gout diets - 4 Tips You Must Know About Low Purine Diets For Gout
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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.


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.


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 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.

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.

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.

How do you know if you have arthritis? While symptoms and severity vary from person to person, the most common symptoms are: pain, swelling, stiffness, tenderness, redness and warmth. Osteoarthritis is characterized by progressive stiffness without swelling, chills or fever.

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.

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.

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

In reality, there are no easy cause-and-effect connections, but contributing factors include: age, weight, anatomy, infection of the joint and trauma. Lastly, some believe that joint replacement surgery (arthroplasty) should be avoided for as long as possible. Yet the surgery has helped millions of Americans and is seen as a viable option when exercise, physical therapy and medication fail.

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

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.

Though it is not yet known what part of coffee is responsible for lowering the uric acid levels in the body, it is known that it is not just the caffeine content, as the same results were not found from drinking caffeinated tea. Whatever the cause, when participants drank one to two cups of coffee every day, the levels of uric acid in the blood reduced dramatically. Furthermore, as coffee consumption increased, uric acid levels decreased.


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.

A similar study in Japan looked into the same concept, but used decaffeinated coffee. Similar, though not equal, results were witnessed. This is why it is now thought that components of coffee other than soley caffeine are responsible for lowering the uric acid levels in the body.

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.

It was also believed at one time that eating rich foods was the root cause of gout. Indeed, some rich foods are high in proteins and purines and therefore may contribute to gout flare-ups, however low fat dairy products have now been shown to have a preventative effect. Also Gout is believed to be caused by many factors, including being heredity.

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.

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

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.


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.

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.

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.

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.

 
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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

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

Recently, a gout and diet prevention study was published in by Dr. Hyon K. Choi and Gary Curhan in Arthritis Care & Research's June 2007 issue which examined the fact that, contrary to popular belief, coffee may not be as bad for gout sufferers as previously thought. Although gout patients have been told to stay away from coffee, there may be an ingredient in the beverage that can actually help to lower the uric acid levels in the body.

It is important to speak with your doctor and dietitian about gout and diet prevention and what you should be eating to help to control your gout. However, it is also wise to keep up with the latest research, as the "truths" that we know about gout diets are always changing.

Rheumatoid arthritis is the painful swelling, inflammation and stiffness in the fingers, arms, legs and wrists, which are prevalent on both sides of the body and are usually worse in the morning. Children with on-off fever, loss of appetite, weight loss and a blotchy rash on the arms and legs might have juvenile rheumatoid arthritis. You should call the doctor if symptoms appear suddenly, or if they are accompanied by a fever or rash.

Considering that until this study, gout sufferers had been discouraged from drinking coffee, many gout sufferers may now be wondering what other gout and diet prevention beliefs may soon turn out to be disproved. For example, though tea has not been found to reduce uric acid levels in the body as has now been demonstrated with coffee, tea is often thought to be unacceptable as a part of a gout and diet prevention strategy. Instead, tea can indeed be a part of a gout diet as long as it is consumed in moderation and as long as its dehydrating effect is compensated for by taking in additional water.

For treatment, Methotrexate slows the progression of rheumatoid arthritis and restores some function. For osteoarthritis sufferers, NSAIDs like ibuprofen are good at relieving short term pain and stiffness. Disease modifiers like Methotrexate, Leflunomide, Adalimumab, Etanercept or Infliximab can help long term effects and reduce joint damage.

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.

Mike Selvon owns a number of niche portal. Please visit our portal for more great information on arthritis myths, and leave a comment at our arthritis treatment blog.

There are several common misconceptions about arthritis. Myth # 1 is that every day is the same for patients. In reality, this form of chronic pain comes and goes, which makes it difficult for diagnosis. Myth # 2 is that only older people have arthritis. However, in some cases, even children have this type of pain. Myth # 3 is that arthritis is caused by cold, wet weather or a poor diet.

A similar belief was once applied to alcohol. It was thought that spirits, wine, and beer were the true cause of gout. Indeed, drinking to excess can be harmful to gout sufferers, especially due to the resulting dehydration of the body. Hydration is especially important to gout sufferers as it allows the body to flush the uric acid out of the blood, preventing its buildup as crystals on the joints. However, drinking alcohol is not a direct cause of gout.

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.

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.

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.

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

There are pain syndromes like fibromyalgia and arthritis-related disorders, such as systemic lupus erythematosus, that involve every part of the body. There are relatively mild forms of tendinitis (as in 'tennis elbow') and bursitis to crippling systemic forms, such as rheumatoid arthritis. There are forms of the disease, such as gout, which almost nobody connects with this condition, and there are other conditions - like osteoarthritis, the misnamed 'wear and tear' arthritis - that a good many people think is the only form of the disease.

For people with gout, NSAIDs, Corticosteroids, Allopurinol and Probenecid are effective drugs. Be sure to see your doctor if you have been suffering with any symptom of chronic pain.

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:

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.


 
 
     
 
 





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