How Weight Loss May Help Improve Your Gout

It’s not a big revelation that being obese or being above your ideal weight can cause you a lot of health problems and one of them, of course, is an increased risk of gout. When I got my first gout attack, I weighed 240 pounds, about 45 pounds overweight from my ideal weight as per my doctor. I had what is called central obesity, basically carrying weight around my middle, having a pot belly if you prefer.

Losing weight alone can decrease uric acid levels in the blood, as well as the number of gout attacks, staving off hyperuricemia, so it’s a no brainer that if you are overweight and have gout that you immediately consider losing weight with whatever method you like. In addition, weight loss will also help relieve your joints (knees, feet, hips, ankles etc…) by reducing the stress from the excessive weight, avoiding pain in those joints.

Gout and Weight Loss

Gout is a painful and debilitating inflammatory disease that worsens over time if it is not managed properly. Hyperuricemia is caused by factors that raise serum uric acid levels (sUA). If sUA levels remain high, MSU (Monosodium Urate) crystal deposition in joints and soft tissues, as well as acute and chronic inflammation, can ensue.

Hyperuricemia and gout have become more common in recent decades, owing to an aging population, increasing obesity, changes in lifestyle and food, and an increase in gout-related comorbidities.

Chronic gout can result in persistent inflammation, an increased number of flares, the formation of tophi, and structural joint damage if left untreated or incorrectly treated.

Even when patients are asymptomatic, data shows that continuous inflammation and resultant damage mayoccur both locally and systemically, although the extent and clinical significance can vary between patients.

Long-term gout treatments

The goal of long-term gout treatment is to lower sUA levels to less than 6 mg/dL, which is below the MSU saturation point of 6.8 mg/dL, inhibit new crystal formation, and promote dissolution of existing crystals. According to EULAR guidance, a lower target may be considered in some patients with severe gout.

Gout treatment should improve disease outcomes by minimizing gout flares, inducing long-term resolution of tophi, and more effectively treating comorbidities, many of which are associated with hyperuricemia.

However, gout is frequently mismanaged due to a variety of causes, including a lack of patient compliance with treatment protocols and implementation of treat-to-target strategies by the physicians.

What diet should I follow in order to lose weight?

If you are determined to lose weight, it is important that you avoid crash dieting at all costs since rapid weight loss as well as going hungry for long periods of time may increase uric acid levels in your body and may cause you an undesirable gout attack. A balanced diet rich in fruits and vegetables, with low meat intake, plenty of whole wheat bread, whole wheat cereals, moderate amounts of dairy products, plenty of water, little alcohol if any at all, the complete elimination of highly processed foods and drinks is the key to a successful gout diet. This will help you control your weight and provide you with all the necessary nutrients required for you to fight this disease.

What does the scientific community have to say about weight loss and gout?

The famous gout researcher Hyon K. Choi from Massachusetts General Hospital while studying 47,150 middle aged men for a period of 12 years did conclude that the more weight men gained the greater was the risk of developing the disease in such individuals. Men who lost 10 pounds or more from baseline had a 39% lower risk of developing gout compared with men whose weight remained essentially unchanged. Choi also concluded that regardless of their diet, men who gained weight would get gout more often. Men with a BMI of 25–29.9 kg/m² had about twice the risk of developing gout compared with men with a BMI of 21–22.9 kg/m², while men with a BMI of 35 kg/m² or greater had about three times the risk.

Another small pilot study on gout and weight loss was done with 13 gout patients who followed a calorie-restricted diet for 16 weeks. All 13 were gout patients who would get an attack every month and after losing weight through their diet after a few months only but one patient would have less than one gout attack per month.

Yet another study conducted at the University of Auckland in New Zealand also suggests that gout patients who are obese may benefit from bariatric surgery which will result in controlling uric acid crystallization in the joints further preventing gout attacks and reduced inflammation from the weight loss, although gout attacks can temporarily increase during the early postoperative period.

Adipose (body fat) tissue produces and secretes uric acid because it contains high levels of xanthine oxidoreductase (XOR), an enzyme that actively produces and secretes uric acid. Weight loss may allow this type of uric acid to reduce in the body in a consistent manner because of reduced XOR enzyme activity. If you have a gout attack or swelling in any of your joints, it will help diminish those effects due to the fact there will be fewer fat deposits to secrete uric acid and cause gout attack. If you plan on losing weight, make sure you are losing 1-2 pounds a week and not more, avoiding increasing your uric acid levels abruptly causing a painful gout attack. So, tread carefully and do it right!

If you don’t have gout, make sure to maintain a healthy weight in order to avoid getting it. Weight loss is not the only answer when it comes to controlling your gout but it is a big piece in the overall pie, that’s for sure. Remember to begin with small changes in the beginning making sure you are losing only 1-2 pounds a week in order to avoid a gout attack, then keep progressing in eliminating whatever foods that are bad for you for healthier choices eventually moving towards your ideal sustainable weight. Don’t forget to include your doctor’s advice when planning your diet, even consulting with a dietitian can do wonders.

Weight loss surgery

Obesity is a known risk factor for developing gout. It may also result in recurrent gout attacks.

Many doctors recommend weight loss programs to gout patients who are overweight or obese.

The problem, however, is that most gout sufferers find losing weight just by diet and exercise challenging if not impossible to do. Their feet can get very swollen during a gout episode, making simple things like walking difficult, much less exercise.

Thankfully, recent clinical data shows a positive link between gout and weight loss surgery which is giving gout sufferers renewed hope to battle this painful condition. In fact, more and more gout patients are opting for weight loss surgery.

As a result, gout and weight loss surgery are topics worth discussing with your doctor. For patients with gout who need to lose weight, bariatric surgery such as LAP-BAND, gastric bypass, or gastric sleeve surgery may be a good option.

Bariatric surgery
The most successful treatment method for severe obesity and accompanying comorbidities is bariatric surgery.

Early postoperative gout attacks, on the other hand, are substantially more likely in bariatric surgery patients than in individuals undergoing other procedures.

Bariatric patients have been documented to see an increase in gout attacks in the short term. Quick weight loss is known to cause uric acid buildup, and following bariatric surgery, a very low-calorie diet and rapid weight loss appear to trigger gout attacks.

Over the long term, however, bariatric surgery has been demonstrated to help reduce the risk of gout flares by up to 40% according to a Swedish study. Needless to say, these kinds of results could easily be considered a dream come true for longtime gout sufferers.

Here are some of the most popular bariatric procedures:

• Gastric Sleeve Surgery:
  This is currently the most commonly performed weight loss procedure, resulting in rapid and dramatic weight loss. Laparoscopic Surgery sleeve gastrectomy, commonly called the sleeve, involves the removal of around 80 percent of the stomach.
• Gastric Bypass:
  The stomach is divided to create a small upper pouch, and the small intestine is rearranged so that food bypasses most of the stomach and the upper part of the small intestine before joining the digestive tract further downstream.

• Gastric Banding:
  LAGB (laparoscopic adjustable gastric banding) is a surgical procedure in which a laparoscope is used to insert an adjustable belt around the upper portion of the stomach. It reduces the amount of food that can enter the upper part of the stomach at one time.
  
  
  LAGB reduces the size of the stomach and the amount of food it can hold in the end. It also delays food digestion in the intestine. As a result, signals from the gut to the brain allow for a feeling of fullness and satiety while consuming less food.

Weight Loss Surgery Results That Are Promising

Many obesity-related disorders and health problems can improve substantially after metabolic and bariatric surgery. Although there is no cure for gout, weight loss surgery has also been shown to be effective for diet-related disorders, including gout.

This expands the therapeutic possibilities for serious medical conditions. The findings suggest that for those who suffer from both obesity and gout, bariatric surgery may be worth considering.

The potential of bariatric surgery to improve long-term gout outcomes is not surprising given the well-established association between diet and gout.

Another characteristic that may make weight loss surgery a perfect option for those with obesity who have had trouble controlling their food and have suffered from recurrent gout is the ability to control gout on a regular and efficient basis.

Weight loss is recommended for overweight/obese gout patients, with evidence of poor, moderate, and low quality for impacts on sUA, achieving sUA target, and gout attacks, respectively.

In the short term, negative repercussions may arise. Because the present evidence is based on a small number of low-quality studies (mostly observational), rigorous prospective studies (preferably randomized controlled trials) are urgently required.

DISCLAIMER

This article is for educational purposes only and should not replace medical advice. Patients should consult their physician for individual management.