Tips You Need to Know about Gout, High uric acid symptoms and excess salts in the body. (2 of 2)

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my name is dr. hottie Malaysia I'm a professor of Rheumatology at Cal university and a consultant Kepler clinics in Cairo before let's see what we do with a high orac acid patient first and then we see what we do the gouty patient if someone has high Heric acid only in the blood we didn't say his gal he only has high uric acid what do we do we do two things first we reassure him this is not serious this is not a problem this is not God second what medications do prescribe will prescribe for his high uric acid I / limited 7 and his 8.8 what medications we prescribe none we prescribe no medications for the high uric acid so we tell him go home no we don't we don't tell him go home remember why i auric acid got high got hell because you're you're overweight you have high cholesterol you have high blood pressure okay those conditions are there when I are are they benign conditions are those kind diseases or potentially really problematic over the years they are potentially problematic they cause atherosclerosis of the vessels how do you get a heart disease if those conditions are unattended if they are not treated over the years you can get a heart attack because of those conditions so they are potentially serious and the uric acid was so good when it got high because it made us alert to looking for for alerted to looking for one of those conditions so we look for one of the common important reasons that might have resulted in an increase in uric acid if you find it we treat it and we thank the uric acid from the heart you see the doctor is thanking the high uric acid really it's very happy that these I found the high orac acid to look for one of those conditions that are treatable and that put put he will prevent serious problems later in life and we explain to the patient something very important we answer to him a question that he did not ask yet why uric acid decided to increase in those diseases the reason is that it is serving a useful function in those diseases you heard about antioxidants of course and the ad vitam in AAC is selenium we use antioxidants to protect our blood vessels we don't get at Paris chlorosis blah blah like this okay uric acid is a strong antioxidant and it's useful to protect the vessels against atherosclerosis over the years so if you have high cholesterol if you are obese and you're susceptible to get after school roses so the body decides to tell the kidney kidney please don't excrete uric acid really leave some in the blood I want it to go higher because I want to use it to protect my blood versus against atherosclerosis later in life so this is why we have a hydric acid to use to serve a useful function but of course anything that exceeds certain limits maybe it turns into something that is really harmful like if you like acid decides over the time to make a gout oh we don't like that especially becomes if it becomes troublesome guard so you look as it is serving a good function this means that if the serum uric acid as high man its value is like 10.3 it should not really upset me quite the opposite you should make it should make me alert it okay let me look for one of those reasons that raises the uric acid and if I find it I will treat it so the high orac acid in itself we don't read it up till when we just keep it 10 20 30 know we have a ceiling we have a limit to accept its innovations 13 and men and 11 women more than 13 this is too much only then we decide to treat the figure okay this is how we manage the high orac acid just reassure the patient and then one of the reasons that made it hi how do we treat gout if you had the gout if you have a first attack of gout that lasts for one week we agree together that maybe you never get a second attack okay palace right no problem we just get you give you painkillers that's all and we will not give you medication to decrease the uric acid although you really got the diagnosis of gout now you have the disease no problem the first attack maybe it's only the only attack you get in your life I will just give you painkillers for three or four five days but it means high uric acid okay I want to look for one of the reasons that made the uric acid hi this is the most important to me this is the life saving over the next 10 or 20 years and now you got the second attack okay still no problem maybe you never get a third attack in your life so what I will do simply painkillers take those painkillers but still I would be investigating and looking and checking and making sure that your blood cluster is well controlled your blood pressure's well controlled check your kidney control your weight this is what I will do but if you go towards you know that troublesome road of 3rd 4th attacks on words and frequency increased frequency of attacks and you're getting an attack every one or two month this is too much really you're suffering now I cannot just sell our eunuch acid is not a problem this is too much so we will give you the painkillers when you have the attack but now we start to consider treatment for those recurring gout attacks who prescribes those medications the rheumatologist when does he prescribe them after some lab tests students to decide which one of the medications for God is best for you but it's very important to know this this medication should never start if you are having the gout attack whenever we'll start treat me to decrease you acid we started after the end the complete resolution the complete end of an attack we never start medications that decrease uric acid during a gout attack ever number six doc you didn't start treatment for high orac acid when I first discovered it you said don't worry high uric acid is not a problem just let's look for the reasons that made it high and I said okay then got happened I had I had a first attack you told me okay no problem you just take painkillers and let's look for one of those reasons that raises the uric acid to treat it if we find it maybe you never get a second attack and I said okay and then I get a second attack and then you told me no problem just take those pills take those painkillers maybe you never get a third attack and again I said okay now I'm getting the third attack and onwards in the end when I got the third attack and and the frequency started to really be troublesome you said okay why not let's consider treatment it took you such a long time to consider treatment what's going on isn't God a disease doctor isn't got a disease that should that should receive treatment so we don't get into complications you are the doctor you should you're the one who should treat why you're taking such a long time to decide to give me treatment maybe this is a disease maybe it has complications I will tell you three things the first gap is a benign disease gout if you get the first attack or a second attack it leaves you with a completely normal joint a completely normal join you can draw you can run you can climb mountains you can ride your bike you can do think you guys unlike other diseases like autoimmune diseases like rheumatoid arthritis for example those diseases they are active and they are troublesome and they are every day in the morning you have stiffness and we really care to find those diseases and diagnose them early and to start treatment for those diseases early because they are not that benign if left untreated they're potentially really problematic so God has a benign disease you know what we know what's the difference between gout and rheumatoid for example gout consider those deposits those salt deposits in the joint considered that like some sort of dust that you can remove with a broom any time you decide just some dust no more but in a disease like rheumatoid consider what's going in the going on in the joint like a dog that is attempting or trying to bite the bones and to bite the cartridge and really affect the joint end and cause damage in the joint so I have to control him but God it's just one attack and you're left with a completely normal joint second anytime I decide I can remove the dust in the joints anytime I do if you have a room and it has dust like that room on the left side anytime i decide i can get my broom and i will make it really shiny and wonderful just like that in gout anytime i decide i can start you on medications to decrease the uric acid and i will leave a normal joint without any deposits but within limits what are those limits look at that room it was just dust but if I live that us for such a long time is this room ringley can I clean this room with the broom and it would be shiny again you lost this room it's completely destroyed it's just the same those are my limits if you get the first attack no problem second attack I can the dust anytime but if you go to the third fourth fifth and become you get a high frequency of attacks now the dust is too much those sort of deposits that I considered us are too much and if it's so if the attacks keep recurring and we and we ignore them we are leaving the joints to be destroyed over the years over the month I cannot accept that and the third and this is the quest the answer to the question that you might be asking to yourself to end to me right now okay though why you didn't simply remove the dust from the start why wait you told me that you can remove the dust anytime it's just dust you have medications any time you start your medications you remove it so I wait all this time and and you can make all this reluctance that you treat after such a long time why wait because the why didn't start the medications to decrease the uric acid because if there is something that is really silly and troublesome an annoying it is the gut medications rather than the waiting and the following up treatment is always a matter of weighing weighing decisions like look at this if I follow you up and treat only the causes of high uric acid if I compare it with giving you medication so decrees uric acid bearing in mind that if you get the first attack you might never get a second and if you get a second you might never get a third so why would I start you in those silly medications with potential side effects you know if I start you in those medications it's not a matter of one or two weeks or one month you might be on them for life for years and they have potential side effects so why would I started on medications that easy I will give you all that chances maybe you will be free of attacks and free of medications and leading a completely normal life but if I discover that you're not going on on that track only then I consider the medications number seven how about diet we agree together that if you have a high Rick acid over many years and it deposits in twenty percent of those people where you have the deposits you get a gout attack and you're waiting for a push to get an attack one of those pushes is some foods so what are the foods that cause God that that trigger the gouty attack it's not that foods cause cut foods trigger count you are already predisposed you are already ready for the god then the food comes to press the button food doesn't initiate God it just triggers the god presses the button of God avoid avoid those sea foods and show his herring tuna there are relatively safer seafood they still cause God but they are relatively safer shrimp ill crab lobster avoid beer or at least know that beer is one of the really important triggers the very significant triggers for gout attacks avoid fructose containing beverages you find this written on the on the cans it contains fructose avoid vision avoid those meats bread meat pie pigeon pigeon is eating in the Middle East actually maybe in the Western cultures they are not very familiar with eating pigeon goes turkey the really trigger gout relatively safer meets if you want to eat meat chicken eat the thigh rather than that then the the thigh better and remove the britta better than the press and remove the skin it rips it duck duck still triggers gun but it's I'm ottoman is relatively safer liver kidney pancreas all of them trigger guard well try to eat less less spinach mushroom asparagus cabbage so what are the safe words looks like nothing is left no there are low-fat dairy products starchy foods whole grains fruits specialty citrus fruits coffee jewels without sugar drink drink 12 to 16 glasses of water daily number 8 this is the last piece of information you need to know about gout and uric acid it's the relationship between high uric acid and heart disease some fish some patients who are into reading a lot on the internet they come and ask that question well we know that the most important and the most one of them three of the most significant reasons that cause a high orac acid are the high blood pressure the high cholesterol and being and obesity they cause high uric acid and we know very well that those three conditions also are accused of causing atherosclerosis and maybe heart attacks or heart disease someday so the question was if those three guys are related to that guy somehow and their related here somehow so this guy it will be always found in scenes when you have a heart attack because they raise it and they caused this so there was a question is high uric acid related because you find it high in a lot of people who have heart disease because it's related to the same conditions that caused that cause heart disease so is high uric acid also accused well there were a lot of studies the most important or one of the first big studies that really started that issue was the framingham heart study that was in 1970's and I guess there was something like 6,000 something patients 6700 or something patients with heart disease and they were studying the risk factors for heart disease in those patients so they found that in those patients there was a high incidence of obesity the high cholesterol high blood pressure and high uric acid so uric acid was accused why did we find you in the scene of heart disease statistics can happen situations like this how we're using statistics you can sometimes if you have four factors implicated or accused you can isolate each one of them I isolate one of them and exclude it and study and is and study it alone likely you can exclude the high cholesterol and the creative and the blood pressure and the uric acid and study obesity alone so when they started obviously alone it was accused high cholesterol alone it was accused or it was implicated and high blood pressure it was accused hike uric acid could not be really accused of being a course for heart disease so uric acid is good it's not a cause for heart disease but when they started groups of patients who have heart disease and have high uric acid and they decided okay its goal is not bad but some patients were receiving for some reason treatment for high uric acid they found that over the years over five years on words that they had better outcome those patients who had medications to the key to decrease uric acid had a better outcome so uric acid is bad it causes heart disease because when I when I use medications to decrease uric acid the outcome was better in patients with heart disease so it's bad it causes heart disease but when they started patients of heart disease and have normal uric acid we don't have a high near occasion but some of them for some reason we're receiving medic to decrease the high uric acid they found that they also had still had a better outcome so the conclusion was some of those medications that decrease the uric acid they have positive effects on patients with heart disease that are not related to decreasing the levels of uric acid the final conclusion high uric acid does not cause heart disease and there is no scientific reason to prescribe uric acid lowering drugs in patients with heart disease however it is common practice in some of the cardiology societies in different parts of the world and very specially in Japan that if you have if you have a heart disease whether or not you have a higher uric acid you will be on uric acid lowering medications the conclusion of this lecture what most people know about God most of it is not correct information most people think that gout is Souls excess salts in the body any eggs with a blood sugar with a high uric acid is god this is not true as we explained the most important eight pieces of information you need to know about galton uric acid are those high uric acid is one thing go to something else we know now the story of uric acid how the body produces uric acid uric acid within limits is useful and we need it in the body and we don't know how it goes high and there are common conditions that that are like blood pressure blood cholesterol obesity they are and being overweight they increase the uric acid in the blood and we know the story of gout at how it happens and how lazy the body is to make a first attack of gout someday we know how to manage high uric acid just look for what made it high this is the most important and we know how to manage to manage God just wait maybe he never gets a second if you get to first maybe an event gets a third attack if he gets the second but if you gets troublesome attacks then we start to consider treatment always remember that God medications are worse or sillier than got itself and this is why we keep following up the patient maybe we don't need to start them and we don't know what to eat and what not to eat and we know the relationship between uric acid and heart disease thank you so much you

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