Case study: chef with severe foot pain

Michael's GP diagnosed an acute attack of gout and has advised lifestyle and diet changes, along with medication to allieve the symptoms.

Name Michael

Age 62 years

Problem

Michael woke up in the night with uncomfortable tingling at the base of his right big toe. Over the next two hours the pain became more severe and he noticed swelling and redness on the toe. He could not sleep all night and called his doctor in the morning for an emergency appointment.

Lifestyle

Michael is a chef at a small restaurant. He is on his feet for ten to 12 hours every day and is very upset that this pain in his foot will prevent him from going to work. He has a history of mild high blood pressure, for which his doctor has prescribed a diuretic medication. Michael is moderately overweight and his only exercise is playing a round of golf at the weekend.

Michael's GP diagnosed an acute attack of gout and placed him on anti-inflammatory medication. He is advised to stay off of his foot for five to seven days and then to make a follow-up appointment to discuss how to prevent future attacks of gout. His GP also advised him to reduce his intake of purines (see Protein and purine foods).

At his follow-up visit, Michael's doctor explained that gout has been linked to “rich” diets high in meat and wine. Michael's doctor changed his blood pressure medications because diuretics may make gout worse, and explained that he wanted to check his blood levels of uric acid and LDL cholesterol. He explained that gout can be a sign of a serious condition, known as metabolic syndrome, which he may have because he is overweight and has high blood pressure (see Cardiovascular Disease).

Advice

By losing weight and limiting his intake of alcohol and foods high in purine, Michael can reduce his risk of another attack. Gout is more common in those who overeat or are overweight. Rapid weight loss can precipitate a gout attack, so a reduced-calorie diet for gradual weight loss is important. Too much alcohol can cause an attack and so should be avoided or limited. Some beers even contain purines. Plenty of water is recommended to ensure dilute urine and prevent the formation of uric-acid kidney stones.

Lisa Hark, PhD RD & Dr Darwin Deen

Posted 14.02.2011

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See more in the dossier: Nutrition for bone and joint disorders