THE BLOG
12/11/2012 11:26 am ET | Updated Feb 10, 2013

News Flash: Santa Has Gout and Adjusts Holiday Meal

There is a lot of buzz at the North Pole. Santa is hobbling around with a large, painful, swollen big toe that came on after eating a large burger and a beer. It happened rather quickly, and it has really made it hard to get in and out of his sleigh.

Santa reportedly called Dr. Robert Keenan of Duke University's Gout Clinic to discuss his symptoms. Dr. Keenan told Santa: "You've got the classic symptoms of gout, a type of arthritis caused by the breakdown of purine from certain foods. When purine metabolizes, it releases uric acid crystals. These crystals are typically excreted in the kidneys, but not so well in people with gout."

"It must have been that burger and beer," Santa responded.

"Probably," said the doctor. "The largest source of purines is in organ meats like liver and kidney. Red meats and shellfish are another source, and so is beer and whiskey (wine has a bit less purines). The good news is that if you lose some weight and drink lots of water, it will flush out the uric acid crystals through your kidneys and lower your risk."

Santa did not appreciate the comment on his weight but said after the holiday he would work on his diet again.

Dr. Keenan went on to tell Santa that "uric acid crystals stay at high levels in the blood and sprinkle down like sediment into the joints, and that leads to inflammation and pain so bad that even touching the skin with Christmas stockings can be unbearable."

Santa nodded his head.

Keenan told Santa: "The most common joint that is affected is the one at the base of the big toe -- exactly what happened to you. But the ankles and knees are the next most common places." Santa also found out gout is much more common in men, but after menopause, lower estrogen levels can reduce a women's ability to clear uric acid crystals from the urine. Santa made a mental note about this, in case Mrs. Claus developed a painful joint, and downloaded a free menopause ebook.

The pain of gout usually comes on quickly, and after a day or so, it starts to subside. But over time, the crystals, which stay in the joint, can destroy the entire joint. Santa found out he could be getting symptoms of gout either because his kidneys can't excrete uric acid well enough or because he eats too many foods that contain purine, especially during the Christmas season; and that overloads his kidneys.

Santa got off the phone, searched the Internet and found out that 8 million Americans have gout, and if he doesn't take action, it could become chronic gout, a type of arthritis, with sore achy joints. Sometimes the uric acid crystals can even deposit in the soft tissues of the body like the elbows, ears, and finger joints.

Santa decided to fly in early to see the doctor. He found out that to make the diagnosis, the doctor must place a small sterile needle into the inflamed joint and remove a tiny drop of fluid to look at under a microscope to look for uric acid crystals. In the meantime, Dr. Keenan suggested starting daily exercise, like going for a walk and helping the elves load the sleigh. He also suggested taking analgesics like acetaminophen or nonsteroidal anti-inflammatory treatments. If those fail, he'll get a prescription for colchicine and corticosteroids to reduce inflammation.

He also started changing his diet. Now Santa:

• Limits servings of meat, poultry and fish to 4 to 6 ounces at any one meal, since they all contain purine.
• Eats less fat. The more fat eaten, the harder it is to excrete uric acid.
• Replaced most of the meats, poultry, fatty fish and shellfish with vegetables, beans and legumes.
• Steers clear of beer. Alcohol in general makes it harder for kidneys to excrete uric acid, but beer is the biggest offender followed by hard spirits. According to the Mayo Clinic, it's okay to drink one to two 5-ounce servings of wine daily without increasing your risk of an attack.
• Eats little high-fructose corn syrup. Santa reads the labels. Soft drinks and juice drinks are a real risk for flaring up. Pure fruit juices that are 100 percent fruit don't seem to be a problem.
• Eats complex carbohydrates. Santa says: "It's not easy eating more whole grains, fruits and vegetables and skipping the refined sugar, white bread and candy, but it's worth it!"
• Drinks lots of water. Eight to 12 glasses of water can flush the crystals through your kidneys and help eliminate the crystals. Some research suggests drinking several cups of coffee daily is a good way for men to lower their gout risk.

So if gout has your goat, do what Santa does; follow doctor's orders.

Based on my recent interview with Dr. Robert Keenan, assistant professor of medicine at Duke University.

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