Non – Pharmacological Management of gout

K. Kavindya M. Fernando

Maintain your body weight• Research has shown that excess weight

is a major risk factor for developing gout. • If you are overweight, • losing weight can lower uric acid levels in

your body and • significantly reduce your risk of gout attacks.

Nicholls A, Scott JT. Effect of weight-loss on plasma and urinary levels of uric acid. Lancet 1972;2:1223–4.

Control your diet• The traditional thinking was

• reducing the amount of foods that contain purines • Decrease the risk of gout flares.

• However, • managing a low-purine diet can be quite cumbersome, • and the success of such a diet in lowering blood uric

acid levels is actually quite low.

• Therefore, strict low purine diet• Not enough to cure

Control your diet. Cont…• Instead, a lower-calorie diet • Replaces refined carbohydrates (sugar, white

flour, others) with more complex carbohydrates, • limits meat, and • increases vegetables and fruit

• often can be much more effective at reducing blood uric acid levels than a low-purine diet.

Evidences found on effects of Vitamin C on serum [] of uric acid

• In one randomized trial involving persons without gout, • 500 mg of vitamin C per day for 2 months • resulted in serum urate levels that were 0.5 mg

per deciliter (30 μmol per liter) lower than in those receiving placebo

Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum 2005;52:1843-1847

Control your diet. Cont…• Have fat-free or low-fat milk products. • Get your protein mainly from • low-fat dairy products • because they may protect against gout.

The intake of dairy milk, reduced serum urate levels by approximately 10% during a 3-hour period in a small, randomized, crossover trial involving healthy volunteers

Dalbeth N, Wong S, Gamble GD, et al. Acute effect of milk on serum urate concentrations: a randomised controlled crossover trial. Ann Rheum Dis 2010;69:1677-1682

Acute effect of milk on serum urate concentrations

Control your diet. Cont…• Limit • meat, • fish and • Poultry

• Drink 8 to 16 cups, or about 2 to 4 liters, of fluid daily, with at least half of that being water.

to no more than 4 to 6 ounces a day.

Avoid alcohol• Drinking alcohol, especially beer, • significant risk factor for gout• Studies have suggested that drinking two or

more beers a day can double the risk of a gout attack.

• So limit the amount of alcohol you drink, or avoid it completely.

Control your diet. Cont…• It has been shown that, following will

increase the risk of gout attacks• Fruit- flavoured drinks (rich in fructose)• Non-diet soda• Many processed food

In summery

Stop diureticsDietary changes

Include:

Stop alcohol weight loss

Dietary advices: Summery

Fructose Red meat/sea food.

Avoid:

Beer Spirits