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4 Tips You Must Know About Low Purine Diets For Gout

If you have been living with the painful symptoms of gout for a while or this is the first time you have suffered from swelling, stiffness and pain in the joints, you have no doubt come across people telling you about low purine diets for gout.


Complex carbohydrates are lower on the Glycemic Index (GI) scale than refined carbohydrates because they have a slower effect on blood glucose, and so the response of insulin to blood glucose is slower and more moderate. Insulin is much more responsive to refined and simple carbohydrates.


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 Refined and simple carbohydrates are found in foods made from refined grains (for example refined flours which are the basis for pasta, breads, cakes, biscuits (cookies) pies, pastries); white rice; and most cereals. And notably from sugars with the exception of fruit sugar,(fructose) and galactose. Simple carbohydrates include corn and other syrups, table sugar and honey; candies (sweets); processed foods with added sugar; and some fruits and vegetables.

Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

To examine whether a diet could affect the markers that show insulin resistance exists, and lower uric acid levels, researchers in South Africa put 13 males, all gout sufferers, on a diet governed by three cardinal rules of the Zone diet, the well-known diet book written in the1990's by Barry Sears PhD.

A further danger of excess uric acid is the formation of kidney stones. These can be very painful and can also further reduce the ability of the body to expel waste uric acid.

3. Avoid alcohol as much as possible, as alcohol consumption can this can cause gout flare-ups. 4. Drink 2 - 3 liters of water per day, as this will help dilute the uric acid in the body and allow the kidneys to regain control.

Meat and Alcohol They also ate meat, no doubt lean meat since mono and polyunsaturated fats were encouraged. (Meat does contain both these fats, as well as saturated fats). Participants' alcohol consumption was moderate, there were no alcohol rules, and it remained the same as usual.

Ronconi, P., Monachino, P., Baleanu, P.M.,Favilli, G. Distal Oblique Osteotomy of the First Metatarsal for the Correction of Hallux Limitus and Rigidus Deformity. J. Foot Surg. 39:3, 154-160, 2000

Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe

References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001

People may have an elevated uric acid also called hyperuricemia but have no symptoms. Later they may develop acute gouty arthritis where the joint is affected. Almost three fourths of people with gout will develop it in the big toe at some point of time. In between attacks the gout is said to be in an interval or intercritical phase and finally some people get chronic tophaceous (with the tophi) gout.

It is interesting to note that purine is naturally present in the tissues of our body, and it is only when there is an excess of purine, often caused by a diet rich in foods with high purine levels that the uric acid builds up.

When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.

Fats Saturated fats, which are among the fats found in meat fat, dairy products, beef tallow (beef dripping) and lard, were swapped for monounsaturated fats (e.g. olive oil, canola oil) and polyunsaturated fats, (oils such as corn, sunflower and soybean oils). However, in the study, participants took polyunsaturated fats from fish. They were advised to eat fish at least four times a week during the study, even fish that are high purine such as mackerel.

But some studies have found that a low purine gout diet has no effect on uric acid levels. Most likely one reason is because most uric acid in the body is made in the liver from purine molecules of DNA and RNA, and not from the purines in foods and beverages. Another reason may be that the problem for a gout sufferer is not that he/she is producing too much uric acid but that he/she is not excreting enough.

Is the onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.

Uric acid is a natural by-product that is produced when the body breaks down purine, so less purine in the body means that the kidney's can work to get the body back into balance by eliminating the excess uric acid as waste.

Following a low purine diet has been shown to reduce the level of purine in the body, and this in turn reduces the levels of uric acid being produced.

So in this diet there was moderate restriction of calories and carbohydrate, and control over proportional consumption of carbohydrate, protein and of fats. In the Zone diet the number of calories you get from food should be in the proportions of: from carbohydrates (40%), from protein (30%) and from fat (30%). This is one of the principles at the core of the diet. These proportions, or numbers close to them (getting more or less there is allowed) should be eaten at every meal and snack too. In the study, participants were asked to keep to these proportions at each meal, and they were encouraged to eat 3 to 5 meals and snacks daily, another Zone diet rule.

Kidney stones can form due to gout and can cause back pain. Other joints such as the knee, fingers and heel can also be affected. Some people get lumps on the rim of the ear or other parts of the body near joints under the skin and these are called tophi.

So, when starting out on a low purine diet for gout, there are a few things that you should bear in mind. 1. Eat a balanced diet, which should be high in complex carbohydrates, low in protein and fat.

There is another cause of gout theory, which is that excess uric acid (hyperuricemia) is the result of insulin resistance, the pre type 2 diabetes condition. Insulin resistance in gout has been the subject of many studies. Simply put, insulin resistance is the condition where the cells become more resistant to allowing insulin to deliver glucose (mainly broken down from carbohydrate in foods) to them, for the purpose of energy creation. It's as if the jailer refuses to open the door of the cell. It's one of the causes of excess insulin. Excess insulin has been found in a number of studies to inhibit uric acid excretion as well as causing other problems.

Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint.

Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.

Indeed, many gout sufferers change their diet for life so that they never again suffer a gout flare up.


So, when creating low purine diets for gout sufferers you love, or changing your lifestyle to include a new gout diet, keep in mind that the sooner that the above strategies are adopted the sooner you can get relief from relief from gout symptoms.

Turf toe gets no respect. Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:

The definite diagnosis or determining if the arthritis is due to gout may involve drawing fluid from the joint and looking for crystals of uric acid.

Over the long term there can be deformity of joints and there can be many large lumps under the skin. Nowadays with proper treatment this is less likely. The symptoms can last from three to ten days and often get better even without treatment. The next attack may occur many months or even years later. Usually (and fortunately) only one joint is affected at a time and the symptoms of the swelling and pain start within a day.

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000

 
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Anyone going on the Zone diet will have their personal daily carbohydrate, protein, and fat requirement. How to discover it is explained in Barry Sears' "Enter the Zone" book. The amount of protein you can eat determines the amounts of carbohydrates and unsaturated fats, in the 4:3:3 proportions, you can eat. Why the 4:3:3 rule is important is also explained in the book. If you know about soccer, you can think of the 4:3:3 rule as the commonly used soccer team formation. Or, another way of putting it, is to say that calories from protein are 0.75 (75%) of calories from carbohydrate and calories from fat are in the same proportion as calories from protein. Getting almost to 4:3:3 is allowed.


Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

This is the first of an article series about this diet. See the bottom of this article for how to read the second article. Natural gout treatment largely involves diet. The most widely touted gout diet for sufferers of "the disease of kings," is the low purine gout diet. The cause of gout theory behind it is that because uric acid is made from purines, and because uric acid is the gout culprit, purine intake from foods and beverages should be restricted.

What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone.

2. Eat food that have a moderate to low purine levels, such as most vegetables, fruit, cereals, white breads and avoid foods that are high in purine like meat extracts, shellfish, offal (liver, kidney's, brains, sweetmeats), gravies, dried beans.

But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, when we discuss hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.

Gout is relatively common, and can usually be treated successfully, without having to resort to pharmaceutical drugs. Some quick and simple changes to your lifestyle can reduce and even eliminate your gout symptoms.

There isn't space in this article to explain more about the difference between complex and refined carbohydrates. If you're not sure, the subject is easily researched on the Internet. For example, do an Internet search for "Glycemic Index," or "Glycemic Load."

Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

Refined carbohydrate foods were swapped for complex carbohydrate foods. i.e. they ate complex carbohydrates, not refined carbohydrates. Complex carbohydrates can be found in foods made from whole grains, (eg. whole grain flours and products made from them), and in many vegetables, low sugar fruits and beans.

NB. The contents of this article contain medical information not medical advice. Please always discuss remedies with your doctor or other health care professional before implementing any treatment.

Gout is a common disease and often presents suddenly with a painful joint. The most common and well-recognized symptom is swelling of the joint in the big toe where it joins the foot. This can be extremely painful and enlarged and if not treated the pain will last about 10 days and can cause lasting damage with repeated attacks. The area can be red, hot, inflamed and very painful or tender.


Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe.

Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.


Differential Diagnosis: The differential diagnosis of turf toe includes; Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis

RULES Calories were restricted to 1,600 a day: 40% from carbohydrates, 30% from protein and 30% from mono and poly unsaturated fats.

Further information about natural gout diets can be found on our web site. Of course, the adoption of a low purine diet may seem like quite a sacrifice, especially as it can be different to the typical western diet. However, many gout sufferers see the inconvenience of a new diet as a small price to pay to relieve themselves of the pain and discomfort of gout.

Causes Of Gout provides detailed information on Causes Of Gout, Foods That Cause Gout, Gout, Gout Home Remedy and more. Causes Of Gout is affiliated with Laser Printers.

Now please visit the second article: Natural Gout Treatment - The Results Of A Gout Diet That Had A Lot Of Success

John Mepham has spent much time researching gout. His best tip for curing gout naturally? Get to your ideal weight whatever the sacrifices may be. Learn more about this study and about natural gout treatment in detail at www.gout-smashers-guide.com/ It's an e-book with an emphasis on natural gout treatment The Zone diet, and other books by Barry Sears, are available at the Official site of The Zone Diet The books can be found by clicking on the products tab on the home page.


 
 
     
 
 





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