Q&A: Gout Attack; Prehypertension; Medication; Stroke Risk
Q. I just had my first gout attack, which was extremely painful. How can I prevent another attack? Should I follow any particular diet?
A. Many people don’t realize that gout is a form of arthritis. An attack of gout causes severe pain, redness, tenderness, warmth, and inflammation, and usually manifests in the big toe, though it can affect any joints. The primary cause of gout is too much uric acid in the body, which causes uric acid crystals to form around the joint cartilage and then release into the joint fluid. In terms of diet, alcohol is usually the culprit, particularly if consumed in excess. In the past, people with gout were advised to limit foods that contain purine, found in organ meats, beef, pork, lamb, some fish, shellfish, and dark vegetables, such as spinach, green peas, beans, and cauliflower. Once eaten, the purine in foods is broken down into uric acid, leading to gout. However, one study undertaken a number of years ago found that high intakes of meat and seafood increased the chance of developing gout, but purine-rich vegetables didn’t. It’s probably best to switch out some of your meat and seafood intake for more poultry and legume-based meals. Also, drink two to three quarts of water each day to help excrete uric acid, and avoid sugar-sweetened soft drinks and fruit juices. Beer and spirits, in particular, prevent uric acid from leaving your body, and alcohol may also interfere with gout medications. It helps to maintain a healthy weight, as being overweight can boost uric acid levels.
Q. I was diagnosed with prehypertension. What does this mean—and how often should I have my blood pressure checked?
A. Simply, the worse your numbers, the more you should be checked. Prehypertension refers to someone whose systolic (upper number) blood pressure (BP) is between 120 and 139, or whose diastolic (lower number) is between 80 and 89 mmHg. Lifestyle changes will help bring your BP down, including weight loss, a low-fat, low-sodium diet rich in fruits and vegetables, exercise, and moderate alcohol intake. If you’re not being treated with BP medications, you can follow up every three to six months with your doctor. If you’re taking medication, you should be evaluated monthly, until your BP is under control (see p. 1 article, this issue, on revised BP guidelines). You also can check your BP twice a day with a home monitor.
Q. Does it make a difference what time of day you take a medication? Some of my medications say to take the drug first thing in the morning, while others say they should be taken in the evening or right before going to bed.
A. The specific time of day a medication is taken may make a significant difference. Some drugs are not as effective or well-tolerated if they’re taken at the wrong time because your body responds to medications in different ways at different times of the day, making them less effective. Many drugs labeled “take one a day” often work better at night. In the case of statins, for example, cholesterol production in the liver is highest after midnight and lower during the morning and early afternoon, making statins more effective when taken just before bedtime. When taking nonsteroidal anti-inflammatory drugs (NSAIDs) it’s best to take them four to six hours before the pain is at its worst, for example, mid-morning to noon to alleviate afternoon pain. If taking NSAIDs twice a day, schedule them eight to 12 hours apart, or six hours apart if taken every six hours. NSAIDs are best taken with food to prevent gastrointestinal problems.
Q. Does depression increase your risk of stroke?
A. An analysis of 17 studies tracked incidence of depression and stroke among more than 200,000 paricipanats and found that those who reported experiencing depression at some point in their lives were about 34 percent more likely to suffer a stroke. The connection between depression and stroke may reflect the health consequenes of depression, which are often associated with smoking, poor diet, physical inactivity, diabetes, and hypertension, among other factors that increase stroke risk.
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