate professor of medicine at Harvard Medical School and physician in the rheumatology, immunology, and allergy department at Brigham and Women's Hospital in Boston.

Gout develops in people who have high levels of uric acid, produced when the body breaks down substances called purines, which are found in many foods, particularly meat and seafood. Excess uric acid can form sharp, needle-like crystals in the joints, leading to pain and swelling.

While some people will develop gout no matter what they do, there are some lifestyle and diet factors that can cause high uric acid levels. Researchers have identified a number of gout prevention strategies to help reduce your risk of developing gout or, if you already have gout, lower your chances of having a severe gout attack in the future.

Gout Prevention: Know Your Risk Factors

When it comes to gout prevention, scientists still don't know how much control people have over their risk of developing gout. "Gout is related to genes, environmental [influences], and gender," says Dr. Solomon. There seems to be a genetic component since gout sometimes runs in families. Also, men are at higher risk of developing gout than women. And the risk of gout increases with age.

But researchers have identified a number of gout risk factors that you can work to control:

Purine-rich diet
Excess weight
Excessive alcohol consumption
High cholesterol
Diabetes
High blood pressure
Certain medications, including some diuretics, niacin (a B vitamin), low-dose aspirin, cyclosporine, and several cancer drugs
There's more content below this advertisement. Jump to the content.
Gout Prevention Strategies

If you are looking for ways to reduce your risk of developing gout, try the following:

Limit purines in your diet. Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine, says reducing the amount of purine-rich foods in your diet can lower your chances of developing gout. Eat less salmon, herring, sardines, organ meats, mushrooms, and asparagus.Reduce the red meat and seafood in your diet. In his research on gout risk factors, Dr. Choi and his colleagues found that people who had more red meat and seafood in their diet were at higher risk of developing gout.Eat more dairy. Choi also looked into how dairy products affected patients’ gout risk. "Dairy products — particularly low-fat dairy products like skim milk or yogurt — reduced the risk of gout," says Choi. For gout prevention, your daily diet should include the equivalent of two or more cups of milk.Watch what you drink. "Coffee, including decaffeinated coffee, was associated with a lower risk of gout," Choi says. On the other hand, people who drink more alcoholic beverages, especially beer, are more likely to develop gout. Choi says that drinks sweetened with high-fructose corn syrup are also associated with an increased risk of gout.Take your vitamin C. "Vitamin C tablets — 500 milligrams per day — decrease the risk of gout," Choi says. That extra vitamin C will cause you to excrete uric acid through your urine.Maintain a healthy weight. Being overweight is a risk factor for the development of gout, so aim to maintain a healthy weight.Control medical problems. Since high cholesterol, high blood pressure, and other health problems are associated with an increased risk of gout, follow your doctor's instructions to keep these conditions under control.Consider switching medications. If you are taking a medication associated with increased gout risk, ask your doctor if switching to another drug is an option for you. If you are concerned about your gout risk, talk with your doctor. The earlier you start treatment, the sooner your pain will be under control.

By Krisha McCoy, MS
Medically reviewed by Lindsey Marcellin, MD, MPH

A Major Cause of Amputation in Diabetics

A major cause for leg amputation in diabetics is an infection in the foot or ankle. Because many diabetics do not recognize the signs of a foot or ankle infection, the condition often goes untreated and can rapidly lead to amputation.

Early signs of an infection to the foot or ankle include any area that is red, hot, & swollen. A diabetic may also notice an unexplained elevation of their blood sugar. As the infection progresses, the person may experience nausea, vomiting, fever & chills.

Infection in diabetics needs to be treated early and aggressively. Diabetes can decrease the body’s ability to fight infection. When this happens, a simple foot infection can lead to leg amputation in a matter of days.

Open wounds, blisters, athlete’s foot, and cracks in the skin can leave a diabetic susceptible to a foot or ankle infection. If you are diabetic and you notice any area of your foot or ankle that is red, hot & swollen, or you have an open wound or a blister, call your foot and ankle specialist immediately! Remember, aggressive & early treatment of infection in diabetics can greatly reduce the need for amputation.

Diabetes Patients NEED More Prevention Services

It has been found that there is a distinct lack of appropriate prevention programmes for foot ulcers and amputations for patients that are suffering from type 2 diabetes, and it has been recommended that improved prevention services could significantly improve the high rate of amputation for diabetes patients.

Researchers have used information taken from electronic medical records to identify 150 patients on dialysis and 150 patients with a previous foot ulceration or amputation from 2000 to 2006. Factors such as patient education, podiatry care and the use of therapeutic shoes and insoles were monitored over a 30-month period. Despite 92.3 per cent of the overall population of the study having type 2 diabetes, only two patients in the dialysis group and none in the ulcer group were reported to be offered formal diabetes education.

In the study, 65 per cent of patients were seen by a podiatrist, of whom 70 per cent received care after developing a foot ulcer. This is compared with 42 per cent of patients in the dialysis group, and only 18 per cent of patients in the ulcer group received preventive care from a podiatrist.

It was noted that "Prevention services for the diabetic foot are simple to establish and can be made easily accessible through organized multidisciplinary care. These data provide further evidence that preventative foot care is not regularly provided, even among patients with the highest risk for lower limb complications. It also highlights an opportunity to improve prevention services for the diabetic foot with simple protocols for evaluation and referral."

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.

"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."

Are Your Feet Vacation Ready?

Although rest and relaxation are the goals for most vacations, they usually involve a lot of walking and a lot of walking usually involves sore feet.

Walking is great exercise and one of the most reliable forms of transportation. But if your feet aren't in the best shape or you don't have the right shoes, too much walking can cause foot problems.

Good foot care is essential if you plan to subject your feet to long periods of walking. Some simple foot care tips include:

1. Wear thick, moisture control socks (wool or synthetic fabrics instead of cotton) and change them often!

2. Dry feet thoroughly after bathing, making sure to dry between toes. Use powder before putting on shoes and even antiperspirant on your feet if you sweat profusely.

3. Nails should be cut regularly and straight across the toe. Check for ingrown toenails and avoid cutting them too short.

4. Moisturize your feet regularly, but never between your toes. Also watch out for athlete's foot fungus infections.

5. Massage any aching muscles after exercise and apply ice to any sore joints for at least 15 minutes.

6. Bunions, hammertoes or any other serious foot problems should be evaluated by a podiatrist prior to your planned vacation. Custom orthotics can help balance your feet so your vacation can be more enjoyable and pain free!

The right shoe is also important to healthy walking. The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes will fit the bill. There are also shoes made especially for walking. Walking shoes tend to be slightly less cushioned, bulkier, and heavier than running shoes. Whether a walking or running shoe, the shoes need to feel stable and comfortable.

Never wear new shoes for the first time on vacation. Always "break them in" for at least a week to make sure the fit is proper and there are no seams rubbing! Blisters can put a damper on a vacation!

Also, two pairs of shoes can be very helpful in making your vacation more comfortable. After a vigorous day walking, your shoes need almost 24 hours to dry out so they do not smell and harbor fungus, the cause of athlete’s foot.

Warm up exercises to help alleviate any muscle stiffness or pulled muscles are advised before walking. Loosening up the heel cords (Achilles tendon and calf) and thigh muscles before a walk is especially effective.

If you're not accustomed to long walks, start slowly and rest if your feet start hurting.

Medicare Diabetic Shoe Program

Diabetes is reaching epidemic proportions in the United States. Over the past decade, there has been an increase of 33% with the diabetic population currently topping 16 million people. There are many complications associated with diabetes including kidney, heart, vision, circulatory and foot problems. The good news is that many of these potential problems can be minimized as a result of life style changes, medications and other preventive care.

Amputations, and/or partial amputations, of the feet and legs are growing at an alarming rate. In fact, it is one of the leading causes of non-traumatic amputation in the US alone. Just recently American Podiatric Medical Association, Medicare officials and the American Diabetes Association established a team to explore ways to reduce the number of amputations in the diabetic population. The number of these lower extremity amputations grew by 28% in the past several years. However, it has been determined that a majority of these amputations could have been prevented by routine foot care.

As Medicare providers our doctors not only treat everything from routine foot care to surgery we also prescribe and dispense Medicare approved diabetic shoes and inserts. This valuable prevention program allows diabetic patients to receive one pair of diabetic shoes and 3 pairs of diabetic inserts every calendar year. As an approved program participant Medicare will cover 80% of the allowable amount and many supplemental insurance plans take care of the remaining 20%, leaving you with little or no additional cost. Many diabetic patients qualify for this benefit.

Comprehensive Diabetic Foot Exam

The American Diabetes Association's "2010 Standards of Medical Care in Diabetes" statement on diabetic foot care and the newly established Physician Quality Reporting Initative (PQRI) for the treatment of feet of patients with diabetes now requires an annual comprehensive diabetic foot examination to assess all lower extremity risk factors. We are requesting all of our patients with diabetes to schedule a Comprehensive Diabetic Foot Exam (CDFE) appointment if you have not already done so. This appointment should only take about 15 minutes of your time and will allow us to perform the necessary testing and examination to meet this new requirement. The exam may include the treatment of your nails, calluses, or corns.