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Image result for gout in toe Gout is something that is not discussed that much, but it has been increasing in recent years and now afflicts about  3.9% of adults in the US. Gout is a form of inflammatory arthritis, characterized by recurrent attacks of pain, tenderness, and swelling of a joint, frequently the joint of the big toe. It is caused by elevated levels of uric acid in the blood (known as hyperuricaemia).

Gout occurs more commonly in men ages 40 and older, who eat a lot of meat and seafood, drink a lot of alcohol (especially beer) or sweetened drinks, have high blood pressure, metabolic syndrome, or are overweight.  Gout used to be known as "the disease of kings" or "rich man's disease". [On the other hand, past research has shown that consumption of coffee, cherries, vitamin C foods, and dairy products, losing weight and physical fitness seems to decrease the risk.]

Recent research showed that the DASH diet reduces blood pressure and reduces uric acid in the blood, which is why a research team (study in The BMJ) now looked at  whether it lowers the risk of gout. The Dietary Approaches to Stop Hypertension or DASH diet is high in fruit, vegetables, whole grains, legumes, nuts, and low-fat dairy, and low in red and processed meats, salt, and sugary drinks. On the other hand, the typical Western diet has higher intakes of red and processed meats, sweetened beverages, sweets, desserts, French fries, and refined grains. The researchers analysed data on a total of 44,444 male health professionals, who had no history of gout at the start of the study. During the 26 years of the observational study, they documented 1731 cases of gout.

The researchers found that eating a more DASH type diet - a diet rich in fruits, vegetables, legumes, nuts, whole grains, and low in salt, sugary drinks, and red and processed meats, is associated with a lower risk of gout. On the other hand, a more 'Western' diet is associated with a higher risk of gout. They found that the effects are dose dependent - the more DASH-type diet, the lower the risk of gout. Bottom line: Once again, eating lots of fruits, vegetables, nuts, legumes, and whole grains is linked to health benefits. From Science Daily:

Diet rich in fruit, vegetables and whole grains may lower risk of gout

A diet rich in fruit and vegetables, nuts and whole grains and low in salt, sugary drinks, and red and processed meats, is associated with a lower risk of gout, whereas a typical 'Western' diet is associated with a higher risk of gout, finds a study published by The BMJ.

Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older and is caused by excess uric acid in the blood (known as hyperuricaemia) which leads to uric acid crystals collecting around the joints. The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and is recommended to prevent heart disease. It has also been found to lower uric acid levels in the blood. Therefore, the DASH diet may lower the risk of gout.

To investigate this further, a team of US and Canada based researchers examined the relationship between the DASH and Western dietary patterns and the risk of gout. They analysed data on over 44,000 men aged 40 to 75 years with no history of gout who completed detailed food questionnaires in 1986 that was updated every four years through to 2012.

Each participant was assigned a DASH score (reflecting high intake of fruits, vegetables, nuts and legumes, such as peas, beans and lentils, low-fat dairy products and whole grains, and low intake of salt, sweetened beverages, and red and processed meats) and a Western pattern score (reflecting higher intake of red and processed meats, French fries, refined grains, sweets and desserts). During 26 years of follow-up, a higher DASH score was associated with a lower risk for gout, while a higher Western pattern was associated with an increased risk for gout.

Image result for gout NHS Credit: Both photos of gout on this page are from NHS.UK

Another reason to cut back on soda and highly processed foods. Research in mice and women showed that a high-fructose diet during pregnancy may cause defects in the placenta and restrict fetal growth. But the advice in the article was disturbing - rather than giving a drug (allopurinol) to pregnant women with high fructose levels (which is what the researchers suggest), why not focus on giving them nutrition advice and strongly encourage them to avoid or cut back on high fructose products? Especially foods containing high fructose corn syrup (HFCS), such as soda and highly processed desserts.

Nutrition and why it's important should be discussed extensively with pregnant women, starting with the first prenatal care visit. Good advice is to read food labels and avoid products that list fructose, high-fructose corn syrup, or corn syrup solids. One easy first step would be to stop drinking soda and sweet drinks and juices. The researchers admit: "One of the best ways to ensure healthy maternal and fetal outcomes is by eating natural foods." Natural foods and good nutrition, not drugs, should be the focus. From Science Daily:

High-fructose diet during pregnancy may harm placenta, restrict fetal growth

Consuming a high-fructose diet during pregnancy may cause defects in the placenta and restrict fetal growth, potentially increasing a baby's risk for metabolic health problems later in life, according to research in mice and people by a team at Washington University School of Medicine in St. Louis.

However, giving the mice allopurinol, a generic drug frequently prescribed to treat gout and kidney stones, appears to mitigate the negative maternal and fetal effects. The findings suggest it may be possible to devise a prenatal screening test and treatment plan for pregnant women with high fructose levels. The study is available online in Scientific Reports, a journal affiliated with Nature Publishing Group.

Fructose, a sugar occurring naturally in fruits and honey, has been popular for decades among food manufacturers who process it into high-fructose corn syrup used to sweeten food and beverages. In fact, researchers have reported that the refined sugar accounts for more than half of all sweeteners used in the U.S. food-supply chain. And in recent years, there's growing concern that fructose in processed foods and sugary drinks may be linked to diabetes and obesity. "Since the early 1970s, we've been eating more fructose than we should," said Kelle H. Moley, MD,.....This study shows potentially negative effects of a high-fructose diet during pregnancy.

Fructose is processed differently than other sugars such as glucose, which the body converts into energy. Instead, fructose is broken down by liver cells that turn the sugar into a form of fat known as triglycerides while also driving high levels of uric acid, a normal waste product found in urine and stool. Too much uric acid can create metabolic mayhem resulting in obesity, type 2 diabetes and other health conditions.

Studying mice, the researchers found elevated uric acid and triglycerides in otherwise healthy mice who were fed a high-fructose diet during pregnancy. Additionally, the mice developed smaller fetuses and larger placentas than those fed standard rodent chow.

Maternal health also may suffer. Metabolic problems caused by high levels of uric acid and fat increase a woman's risk of developing pregnancy complications such as preeclampsia -- a potentially serious condition in pregnancy often marked by high blood pressure, swelling and high protein levels in the urine -- and gestational diabetes, Moley said.

To assess the relevance of the mouse data in pregnant women, the researchers examined the association between fructose and placental uric acid levels in a small controlled group of 18 women who underwent scheduled cesarean sections. The women had no disorders that would have caused elevated uric acid. "We found a correlation suggesting similar maternal and fetal effects occur in humans," Moley said.

And the scary part is that they only tested for 32 chemicals, but there are thousands of others they didn't test for that could be lurking in the water, including pesticides used on the lawns and grounds around outdoor swimming pools. From Science Daily:

Pharmaceuticals, personal care products could taint swimming pools

A new study suggests pharmaceuticals and chemicals from personal care products end up in swimming pools, possibly interacting with chlorine to produce disinfection byproducts with unknown properties and health effects.

Chlorination is used primarily to prevent pathogenic microorganisms from growing. Previous research has shown that many constituents of urine including urea, uric acid, and amino acids, interact with chlorine to produce potentially hazardous disinfection byproducts in swimming pools. However, chemicals from pharmaceuticals and personal care products, or PPCPs, also could be interacting with chlorine, producing potentially harmful byproducts. There are literally thousands of chemicals from pharmaceuticals and personal care products that could be getting into swimming pool water.

A research group led by Ching-Hua Huang, a professor in the School of Civil and Environmental Engineering at the Georgia Institute of Technology, has developed an analytical technique that identifies and quantifies 32 pharmaceuticals and personal care products in water... Water samples were taken from indoor swimming pools in Indiana and Georgia.

Of the 32 chemicals investigated, the researchers detected three: N,N-diethyl-m-toluamide, known as DEET, the active ingredient in insect repellants; caffeine; and tri(2-chloroethyl)-phosphate (TCEP), a flame retardant.

"The other 29 could have been present at concentrations below the detection level," Blatchley said. "And because there are literally thousands of pharmaceuticals, this is just a small subset of compounds that could be present in swimming pools. The main issue is that the release of chemicals into a place like a swimming pool is completely uncontrolled and unknown. I don't want to be an alarmist. We haven't discovered anything that would be cause for alarm right now, but the bottom line is we just don't know."

Some chemicals are volatile, which means they can escape into the air to be inhaled. Others can be ingested or absorbed through the skin."Swimmers are exposed to chemicals through three different routes: You can inhale, you can ingest and it can go through your skin. So the exposure you receive in a swimming pool setting is potentially much more extensive than the exposure you would receive by just one route alone," Blatchley said.

His previous research has shown that certain airborne contaminants are created when chlorine reacts with sweat and urine in indoor swimming pools. Pharmaceuticals may get into swimming pool water from personal care products applied to the skin such as insect repellant, makeup and sunscreen. Many pharmaceuticals that are ingested are not fully metabolized by the body and are excreted in sweat and urine.

"Urine, I think, is really the primary mode of introduction," Blatchley said. "When it comes to pharmaceuticals, these are chemicals designed to be biologically active at pretty low concentrations. Birth control pills, for example, contain hormones. If those chemicals and others are present, especially in a mixture in a water sample that humans are going to be exposed to, then what are the consequences of that? That is a largely unanswered question."...The previous research suggested that about 93 percent of uric acid introduced to pools comes from human urine.