health

Following a Restricted Diet Will Help Prevent Gout Recurrence

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | July 24th, 2017

Dear Doctor: I've had gout three times in the last three years. I was prescribed Colcrys and indomethacin, but I'm finding confusing information about foods and beverages. One site told me to avoid potatoes and chicken. Other sites said I could drink wine. Any advice would be appreciated.

Dear Reader: The correlation between gout and elevated uric acid in the bloodstream was discovered in the mid-19th century. The problem is that in joints, where the temperature is cooler than in the bloodstream, elevations of uric acid cause the formation of monosodium urate crystals. This is most common in the big toe joint and in the ankle. White blood cells then engulf the uric acid crystals, creating even more inflammation. The result, as you know, is an extremely painful joint.

The first aspect you should assess is your weight. A 2005 study that followed 47,150 men for 12 years found that those with a BMI greater than 35 were three times as likely to develop gout than those with a BMI between 21 and 23. In addition, those who gained 30 pounds during the study were twice as likely to develop gout, while those who lost 10 pounds had a lower risk.

In line with this, the consumption of sugary sodas has also been associated with gout. A subsequent analysis of the data found men who drank five to six sugar-sweetened sodas per week had a 29 percent increased risk of gout compared to men who drank less than one serving per month. Those who drank one soda per day had a 45 percent increased risk, and those who drank two or more servings per day had an 85 percent increased risk. Researchers did not see an association between gout and consumption of diet soft drinks.

The next aspect you should assess is your alcohol consumption. Beer, wine and liquor have all been associated with gout attacks. In a study of people with a history of gout, two to four drinks within 24 hours increased the odds of having an attack by 51 percent. Even one drink increased odds by 13 percent. In regard to wine: If you have never had gout in the past, wine appears safe. But in this study, of those who had gout, even one glass or less of wine was associated with a 26 percent increased risk of a gout attack.

A low-purine diet is often touted as a way to decrease gout attacks. Foods that are high in purines -- a type of chemical compound -- include sardines, anchovies, herring, mackerel, scallops, liver and other organ meats. Beer is also high in purines. If you have gout, you'd be wise to eliminate or severely restrict such products in your diet. Other foods, including a variety of meats and fish, have moderate purine levels, but they won't make a large difference in your uric acid level, so there's no need to be overly restrictive toward them.

That said, other types of protein -- found in dairy, soy and other beans -- have been shown to lower uric acid levels when compared to the protein found in meat and fish. Cherries have also been shown to reduce the risk of gout attacks, although the mechanism is unknown. Vitamin C, too -- at a daily 500 milligram dose -- has been shown to slightly lower uric acid levels.

Lastly, check your medications. Hydrochlorothiazide (a diuretic), aspirin and niacin can all increase the uric acid level within your bloodstream and increase your chance of a gout flare.

My essential advice is: If you're overweight, try to lose weight. The most simple way to start is to avoid desserts and sugary drinks. Second, if you drink alcohol, either eliminate it or limit yourself to not more than one drink per day. Third, stay away from foods that are very high in purines.

Each of these steps will lower your risk of a new painful gout attack -- and put you on the road to an overall healthier lifestyle.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Try Some of These Balancing Exercises to Steady Yourself

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | July 22nd, 2017

Dear Readers: In our previous column, we talked a bit about balance and asked you to stand on one foot. How did it go?

When friends and family (and, full disclosure, we) tried the one-foot balance test, there was more than a bit of leaning, arm flapping and burning muscles. So let's get right to a few techniques that, when incorporated into your daily life, can help you remain safely on your feet. With each of these activities, please be sure that you either have a spotter, or are practicing within grabbing distance of a stable object.

That one-minute balance test? Do it daily. Be sure to stand on each leg in turn so you condition both sides of the body. If it's easy with shoes on, try it barefoot. You'll be surprised by how much more you'll have to engage the muscles in your feet. If that becomes easy, and for some of you it will, try adding a bit of instability. A cushion under your feet is low-tech and affordable. Younger people may want to try wobble boards or balance boards, wiggly exercise platforms that not only help with balance, but also improve core strength.

An easier variation is weight shifts. Stand naturally with feet hip-width apart. Shift to one foot and stand for 15 seconds or more. Shift back to center and move to the other foot and hold. For an added level of difficulty, move one foot forward 6 inches or so each time. Wish it were harder? Practice looking left and right during each balance.

Walk heel-to-toe. That is, place your heel directly in front of your toe, like on a tight rope. Again, easier said than done. You may only make it a few steps the first few tries. Try again, and aim for a longer walk each time. Not only are you strengthening your muscles, but this is also a good exercise in mental awareness and concentration. Want a challenge? Try it backward.

If you're physically able and are not at risk for a fall, try rising from chairs and couches without using your hands. You may have to wiggle to the edge of the seat to get proper leverage. In order to rise, you'll have to engage your core muscles and use most of the muscles in your legs. Coordinating the entire move takes concentration, all good for ongoing stability.

The slow march is a great and gentle conditioner. In slow motion, raise one knee as far as is comfortable, hold for a count of three, and slowly return your foot to the floor. Switch sides. For added difficulty, you can slowly move forward.

This is a small sampling of what's available. Senior centers, the YMCA, and local parks and recreation programs can be great resources. We're big fans of tai chi and yoga, which emphasize balance. Also, Medicare covers a certain number of physical therapy sessions per year. A therapist who specializes in balance can create a program tailored to your specific needs.

Good luck, and let us know how it goes!

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Balance Exercises Can Help You Stay on Your Feet Longer

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | July 21st, 2017

Dear Doctor: Your recent column about balance was very useful. My dad is in his late 70s, and I want to help him stay on his feet. Are there specific techniques or exercises that he can do? It would be great if we could do them together.

Dear Reader: We love the idea of you and your dad working on this together. And while the focus of your letter is to help him, the truth is that you're both going to benefit. That's because research shows that balance begins to decline when we hit our 50s and 60s, years before obvious signs like stumbling or falls begin to appear.

For people who don't have specific medical issues that can affect balance, such as neurological or inner ear disorders, the main areas of focus are muscle strength, mobility and awareness. (After the balance test we're about to suggest, you'll be tempted to add endurance to the list.)

The good news is that, no matter your age -- and again, barring medical issues -- each of these areas can be improved. Because we don't want to rush the answer on this very important topic, we'll use this column to lay out the basics. In our next column, we'll follow up with some specific techniques and exercises.

Let's begin with a (deceptively) simple test: Stand on one foot.

Sounds easy, right? So let's add a level of difficulty -- stand on one foot for as long as you can. Grab a watch or smartphone, spot each other to prevent a fall (or, if you're going solo, stand by a wall or chair) and time how long each of you lasts.

Does it take a few tries to find your balance? How long before you have to make physical adjustments, like moving your arms, to remain steady? Also take note of which muscles become most fatigued. Be sure to do the test on each foot. We tend to favor one side of the body over the other. You may be surprised by how different the balance times on your left and right sides can be.

Although the goal here is one minute, many of us, no matter our age, won't make it that long. In a recent study, researchers found that for those in their 50s, the average one-foot stand lasted 45 seconds. That dropped to 40 seconds for people in their 60s, and 27 seconds for those in their 70s. People older than 80 generally managed 12 seconds of balance before the other foot came down.

The main reasons for a decline in balance are loss of muscle tone and the effects of aging. We can change the former and, to a certain degree, learn techniques to compensate for the latter. What we can't afford to do is let nature take its course and hope for the best. One-third of all adults 65 and older suffer a fall each year, many with grave consequences. With our next column, we'll offer some specifics on how to stay on your feet.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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