How risky is occasional seafood when it comes to gout care?
DEAR DR. ROACH: About three months ago, I had an attack of gout. I believe it was my first, but I may have had one a few months earlier that was diagnosed as a foot infection. The symptoms lasted well over a month. My last uric acid reading was 5.1, but it was 8.6 in February 2021. I am watching my diet -- I have not eaten red meat in over 30 years -- and have basically eliminated shellfish, which I love. I also take 100 mg of allopurinol.
Is occasional shellfish a real risk? How likely is this that it is a one-time event? Is gout now likely to be a lifelong concern? -- B.
ANSWER: Gout is caused by deposits of uric acid crystals in various tissues of the body. One of the most common places for these deposits is the joint of the big toe. An acute attack of gout can be extremely painful and can damage the joint. Uric acid crystals can also damage the kidney, so preventing gout attacks is the goal. In people who have gout, this is achieved by making lifestyle changes (weight control; avoiding excess alcohol -- especially beer and spirits; and dietary restrictions) and by medications.
Far too many people with gout take medications that are known to increase gout risk. For example, the blood pressure agents thiazide diuretics (such as HCTZ) and beta blockers.
Diet has been associated with gout for centuries. Animal protein, including from fish and shellfish, is known to increase gout flares, while plant-based protein reduces the risk. Dairy products also reduce gout risk. However, the risk of getting a flare from occasional fish or shellfish is small when you are on treatment. I certainly think it's reasonable to try your favorite meal and see whether it causes a flare. I think it's unlikely to do so.
DEAR DR. ROACH: I am a 64-year-old male and consider myself active and healthy despite my health history for the past seven years. I suffer from Crohn's disease and primary sclerosing cholangitis. In July 2019 I was diagnosed with chronic myeloid leukemia, and in July of 2020 I has a stroke, treated in a timely manner with TPA. I have no residual effects from the stroke. I will, about two to three times a month, take an edible cannabis to help me sleep or deal with a Crohn's episode. My primary care provider does not like me taking any edible cannabis, as he says it is proven to lead to strokes and blood clots. What are your thoughts on edible cannabis leading to strokes or blood clots? -- B.G.
ANSWER: The data on cannabis and blood clots and strokes is mixed. There is evidence that smoked cannabis activates platelets, which is likely to increase clot risk. However, some studies of cannabis users showed increased clot and stroke risk only among those who smoked tobacco as well. I could not find any strong data linking oral ("edible") cannabis to an increased risk of clots or blood clots.
Many people use cannabis or cannabis derivatives, such as THC or CBD, medicinally. There is clear evidence of benefit for only a few conditions, such as rare types of epilepsy in children. However, many people feel better with cannabis products, and while some of this may be a placebo effect, the benefits may outweigh the risks based on the limited published data.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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