Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Women and Gout: What You Need to Know
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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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, and I am back in the Sunflower House for a new pod on everything gout and high uric acid. So I became interested in this when I had some patients in my menopause clinic being diagnosed with gout. And it's interesting because it's classically much more commonly a disease of males, because it's classically much more commonly a disease of males and it's interesting to look at some of the sex differences. And since we cover so much on speaking of women's health in terms of being strong, being healthy and being in charge on diet and nutrition, there's definitely dietary factors that influence this condition, which can be very painful, and the classic kind of presentation of gout was, you know, decades and decades ago, termed a very rich person's disease, because only very wealthy people could afford very rich foods, rich in meat, purines and seafood. So what are purines? Well, they're substances found in certain foods and our bodies turn purine into uric acid, and high levels of uric acid, or what's called hyperuricemia, can cause gout, which is a form of very painful inflammatory arthritis. So you might ask well, what causes the uric acid level to go up, and at least one in five people have elevated uric acid levels, and it's a waste product. When your body breaks down purines that are in drinks and foods, most of the time the uric acid just dissolves in the blood and passes through the kidneys and leaves your body in the urine. But hyperuricemia occurs if too much uric acid stays inside your body. And if you've got too much of these uric acid they can clump together and form very sharp pokey crystals and these crystals can settle right in the joints and really be painful. They can also build up in your kidneys and form uric acid, kidney stones, and if you haven't listened to our earlier podcast on everything kidney stone, that's a good one to listen to. People say kidney stones are more painful than childbearing and at least usually at the end of labor you get the prize of a beautiful baby. But most people are not too happy to have a kidney stone, although they are usually glad if they pass it. And if you do pass a kidney stone, save it if you can, so it can be chemically analyzed. So temporarily having an increase in your uric acid level doesn't mean you have gout, and many people with elevated uric acid levels never get gout and they may not ever get kidney stones. So what is gout? Well, it's a very painful acute inflammatory arthritis and chronically, if the gout crystals continue to be deposited, there can be not just pain and inflammation but actually joint damage.
Speaker 1:So about 5% of people have gout and it's much more common in males than females. Especially, it's much more common in males under the age of 60. But with, like a lot of things after age 60, when women go through menopause and lose estrogen, sometimes they catch up to men or at least start to approach higher incidence of some of these other conditions, whether it's heart disease, sleep apnea. There's a lot of things that it seems like premenopausal women have some protection. Just like gout is very rare in pregnancy, usually there's some genetic defects or kidney issues and obviously anyone that has kidney impairment may have trouble clearing the uric acid. So in general we don't usually see gout in young women before the age of menopause and it's thought that estrogen does protect because it may help flush the uric acid out of the kidneys. And women who have much shorter reproductive spans in their life late menarche, early menopause seem to maybe have a higher risk, and some studies have shown that menopausal hormone therapy may actually help reduce gout. But there was one study in Korea of a million women that looked at lots of different factors and found very tiny increases in gout in women on hormonal contraceptive pills and menopausal hormone therapy. So there is some differences in studies. Now, certainly, the higher the body mass index, obesity seems to make pretty much every condition worse. And again, the caricature of someone with gout was usually a wealthy, quite overweight man who enjoyed rich foods and lots of alcohol, and certainly many alcohols, like hard liquor and beer, increase purines.
Speaker 1:Now, according to the Arthritis Foundation, where we got some of this information from, women tend to develop gout in several joints very slowly and insidiously, whereas men get the more classic pedagra, which is pain in that big toe joint that can strike in the middle of the night. Just even the light touch of bed covers tend to cause just terrible pain, whereas women may get it in their hands and their knees and their wrist, the ends of their finger, where they might already have some osteoarthritis, and osteoarthritis is the most common arthritis affecting the vast majority of people starting at age 30. Sometimes you get it in the big toe where you have a little bunion or maybe more on your dominant hand compared to the non-dominant hand Trauma, sports injuries. Certainly there's genetic components and we have a lot of information on osteoarthritis on our speakingofwomenshealthcom site and upcoming podcast. We also had a great podcast on joint supplements for joint pain and preparing for joint replacement.
Speaker 1:So a lot of times gout in the hands are misdiagnosed and that's where I have seen it in some of my patients. It's kind of reminiscent of how myocardial infarctions, heart attack in women, may be misdiagnosed because they're not classic. Like an elephant sitting on my chest, it might just be shortness of breath, I can't do as much activity or housework, or I might be nauseated or fatigued and I definitely would go back and listen to season one's podcast on gender matters in terms of heart disease in women and the manifestations. So, getting back to the symptoms of gout, as I mentioned, classically it's the big toe, but it doesn't have to be the big toe. It could be the knees or the ankles or the small joints in the feet or hands, wrists or even elbows.
Speaker 1:A lot of times they can occur at night when someone's a little dehydrated. They can occur for several weeks. Usually the most intense, unbearable pain is in the first 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 like their joint is on fire or they're being stabbed with a poker stick. So gout can affect anyone. But the risks include being overweight, having too much body fat, congestive heart failure, kidney failure, type 2 diabetes, and we have a podcast on diabetes. How to be less sweet. We have information on gestational diabetes, which is a risk for adult onset diabetes, as well as sleep apnea, hypertension. I have a podcast talking about cholesterol and calcium and hypertension and how.
Speaker 1:Almost every day in clinic I have discussions with women who say oh, my blood pressure's always been great, everybody's blood pressure's always great until it isn't Just like I've had women tell me well, in the past my uric acid levels were always good and now they're not. So it is good to know your history. It's good to keep copies of your lab results and, interestingly, uric acid used to be on a lot of multi-channel chemistries when you would go in and have like a chem 20, you know 20 different lab tests of chemistries in your blood work. But now it usually needs to be ordered specifically. So some people don't even know what their uric acid level is.
Speaker 1:Kidney disease and one in four people over age 65 have some kidney impairment. Just like we reach maximal bone density at age 30, you kind of have your peak renal function at that age and then there's a slow decline with age and certainly obesity and hypertension and medications that can damage the kidney or go through the kidney can impair kidney function. Different types of blood cancer, malignancies that are very where there's a lot of cell turnover there can be higher uric acid levels. Family history if you're able to know your medical history of your biological relatives with thanksgiving, I think is a good time when you might meet up with your family or other holidays or birthdays or other maybe cultural or family celebrations. It is kind of good to get updates on your family history and those that eat a lot of animal proteins, especially animal fish, flesh, animal organs, as well as shellfish and any foods that contain organ meats and those are very rich in nutrients like iron. Our very first podcast on season one was all about iron and certainly zinc and iron are frequent deficiencies in women. There has been somewhat of a carnivore craze, with people just eating meat, which you have to be very careful because not just of the high purines but also because of maybe lack of electrolytes, and so any strict diet or unusual diet really should be monitored, of course, by your healthcare clinician.
Speaker 1:Now, drinking alcohol regularly is also a risk. Alcohol regularly is also a risk, particularly beers and hard liquor. If you're on a diuretic medication like water pills, that can reduce your uric acid excretion. Also, low dose aspirin in contrast to high dose aspirin, which might promote more uric acid excretion. No-transcript.
Speaker 1:So you might ask well, how can I prevent getting an elevated uric acid level and gout? You have some control over this. You don't have control over your genes, that's for sure, but you do have control over the foodstuffs that you put in your mouth and what foods you have in your diet. And what foods you have in your diet. So the foods that are very high in purines and we have a nice list of this on speakingofwomenshealthcom. If you go on the website and on the mobile version, in the upper right hand corner is a little magnifying glass just put in purine or gout. So organ meats like liver and kidney and sweetbreads and brains and tripe Again very rich in nutrients. But if you have high uric acid it's not something that you might want to eat regularly.
Speaker 1:Now red meat which has a lot of iron and zinc and protein and nutrients bacon, beef, pork and lamb. And if you haven't read the column on food freedom and banned foods in other countries that are available in our food supply, I was shocked to learn that 100 countries ban American pork because of stuff that is added to the feed of pork that other countries consider toxic. Now, game meats, specialties like goose and veal venison pate, they all contain very high levels of purines. Turkey, especially the processed deli. Turkey Seafood oh, seafood's one of my favorite foods and it's rich in omega-3. And so many patients that I get their levels of omega-3, maybe because their cholesterol levels are abnormal or they have inflammation or joint pain or depression. I'm really shocked to find out the imbalance of the hard, healthy fats that so many of the people that I see even many of them very health conscious have, and so seafood is a wonderful source of omega-3, but also purines. So tuna, anchovies, sardines, mackerel, herring, scallops, trout, mussels, codfish, haddock, just to name a few. So gravies and meat sauces as well.
Speaker 1:And, as I mentioned, beer and hard liquor. Now for women, I always tell them there's no reason you need to drink alcohol quote for heart health. I mean. That is a common misconception. There is no medical reason to drink alcohol. Now, people that are social alcohol drinkers in some studies might have less heart disease, but it may be markers for other things socialization, exercise. I love to golf and you know we all joke about the 19th hole is the watering hole. Obviously, lots of celebrations have alcohol, but 20% of women can become alcoholic. It's a toxic substance to the brain and the liver and it's also lots of calories and it does interfere with sleep. If you haven't heard some of our great podcast on sleep, that's really good to go back to listen to.
Speaker 1:So alcohol specifically prevents your kidneys from eliminating uric acid, pulling it back, reabsorbing it back into the body where it can accumulate. So if you're predisposed to gout and it's a special occasion and you know you might have a drink and you're predisposed to gout, and it's a special occasion and you know you might have a drink and you're predisposed to gout, I have seen some physicians recommend taking colchicine. Colchicine is an old medicine, naturally derived. It affects tubular spindles and it's very good at treating inflammation and pain and it reduces the inflammation caused by those crystals of uric acid that build up when one has gout.
Speaker 1:Now, one thing that I think you can totally eliminate from your diet safely, because obviously, in general, meat has so much nutrition and protein that we would not say just for most people to ever eliminate meat. Alcohol, of course, is something that is not a necessary nutritional item, that is for sure. But the one thing that we can absolutely say to eliminate is sugary drinks and junky sweets and anything with high fructose corn syrup. So a lot of table sugar is actually made up of half fructose, which is fruit sugar, and fruit sugar breaks down into uric acid and any food or drink that has a high sugar content can trigger gout. So I don't think there's really any reason to be drinking sugary drinks and I would read labels and not purchase things that have high fructose corn syrup and a lot of that's in prepackaged foods, processed snacks, cheaper foods and, if you haven't read the column on food freedom and banned foods in other countries, just researching that, I learned so much Now.
Speaker 1:Yeast and yeast extract also is rich in purines. So what about foods that are low in purines and a lot of these are really healthy foods and can help eliminate the burden of uric acid in your blood, and foods that are low in purine can help improve symptoms of gout and kidney stones and just general health and well-being. Vegetables, certain fruits, like cherries Cherries are excellent, whole grain breads and rice. Eggs. And eggs are really rich in choline, good for your brain and they're a very excellent source of protein, and they've been really demonized too long. Good old water. Coffee, black coffee, I think is a good way to start your day if you're not too sensitive to caffeine, and I say black coffee because I think it's good, as adults in general, to intermittently fast. Black coffee because I think it'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 osteoporosis doctor, I'm always happy to see low-fat cheese and dairy products and milk on the list because those are really rich sources of calcium. Those are really rich sources of calcium. So in that respect, there are some foods I think that you can enjoy and think about when you're planning, you know, your diet for the week, to make sure that you're having some low purine foods and not just high purine foods.
Speaker 1:It's interesting that some of the foods that are high in histamines are also foods that are high in purines and some people are sensitive to histamine and can get hives, and I see a lot more hives and sensitive skin in postmenopausal women. So some of the foods that are super high in histamine include a lot of alcoholic beverages, including red wine. Fermented foods which fermented foods are great for your gut, microbiome, like sauerkraut and comiche and miso, but they are high in histamine. And then the good old meats like bacon and sausage and salami and pork, especially pre-processed meats, as well as fish, mackerel, tuna, sardines and herring. And the high histamine dairy are primarily aged cheese and yogurt. And then strawberries are very high in histamine and the so-called tropical fruits like pineapple, banana and papaya.
Speaker 1:So not everyone has histamine intolerance, that's for sure. But, uh, some people definitely do and have diarrhea and bloating and sneezing and flushing 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, and you've been listening to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, and we're in the Sunflower House talking all things purine and gout.
Speaker 1:So a healthcare clinician can diagnose gout primarily by a physical exam, by asking about symptoms and affected joints, but it's not include a uric acid blood test, and the most definitive diagnostic test would be to draw fluid out of a joint and look under the microscope to see the uric acid crystals. So how is gout treated? Well, the pain has to be managed, as well as the inflammation, and then, long-term, the diet and the weight and, potentially, gout medications. So medications like non-steroidal anti-inflammatory agents, like over-the-counter ibuprofen, naproxen, aspirin. Those medicines can affect kidney function and also the stomach, and those that have aspirin allergy or stomach ulcers or kidney impairment would definitely need to talk to their physician before taking those agents, many of them, which are over the counter counter.
Speaker 1:Now, colchicine is a it's a prescription medicine and it can be very effective in the acute attack, and it can if you take it right away at the first sign of it. It can be very, very helpful. And one of the biggest side effects, though, of colchicine is diarrhea and abdominal cramps, and it's a very old natural medication. It's used also in cases of pericarditis and other autoimmune inflammatory conditions. Now, corticosteroids like prednisone are prescription medications that are very strong. It's usually taken by mouth. Sometimes it can be injected directly into the joint, usually by a rheumatologist or your family physician.
Speaker 1:Long-term to like reduce the burden of uric acid on your body. Besides diet and working to get your weight to the normal body weight, there are medicines like allopurinol which have been used for a long time to lower uric acid, and there's some other ones fabuxostat and peglotocase and then there's one probenicid which increases uric acid secretions. Sometimes I've suggested changes in the diuretic regimen. We use a lot of low-dose diuretics to treat hypertension and in the osteoporosis field I use very low doses of hydrochlorothiazide, not even in blood pressure doses, but just to prevent too much calcium excretion in the urine. We do this in the cases of kidney stones caused by hypercalciuria, as well as women who have osteoporosis and negative calcium balance negative calcium balance Now, most of the time.
Speaker 1:Your healthcare team would suggest following a low purine diet and consuming less foods rich in high purine, and you might be encouraged to eat foods or drink things like maybe you're not a coffee or tea drinker, maybe you do need to be prompted to drink more water in your diet. Um, maybe, uh, some great uh cherries. You might be encouraged to drink cherry juice or tart cherry extract capsules, or frozen cherries. If they're not in season, you might ask well, can gout be cured? You'll get much less painful attacks if you work with your healthcare team to find treatments that manage your symptoms as well as lower your uric acid levels, and so the thing that is under your control is getting rid of those sugary drinks, the high fructose corn syrup and super duper rich, high purine foods or at least minimize them, maybe, and pair them with fruit and vegetables and low fat dairy. Getting regular exercise and strengthening up your muscles around your joints can help, and anyone that is medically overweight or obese, especially central organ body weight, should definitely be working with their healthcare team to get their weight down.
Speaker 1:Now what can you expect if you have gout? The flares can happen more frequently if you're not being managed, and some people paradoxically, actually get more severe or frequent attacks right after starting a new treatment because the uric acid in their body is more in a flux, and most people with gout eventually find a combination of treatments and lifestyle tweaks to manage their symptoms and reduce how often they get gout attacks. Gout is very treatable, and people who can lower their uric acid below 6 mg per deciliter are much less likely to have acute attacks are much less likely to have acute attacks. Now women have asked me well, should I take hormone therapy or not take hormone therapy related to gout, and that doesn't usually weigh into our risk benefit equation Um.
Speaker 1:Untreated gout, though, can lead to permanent joint damage, and if you have a buildup of uric acid in the joints and soft tissue, it's called a tophus, and it can actually erode through the skin. And some people with gout can develop severe joint deformities, the tophi, which is actual uric acid crystals in the joints and around the soft tissue, painful kidney stones and a higher rate of heart disease. So you want to plan for managing a gout attack. So if you start to get a gout attack, you've got to stop alcohol, stop sweet drinks that are sugary and any high fructose corn syrup. You want to drink plenty of water and you want to elevate your affected joint above the level of your heart as you're able to, icing the joint with cold compresses for 15 to 20 minutes, with at least a 20 minute break, doing this a few times a day. You want to avoid stress on the joint from intense physical activity and you want to seek medical attention if this is the first attack, if it hasn't been diagnosed, if you think there might be infection, if the joint is red and swollen, because gout shares many symptoms with serious infections that might need to be treated with antibacterial agents right away.
Speaker 1:So when you're meeting with your physician, if you're having more frequent attacks or more severe than they used to be, you want to find out is this gout? Is it another type of arthritis? What can you do to prevent future attacks? What medication might be used? You know, assuming you've tried to optimize your diet as much as possible. Some questions that you might want to ask are what are the first signs of having gout? It's usually sudden, without warning, and it's very intense pain and they can develop overnight and you might notice the symptoms in the morning and it's common to go.
Speaker 1:It's common to go from no symptoms to severe symptoms all at once during an attack and it's important to get an exam to make sure there's nothing else going on and that you don't have an acute infection. If you've already been diagnosed and you've got your prescription medications, you might be instructed to start on colchicine, and you do need a long-term plan because you want to protect your kidneys and, depending on your kidney function and your uric acid level, that your physician will take into account in terms of determining what might be the best treatment to reduce your uric acid load and burden. It's also good, I think, to keep track and have a journal. Some people will journal what they eat or what their activities are, and that can be helpful. So I hope that this podcast on all things gout and uric acid and some of the gender-based differences has been helpful to you or your family.
Speaker 1:I want to thank you for tuning in for another episode. We're so grateful for your support. Please consider sharing it with friends or family or leaving us a five-star rating, and if you don't subscribe to the podcast, you can follow or subscribe for free. We're on Apple Podcasts, spotify TuneIn, wherever you listen to your podcast. Thanks again for listening and we will see you next time in the Sunflower House. Be strong, be healthy and be in charge.
